Page 75 - JSOM Summer 2020

3. Initial dosing by syndrome: 5. Pretreatment: NOT ROUTINELY INDICATED unless patient
a. NOT INDICATED FOR NEUROTOXIC is unstable, asthmatic/atopic, known hypersensitivity or other
b. HEMOTOXIC initial dose = 10 vials pretreatment criteria met. Low risk of severe allergic reactions
c. CYTOTOXIC initial dose = 10 vials and other EARs.
4. Additional dosing: Additional doses of 5 vials BIOCL-AVT 6. Preparation and administration: Dilute the entire dose of an-
may be given at hours 2, 4, 6, 12, and 24 if needed. tivenom in a single 250–500 mL bag of isotonic solution and
5. Pretreatment: NOT ROUTINELY INDICATED unless patient administer by intravenous infusion over 10 minutes.
is unstable, asthmatic/atopic, known hypersensitivity or other a. If a mild or moderate reaction occurs, slow the infusion and
pretreatment criteria met. Low risk of severe allergic reactions treat symptomatically with antihistamines, steroids, and/or
and other EARs. antiemetics as needed.
6. Preparation and administration: Dilute the entire dose of anti- b. If a severe reaction such as anaphylaxis occurs, stop the
venom in a single 250–500 mL bag of isotonic solution and infusion and treat according to the anaphylaxis protocol
administer by intravenous infusion over 10 minutes. listed elsewhere in the CPG. Reassess the patient once the
a. If a mild or moderate reaction occurs, slow the infusion and reaction has been controlled and resume the infusion at
treat symptomatically with antihistamines, steroids, and/or a slower rate if any of the specific criteria for antivenom
antiemetics as needed. treatment listed elsewhere in the CPG have not completely
b. If a severe reaction such as anaphylaxis occurs, stop the in- resolved.
fusion and treat according to the anaphylaxis protocol listed
elsewhere in the CPG. Reassess the patient once the reaction SOUTHCOM – CENTRAL AMERICA/SOUTH AMERICA
has been controlled and resume the infusion at a slower rate LIQUID/REFRIGERATED
if any of the specific criteria for antivenom treatment listed Instituto Bioclon, Mexico: CORALMYN (BIOCL-COR) 244–248
elsewhere in the CPG have not completely resolved. First Line (SOUTHCOM–CENTRAL AMERICA): Neurotoxic
envenomation in Central America by coral snakes or unknown
SOUTHCOM – ENTIRE AOR species (coral snakes are only strictly neurotoxic snakes in
FREEZE-DRIED/UNREFRIGERATED SOUTHCOM AOR).
Instituto Bioclon, Mexico: ANTIVIPMYN-TRI Second Line (SOUTHCOM–SOUTH AMERICA): May treat
(BIOCL-AVT) 88–92
First Line (SOUTHCOM–ENTIRE SOUTHCOM AOR): some coral snakes in South America but major coverage gaps
in that region compared to the first line for South America
BROAD-SPECTRUM treatment option for all hemotoxic and (INS-AAP).
cytotoxic snake envenomations anywhere in the SOUTHCOM
AOR when the causative species is either unknown or among the Feasibility of use in austere environments: NOT RECOM-
≥ 14 snakes for which this product is directly indicated. Directly MENDED for operational settings. Requires cold chain refrigera-
or indirectly covers most of the WHO category 1 and category 2 tion between 2–8° C (35.6–46.4° F). Recommend storing several
snakes in this region. vials at a small number of strategically located Role 2 & 3 facil-
ities in South America. Likely to retain efficacy for several weeks
Feasibility of use in austere environments: RECOMMENDED in the field but should be disposed of after that duration of time
for operational settings. Unrefrigerated storage at ambient trop-
ical temperatures of ≤ 37° C/98.6° F. Lyophilized product that outside refrigeration.
likely retains stability at higher temperatures for short excursions. Adverse reactions: High-quality product with low rates of reac-
Recommend carrying full dose or loading dose (≥ 5 vials) into tions anticipated.
field on extended operations in austere environments and storing 1. Indications: This polyvalent can be used to treat neurotoxic en-
larger quantities at strategically located Role 2 & 3 facilities in venomations by most major species of Central American coral
SOUTHCOM AOR. snakes from the genus Micrurus.
a. NEUROTOXIC: Central American coral snakes (Micrurus
Adverse reactions: High-quality product with low rates of reac- spp.)
tions anticipated. 2. Initial dosing by syndrome:
1. Indications: This broad-spectrum polyvalent can be used to a. NEUROTOXIC syndrome initial dose = 10 vials
treat hemotoxic and cytotoxic envenomations by more than 14 b. NOT INDICATED for hemotoxic envenomations
different species of Central and South American snakes. It may c. NOT INDICATED for cytotoxic envenomations
be able to neutralize venom from additional species through 3. Additional dosing: Additional doses of 5 vials BIOCL-COR
paraspecific neutralization but this has not been officially de- may be given at hours 2, 4, 6, 12, and 24 if needed.
termined. The species listed below are the official treatment 4. Pretreatment: NOT ROUTINELY INDICATED unless patient
indications recommended by the manufacturer: is unstable, asthmatic/atopic, known hypersensitivity or other
a. HEMOTOXIC and/or CYTOTOXIC: Crotalus durissis pretreatment criteria met. Low risk of severe allergic reactions
terrificus; Bothrops asper, B. atrox, B. neuwiedii, B. alter- and other EARs.
natus, B. jararacussu, B. venezulensis, B. pictus, B. brazili; 5. Preparation and administration: Dilute the entire dose of an-
Lachesis muta muta, L. m. stenophyrs; Sistrurus spp.; Agk- tivenom in a single 250–500 mL bag of isotonic solution and
istrodon spp.
2. Pretreatment: NOT ROUTINELY INDICATED unless patient administer by intravenous infusion over 10 minutes.
a. If a mild or moderate reaction occurs, slow the infusion and
is unstable, asthmatic/atopic, known hypersensitivity or other treat symptomatically with antihistamines, steroids, and/or
pretreatment criteria met.
3. Initial dosing by syndrome: antiemetics as needed.
a. NOT INDICATED FOR NEUROTOXIC b. If a severe reaction such as anaphylaxis occurs, stop the in-
fusion and treat according to the anaphylaxis protocol listed
b. HEMOTOXIC initial dose = 10 vials elsewhere in the CPG. Reassess the patient once the reaction
c. CYTOTOXIC initial dose = 10 vials has been controlled and resume the infusion at a slower rate
4. Additional dosing: Additional doses of 5 vials BIOCL-AVT if any of the specific criteria for antivenom treatment listed
may be given at hours 2, 4, 6, 12, and 24 if needed.
elsewhere in the CPG have not completely resolved.

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