Snakebite treatment protocol in Iran

Introduction: According to the Ministry of Health and Medical Education of Iran report, between 2001 and 2010, about 4,500 - 7,000 snake bites occurred each year. The Ministry suggests that the annual incidence of snakebite is 9.6 cases per 100,000 population (1). Using polyvalent antivenom is one of the therapeutic measures has been applied in the primary health and medical centers dealing with snake- bites. Available polyvalent antivenom in Iran is able to neutralize the venoms of 6 dangerous species of snakes, Vipera albicornuta, Echis carinatus, Pseudocerastes persicus, Agkistrodon halys, Naja Naja Oxiana(2). Because the antivenom is a protein bases product which could induce early and late adverse reactions, reducing the dose administered would be safer. We suggested the more practical and safer snake bite treatment protocol according to literature review. Methods: We searched the databases and sites with keywords such as snake bite, protocol, treatment, antivenom administration, and selected the most effective and practical reported methods in reliable sources since 2010-2019. Result: We found 10 reliable various protocols, however, most of them were not appropriate for Iran. All of them were reviewed and discussed. Finally, a snakebite treatment protocol in Iran was written. Conclusion: The polyvalent antivenom should be started according to type and severity of clinical and preclinical manifestations. The loading dose repetition and the maintenance doses should be applied according close monitoring the course of manifestations. Due to life threatening risk of complications of neurotoxic snake bite that is not predictable on beginning of visit, we recommend that none snake bite in neurotoxic endemic area (such as northeast of Iran) evaluated as dry bite .Concerning the variety of venomous snakes in Iran from other countries such as the US and Australia, and the available antivenom to the Iranian pharmaceutical market, protocols have been written in text books such as GoldFrank s toxicologic emergencies do not make sense(3).