Page 72 - JSOM Summer 2020

caused by Naja atra and Bungarus multicinctus. Has demon- INDOPACOM – JAPAN FREEZE-DRIED/REFRIGERATED
strated efficacy against other related species of Asian cobras Chemo-Sero Therapeutic Research Institute, Japan: Kaketsuken
and kraits but is not directly indicated for these species. Mamushi Antivenom (CSTRI-MAMU) 225–229
2. Pretreatment: NOT ROUTINELY INDICATED unless patient First line (INDOPACOM–JAPAN): First line treatment option for
is unstable, asthmatic/atopic, known hypersensitivity or other Mamushi envenomation (Gloydius blohmhoffi) in Japan.
pretreatment criteria met. Low risk of severe allergic reactions Feasibility of use in austere environments: NOT RECOM-
and other EARs.
3. Initial dosing by syndrome: MENDED for operational settings. Lyophilized but requires cold
chain refrigeration below 10° C (50° F); likely to retain efficacy
a. NEUROTOXIC initial dose = 5 vials for short excursions lasting several weeks in the field but should
b. NOT INDICATED FOR HEMOTOXIC be disposed of and replaced after extended time outside refrig-
c. NOT INDICATED FOR CYTOTOXIC
4. Additional dosing: Additional 5 vials NIPM-NBB may be given eration. Recommend storing several vials at a small number of
strategically located Role 2 & 3 facilities.
at hours 2, 4, 6, 12, and 24 if needed.
5. Preparation and administration: Dilute the entire dose of an- Adverse reactions: High efficacy and low incidence of serious ad-
tivenom in a single 100–500 mL bag of isotonic solution and verse reactions based on current publications.
administer by intravenous infusion over 10–30 minutes. 1. Indications: Directly indicated for the treatment of hemotoxic
a. If a mild or moderate reaction occurs, slow the infusion and and cytotoxic envenomation syndromes caused by the Japa-
treat symptomatically with antihistamines, steroids, and/or nese Mamushi, Gloydius blomhoffi.
antiemetics as needed. 2. Pretreatment: NOT ROUTINELY INDICATED unless patient
b. If a severe reaction such as anaphylaxis occurs, stop the in- is unstable, asthmatic/atopic, known hypersensitivity or other
fusion and treat according to the anaphylaxis protocol listed pretreatment criteria met. Low risk of severe allergic reactions
elsewhere in the CPG. Reassess the patient once the reaction and other EARs.
has been controlled and resume the infusion at a slower rate 3. Initial dosing by syndrome:
if any of the specific criteria for antivenom treatment listed a. NOT INDICATED FOR NEUROTOXIC
elsewhere in the CPG have not completely resolved. b. HEMOTOXIC = 1–2 vials
c. CYTOTOXIC = 1–2 vials
INDOPACOM – JAPAN FREEZE-DRIED/REFRIGERATED 4. Additional dosing: Additional 1 vial CSTRI-MAMU may be
Chemo-Sero Therapeutic Research Institute, Japan: Kaketsuken given at hours 2, 4, 6, 12, and 24 if needed.
Habu Antivenom (CSTRI-HABU) 225–229 5. Preparation and administration: Dilute the entire dose of anti-
First line (INDOPACOM–JAPAN): First line treatment option for venom in a single 100 mL bag of isotonic solution and admin-
Habu envenomation (Protobothrops spp.). ister by intravenous infusion over 10 minutes.
a. If a mild or moderate reaction occurs, slow the infusion and
Feasibility of use in austere environments: NOT RECOM- treat symptomatically with antihistamines, steroids, and/or
MENDED for operational settings. Lyophilized but requires cold antiemetics as needed.
chain refrigeration below 10° C (50° F); likely to retain efficacy b. If a severe reaction such as anaphylaxis occurs, stop the in-
for short excursions lasting several weeks in the field but should fusion and treat according to the anaphylaxis protocol listed
be disposed of and replaced after extended time outside refrig- elsewhere in the CPG. Reassess the patient once the reaction
eration. Recommend storing several vials at a small number of has been controlled and resume the infusion at a slower rate
strategically located Role 2 & 3 facilities.
if any of the specific criteria for antivenom treatment listed
Adverse reactions: High efficacy and low incidence of serious ad- elsewhere in the CPG have not completely resolved.
verse reactions based on current publications.
1. Indications: Directly indicated for the treatment of hemotoxic INDOPACOM – NORTH & SOUTH KOREA/VIETNAM/
and cytotoxic envenomation syndromes caused by the Japa- EAST RUSSIA FREEZE-DRIED/REFRIGERATED
nese Habu (Protobothrops [Trimeresurus] flavoviridis) Japan Snake Institute, Japan: Anti-Yamakagashi Antivenom
2. Pretreatment: NOT ROUTINELY INDICATED unless patient (JSI-AYA) 225–227
is unstable, asthmatic/atopic, known hypersensitivity or other First line (INDOPACOM–JAPAN/CHINA/NORTH KOREA/
pretreatment criteria met; however, total reactions (~11% SOUTH KOREA/VIETNAM/EASTERN RUSSIA): First line treat-
overall; ~25% serum sickness) higher than other regional ment option for Keelback envenomation (Rhabdophis tigrinus).
products. Consider pretreatment on an individual basis.
3. Initial dosing by syndrome: Feasibility of use in austere environments: NOT RECOM-
MENDED for operational settings. Lyophilized but requires cold
a. NOT INDICATED FOR NEUROTOXIC chain refrigeration below 10° C (50° F); likely to retain efficacy
b. HEMOTOXIC = 1–2 vials for short excursions lasting several weeks in the field but should
c. CYTOTOXIC = 1–2 vials
4. Additional dosing: Additional 1 vial CSTRI-HABU may be be disposed of and replaced after extended time outside refrig-
eration. Recommend storing several vials at a small number of
given at hours 2, 4, 6, 12, and 24 if needed.
5. Preparation and administration: Dilute the entire dose of an- strategically located Role 2 & 3 facilities.
tivenom in a single 100 mL bag of isotonic solution and ad- Adverse reactions: High efficacy and low incidence of serious ad-
minister by intravenous infusion over 10 minutes. verse reactions based on current publications.
a. If a mild or moderate reaction occurs, slow the infusion and 1. Indications: Directly indicated for the treatment of hemotoxic
treat symptomatically with antihistamines, steroids, and/or and cytotoxic envenomation syndromes caused by the Tiger
antiemetics as needed. Keelback (Rhabdophis tigrinus) and other East Asian keelbacks.
b. If a severe reaction such as anaphylaxis occurs, stop the in- 2. Pretreatment: NOT ROUTINELY INDICATED unless patient
fusion and treat according to the anaphylaxis protocol listed is unstable, asthmatic/atopic, known hypersensitivity or other
elsewhere in the CPG. Reassess the patient once the reaction pretreatment criteria met. Low risk of severe allergic reactions
has been controlled and resume the infusion at a slower rate and other EARs.
if any of the specific criteria for antivenom treatment listed 3. Initial dosing by syndrome:
elsewhere in the CPG have not completely resolved. a. NOT INDICATED FOR NEUROTOXIC

70 | JSOM Volume 20, Edition 2 / Summer 2020