Page 59 - JSOM Summer 2020

9. First Line (INDOPACOM–MARINE ENVIRONMENTS RDT/Instituto Bioclon, United States/Mexico:
ONLY): CSL-SS ANAVIP (ANAVIP)
a. NOT FIELD-STABLE. BROAD-SPECTRUM COVER- a. FREEZE-DRIED/UNREFRIGERATED
AGE AGAINST INDO-PACIFIC SEA SNAKES ONLY. b. Indications: Currently only indicated by FDA for rattle-
b. Neurotoxic envenomation in INDOPACOM by sea snake envenomations. Not currently indicated for copper-
snakes or unknown species occurring in a strictly marine head or cottonmouth envenomations, although this may
environment. change in the near future depending on results of upcoming
c. Initial dose = 3 vials, additional doses = 1 vial as needed studies. Freeze dried and field-stable at room temperature
10. First Line (INDOPACOM–MALUKU/WEST PAPUA IS- of 25° C/77° F.
LANDS ONLY): CSL-P c. Initial dosing: 10 vials
a. NOT FIELD-STABLE. BROAD-SPECTRUM COVERAGE. Pfizer, United States: North American Coral Snake Antivenom
b. First line antivenom indicated for neurotoxic/hemotoxic (NACSA)
envenomation in INDOPACOM by Australasian elapids a. FREEZE-DRIED/REFRIGERATED
or unknown species occurring East of Wallace’s line. b. Indications: Indicated for neurotoxic envenomations by
c. Initial dose = 3 vials, additional doses = 1 vial as needed
North American coral snake species in the United States
NORTHCOM – Abbreviated Treatment Guidelines including Eastern coral snake (Micrurus fulvius) and Texas
Safe and effective antivenoms are available for all neurotoxic/ coral snake (Micrurus tener). Store between 2–8° C/35.6–
46.4° F; however, likely retains stability for short excur-
hemo/cytotoxic pit viper envenomations and for neurotoxic coral sions in the field.
snake envenomations in this AOR. Treatment does not require c. Initial dosing: 3–5 vials
identification of the species responsible. Snakebite treatment at
the point of injury is not routinely recommended for NORTH- SOUTHCOM – Abbreviated Treatment Guidelines
COM. For all NORTHCOM antivenoms, refer to the package Safe and effective antivenoms are available for all hemo/cytotoxic
insert in the antivenom box for specific usage instructions as per pit viper envenomations and for neurotoxic coral snake envenom-
FDA regulations for domestically approved products. Also see ations in this AOR. Treatment does not require identification of
Unified treatment algorithm for the management of crotaline the species responsible but does require identification of the syn-
snakebite in the United States (Lavonas et al. 2011) for specific drome. Snakebite treatment at the point of injury is recommended
dosing and management guidelines on pit viper bites.
for SOUTHCOM.
BTG Therapeutics, United States: CroFab (CROFAB) 1. First Line (SOUTHCOM–ENTIRE SOUTHCOM AOR):
a. FREEZE-DRIED/REFRIGERATED BIOCL-AVT
b. Indications: Envenomation by all Pit Viper species (rat- a. FIELD-STABLE. BROAD-SPECTRUM COVERAGE 14
tlesnakes, copperheads, cottonmouths) in North Amer- SPECIES HEMO/CYTO.
ica. Freeze-dried; requires refrigeration but one study has b. First line treatment option for all hemotoxic and cytotoxic
demonstrated that it will maintain efficacy under field con- snake envenomations anywhere in the SOUTHCOM AOR
ditions for ≥ 90 days if needed. when the causative species is either unknown or among the
c. Initial dosing: 4–6 vials ≥ 14 snakes for which this product is directly indicated.
Directly or indirectly covers most of the WHO category 1
and category 2 snakes in this region.

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