More than 3,000 Australians are bitten by snakes every year, with 500 being hospitalised and two dying on average. Last year, in Victoria, there were 128 calls to the Victorian Poison Information Centre regarding snake bites.
A paper published by a group of researchers at the Royal Melbourne Hospital (RMH) and University of Melbourne (UoM) reveals a lack of consensus among health care professionals regarding treatment of snake bite and the amount of antivenom to use, was a significant concern regarding treatment.
In 2017 the World Health Organization (WHO) listed snake bite envenoming as a Category A Neglected Tropical Disease because of the magnitude of the suffering caused by snake bites which claims as many as 125,000 lives every year.
The RMH and UoM paper, published in the international journal, Toxins, was triggered by a Victorian coronial inquiry into two snake bite deaths which found that there was conflicting evidence and medical opinion regarding current clinical guidelines for the diagnosis and treatment of snake bites in Australia.
According to the paper, the coroner noted a lack of consensus in treatment guidelines among the experts called to give evidence.
The lead author, RMH's Professor Braitberg, who specialises in toxicology, said the researchers wanted to understand “the real-world experience of clinicians who have treated snake envenoming in Australia.” Envenoming occurs when the snake’s fangs piece the skin and venom is injected into the circulation leading to symptoms.
The survey – of 107 clinicians, mainly emergency medicine doctors had seen 121 snake envenoming cases in the last three years – found that while most felt confident in treating a snake bite, one quarter had concerns about their choice of antivenom, and almost 50 per cent stated that access to pathology was a barrier for management.
“A total of 39.6% of medical respondents stated that they were uncertain or disagreed that publications in peer-reviewed journals were useful in guiding the management of snake bite envenoming, possibly reflecting the conflicting recommendations," said Prof Braitberg.
The paper also raises concerns about the challenges having to maintain stocks of antivenoms in hospitals.
“While over a third of physician respondents identified that availability was or could be a barrier to managing snake envenoming, cost was identified as the least important factor. Similarly, pharmacists also considered cost and shelf life as the least important factors to influence their decision to stock antivenom," Prof Braitberg said.
Antivenom costs between $347 and $2320 per ampoule, with some patients requiring more than one ampoule, and they have a shelf-life of up to three years.
“We need more consistent guidelines for the treatment of snake bite in Australia, to provide clinicians with more certainty as to what to do when a snake bite victim presents at the ED."
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