Page 53 - JSOM Summer 2020

b. Single-source treatment option for all neurotoxic, hemo- WHO category 1 and category 2 snakes in this region for
toxic, and cytotoxic snake envenomations in North Africa which an antivenom currently exists.
(Algeria, Egypt, Libya, Morocco, Tunisia, Western Sahara) c. Initial dose neuro = 10 vials. Initial dose hemo/cyto = 5
when the causative species is either unknown or among the vials. All additional doses = 5 vials.
27 snakes for which this product is directly indicated. Di-
rectly or indirectly covers all of the WHO category 1 and CENTCOM – Abbreviated Treatment Guidelines
category 2 snakes in this region for which an antivenom Safe and effective broad-spectrum, field-stable antivenoms are
currently exists. available for all three syndromes of snake envenomation in this
c. Initial dose = 6 vials all syndromes, additional doses = 2 AOR and treatment does not require identification of the species
vials as needed. responsible. Snakebite treatment at the point of injury is recom-
3. Second line (AFRICOM–SUB-SAHARAN AFRICA): mended for CENTCOM due to potential for prolonged evacua-
SAIMR-P tion times, high incidence of snakebites, and the high risk of death
a. NOT FIELD STABLE. BROAD-SPECTRUM AGAINST or permanent disability from many venomous snakes in the AOR
10+ SPECIES NEUROTOXIC AND CYTOTOXIC ONLY. if early antivenom treatment is not available.
b. Unknown neurotoxic and/or cytotoxic envenomation in 1. First line (CENTCOM–ARABIAN PENINSULA/MIDDLE
sub-Saharan Africa or with no indications of improvement EAST/CENTRAL ASIA): POLYSERP-M
after 10 vials of POLYSERP-P. Will not treat hemotoxic a. FIELD-STABLE. BROAD-SPECTRUM COVERAGE 27+
envenomations. SOUTHERN AFRICA: Directly or indi- SPECIES OF CYTO/HEMO/NEURO.
rectly covers all WHO category 1 and category 2 species b. Single source treatment option for all neurotoxic, hemo-
for which an antivenom currently exists. EAST/CENTRAL/ toxic, and cytotoxic snake envenomations in the Arabian
WEST AFRICA: Covers many cytotoxic and neurotoxic Peninsula, the Middle East, and Central Asia when the
snakes in West, Central, and East Africa but has major cov- causative species is either unknown or among the 27 snakes
erage gaps with no efficacy against all WHO category 1 or for which this product is directly indicated. Directly or in-
category 2 hemotoxic snake species. directly covers all WHO category 1 species in the region.
c. Initial dose = 10 vials neurotoxic/cytotoxic only, additional Directly or indirectly covers all category 2 snakes in this
doses = 5 vials region for which an antivenom currently exists except for
4. Second line, boomslang only (AFRICOM–SUB-SAHARAN Gloydius halys, which is covered by Shanghai SIOBP-G or
AFRICA): SAIMR-B Iranian RAZI-P. Paraspecific neutralization against Gloy-
a. NOT FIELD-STABLE. NOT BROAD-SPECTRUM. SIN- dius unknown but not anticipated.
GLE SPECIES COVERAGE. c. Initial dose = 6 vials all syndromes, additional doses = 2
b. Confirmed or suspected boomslang bite with no indications vials as needed.
of improvement after 10 vials of POLYSERP-P. Monova- 2. First line Glodius Halys only (CENTCOM–MIDDLE EAST/
lent that can only be used to treat the WHO category 2 CENTRAL ASIA): SIOBP-G
boomslang. Does not provide coverage against any other a. NOT FIELD-STABLE. NOT BROAD-SPECTRUM. SIN-
WHO category 1 or category 2 species. GLE SPECIES COVERAGE.
c. Initial dose = 2 vials boomslang only, additional doses = 1 b. Monovalent for the WHO category 2 species Gloydius halys.
vial as needed Indicated as first line only for confirmed envenomation by
5. Second line (AFRICOM–NORTH AFRICA): NAVPC-C Gloydius halys or related Gloydius species. Indicated as
a. NOT FIELD-STABLE. BROAD-SPECTRUM COVERAGE second line for unknown cytotoxic and/or hemotoxic en-
6+ SPECIES OF NEURO/HEMO/CYTO. venomation in Middle East or Central Asia with no signs
b. Unknown neurotoxic, hemotoxic, or cytotoxic envenom- of improvement after 10 vials of POLYSERP-M. Does not
ation with no indications of improvement after 10 vials of provide coverage against any other WHO category 1 or cat-
POLYSERP-M. Directly or indirectly covers some of the egory 2 species.

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