DRUG UTILIZATION ANALYSIS OF ANTI-SNAKE VENOM AT A TERTIARY CARE CENTER IN CENTRAL MAHARASHTRA: A 3-YEAR RETROSPECTIVE STUDY
Objectives: In India, snakebite is a major public health problem. Anti-snake venom serum (ASVS) is the definitive treatment for poisonous snakebites. However, the non-availability of effective ASVS to treat the specific types of snakebite envenomation encountered in various regions of the world has become a critical health issue at global level. In the present observational descriptive study, we observed the prescribing pattern and rationality of ASVS and the dosage of ASVS at our hospital and compared them with the standard guidelines in the treatment of snakebite cases with the aim to observe optimum utilization of ASVS.
Methods: Data collection of registered cases of snakebite of 3 years from January to December 2012, 2013, and 2014 was carried out between January 2015 and December 2015.
Results: A total of 935 cases were studied. ASVS treatment was given to 774 cases of snakebite, out of which 161 had no bite marks and 613 patients had bite marks. Majority (615 [79.45%]) of cases were treated with 1â€“20 vials of ASVS during total stay at center. Overall, 899 cases were discharged, among them 606 cases were not followed the World Health Organization guidelines. 29 cases succumbed and seven were referred to other center. The mortality observed during the 3 years was 3.10%.
Conclusion: We observed individualized treatment for treatment with ASVS, thereby reducing the use of ASVS. Thus, we conclude that individualized approach depending on locally predominant snakes for the treatment of snakebite based on the degree of envenomation is a way by which the scarce ASVS can be used optimally.
2. Mohapatra B, Warrell DA, Suraweera W, Bhatia P, Dhingra N, Jotkar RM, et al. Snakebite mortality in India : A nationally representative mortality survey. PLoS Negl Trop Dis 2011;5:1-8.
3. Bhalla G, Mhaskar D, Agarwal A. Astudy of clinical profile of snakebite at a tertiary care center. Toxicol Int 2014;21:203-8.
4. Al-Mamun MA, Rahman MA, Hasan R, Rahmann Z, Haque KM. Histopathological alterations induced by common krait bungarus caeruleus venom on hepatic, Renal and cardiac tissues of albino mice. Int J Pharm Pharm Sci 2015;7:239-42.
5. Khan PA, Chary MD, Kumar MM. A study on treatment pattern and outcomes of poisoning cases in a tertiary care and government district hospital. Int J Pharm Pharm Sci 2017;9:193-7.
6. Inamdar K, Parhate SM, Randad RD. Pharmacotherapeutic study of efficacy, safety and prognostic analysis of anti snake venom serum in snake bite patients. Int J Basic Clin Pharmacol 2017;6:906-12.
7. Alirol E, Sharma SK, Bawaskar HS, Kuch U. Snake bite in south Asia : A review. PLoS Negl Trop Dis 2010;4:e603.
8. Punde DP. Management of snake-bite in rural Maharashtra: A 10-year experience. Natl Med J India 2005;18:71-5.
9. Kirte RC, Wahab SN, Bhathkule PR. Record based study of snake bite cases admitted at shri vasantrao naik government medical college and Hospital, Yavatmal (Maharashtra). Indian J Publc Heal 2002;25:12-4.
10. Whitaker R, Whitaker S. Venom, antivenom production and the medically important snakes of India. Curr Sci 2012;103:635-43.
11. Padilla A, Bon C, et al. WHO Guidelines for the Production Control and Regulation of Snake Antivenom Immunoglobulins. Geneva: WHO; 2008.
12. Haffkine Biopharmaceuticals. Snake Antivenin. Haffkine Publication; 2016. Available from: http://www.fpnotebook.com/er/Pharm/SnkAntvn.htm.
13. Kalyan B, Nanda SS, Venkateshwarlu P, Kiran Y, Jadhav RT. Antisnake Venom Serum (ASVS). Int J Pharm Biomed Res 2010;1:76-89.
14. Haffkine Biopharmaceuticals, â€œSnake Antivenin,â€ Haffkine Biopharmaceuticals; 2018.Available from: http://www.vaccinehaffkine. com/products/antitoxins-sera/snake-antivenin-detail.html.
15. Redewad N, Bhaisare S, Bansod Y, Hire R. Management and outcome study of snake bite cases in central India. Sch J Appl Med Sci 2014;2:435-41.
16. Ahmed SM, Nadeem A, Islam MS, Agarwal S, Singh L. Retrospective analysis of snake victims in Northern India admitted in a tertiary level institute. J Anaesthesiol Clin Pharmacol 2012;28:45-50.
17. Singh S, Singh G. Snake Bite: Indian Guidelines and Protocol. In: Text Book of Toxicology.; 2010. p. 424-6.
18. Saini V, Sardana D, Samra T. Management of snake bite victims in a Tertiary Care Intensive Care Unit in North India. Indian J Crit Care Med 2014;18:544-5.
19. Ray AS. Snake Bite its First Aid and Anti Snake Venom (ASV): Details Guidelines. Pharma Tutor 2014;2:85-8.
20. Agarwal R, Aggarwal AN, Gupta D, Behera D, Jindal SK. Low dose of snake antivenom is as effective as high dose in patients with severe neurotoxic snake envenoming. Emerg Med J 2005;22:397-401.
21. Srimannarayana J, Dutta TK, Sahai A, Badrinath S. Rational use of anti-snake venom (ASV) : Trial of various regimens in hemotoxic snake envenomation. J Assoc Physicians India 2004;52:788-93.
22. Ghosh S, Maisnam I, Murmu BK, Mitra PK, Roy A, Simpson ID. Locally Developed Snakebite Management Protocol Significantly Reduces Overall Anti Snake Venom Utilization in West Bengal, India. Wilderness Environ Med 2008;19:267-74.
The publication is licensed under CC By and is open access. Copyright is with author and allowed to retain publishing rights without restrictions.