Snakebite: Management Controversies

Abstract

In rural areas where venomous snakes are common, dealing with snakebite is important. However, the definitive treatment of snakebite is a subject of much controversy. The literature is contradictory and anecdotal with conclusions being drawn from animal experiments and uncontrolled clinical trials. Five such controversial issues likely to confront the rural doctor are explored.
1. Four types of tourniquet have been utilised to retard the absorption of venom with proponents both for and against their use. They have proved both beneficial and ineffectual after bites.
2. Controversy also exists regarding the use of snake anti-venom for cytotoxic snakebites. Those favouring pre-necrotic surgical excision believe that anti-venom is ineffective in preventing local tissue necrosis due to the limited local bioavailability of antivenom.
3. The use of routine antibiotics in snakebite injuries is also obscure. Those advocating early antimicrobial therapy recommend antibiotics to cover the mixed oral flora of snakes.
4. Guidelines for the treatment of children are lacking. In addition, the dose of anti-venom to be administered to children is subject to controversy.
5. Finally, management of the gravid victim remains controversial and little is known about the effects of snake venom on the foetus and pregnancy. Research to resolve such controversies will positively contribute to a dramatic fall in mortality and morbidity from snakebites.