Page 55 - JSOM Summer 2020

c. Initial dose = 6 vials hemotoxic/cytotoxic only, additional EUCOM AOR when the causative species is unknown or
doses = 2 vials as needed. species for which this product is directly indicated. Second
3. Second line (CENTCOM–MIDDLE EAST/CENTRAL line treatment option for all neurotoxic, hemotoxic, and
ASIA): RAZI-P cytotoxic snake envenomations within the UK and Scandi-
a. NOT FIELD-STABLE. BROAD-SPECTRUM COVERAGE navia if first line (VIPERATAB) is not available.
6+ SPECIES CYTO/HEMO/NEURO. c. Initial dose = 1–2 vials all syndromes, additional doses = 1
b. Unknown neurotoxic, hemotoxic, or cytotoxic envenom- vial as needed.
ation with no indications of improvement after 10 vials 2. First line (EUCOM–UK/SCANDINAVIA): VIPERATAB
of POLYSERP-M. Directly or indirectly covers all WHO a. NOT FIELD-STABLE. BROAD-SPECTRUM COVERAGE
category 1 species in the region. Directly or indirectly cov- AGAINST SEVERAL EUROPEAN VIPERS.
ers some of the WHO category 1 and category 2 snakes in b. Single-source treatment option for neurotoxic, hemotoxic,
this region for which an antivenom currently exists. Covers and cytotoxic snake envenomations by the most medically
fewer species than POLYSERP-M. and epidemiologically significant species in the UK and Scan-
c. Initial dose = 10 vials all syndromes, additional doses = 5 dinavia (Vipera berus) with paraspecific coverage against
vials as needed. some other European Vipera species. Second line treatment
4. Second line (CENTCOM–ARABIAN PENINSULA): option for all neurotoxic, hemotoxic, and cytotoxic snake
NAVPC-C envenomations in the EUCOM AOR outside of the UK and
a. NOT FIELD-STABLE. BROAD-SPECTRUM COVERAGE Scandinavia if first line (VIPERFAV) is not available.
6+ SPECIES OF NEURO/HEMO/CYTO. c. Initial dose = 2 vials all syndromes, additional doses = 2
b. Unknown neurotoxic, hemotoxic, or cytotoxic envenom- vials as needed. Each box = 2 vials.
ation with no indications of improvement after 10 vials of
POLYSERP-M. Directly or indirectly covers some of the INDOPACOM – Abbreviated Treatment Guidelines
WHO category 1 and category 2 snakes in this region for Safe and effective broad-spectrum, field-stable antivenoms are
which an antivenom currently exists. available for all three syndromes of snake envenomation in South-
c. Initial dose neuro = 10 vials. Initial dose hemo/cyto = 5 east Asia and several other areas within this AOR. Snakebite
vials. All additional doses = 5 vials. treatment in INDOPACOM as a whole is more complex than
AFRICOM or CENTCOM due to the lack of a truly pan-Asian
EUCOM – Abbreviated Treatment Guidelines polyvalent product. Treatment in many places does not require
Safe and effective broad-spectrum, refrigerated antivenoms are identification of the species responsible, but products are syn-
available for all three syndromes of snake envenomation due to drome specific and there is no single product for all 3 syndromes.
European viper species in this AOR and treatment does not re- Snakebite treatment at the point of injury is recommended for ar-
quire identification of the species responsible. Snakebite treatment eas within the INDOPACOM AOR where field-stable antivenoms
at the point of injury is not routinely recommended for EUCOM. are available.
1. First line (EUCOM–EUCOM OUTSIDE UK/ 1. First line (INDOPACOM–SOUTHEAST ASIA): TRC-HPAV
SCANDINAVIA): VIPERFAV a. FIELD-STABLE. BROAD-SPECTRUM COVERAGE MUL-
a. NOT FIELD-STABLE. BROAD-SPECTRUM COVERAGE TIPLE SPECIES OF HEMO/CYTO.
AGAINST MULTIPLE EUROPEAN VIPERS. b. Broad-spectrum treatment option for all hemotoxic and cy-
b. Single-source treatment option for neurotoxic, hemotoxic, totoxic snake envenomations by known or unknown spe-
and cytotoxic snake envenomations by the most medically cies in Southeast Asia. Best regional polyvalent.
and epidemiologically significant species in Europe (Vipera c. Initial dose hemotoxic/cytotoxic only = 10 vials, additional
berus, V. aspis, V. ammodytes) with paraspecific coverage doses = 5 vials as needed.
against other European Vipera species. Can be used in the

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