Pharmacotherapeutic study of efficacy, safety and prognostic analysis of anti snake venom serum in snake bite patients


  • Khalid Inamdar Department of Pharmacology, Government Medical College and Hospital, Akola Maharashtra, India
  • Sudhakar M. Parhate Department of Pharmacology, Government Medical College and Hospital, Akola Maharashtra, India
  • Rahul D. Randad Department of Pharmacology, Government Medical College and Hospital, Akola Maharashtra, India



Adverse drug reaction, Anti snake venom serum, Dose, Prognosis


Background: Snakebite is a common medical emergency especially in the rural areas. The effective measure to treat most of the manifestations of venomous snake bite is timely administration of anti-snake venom serum (ASVS). Problems associated with ASVS use are lack of evidence for optimal dose schedule and occurrence of hypersensitivity reactions.

Methods: A retrospective review of snakebite cases was carried out from record section of a tertiary care teaching hospital from January 2011 to December 2011.

Results: Out of total 202 snakebite patients admitted during the study period, age group of 21-30 years (mainly male victims) accounted for highest no. of snakebite cases (25.7%). The mean (±SD) dose of ASVS used was 124 (±112) mL. 11.8% patients had suffered from adverse drug reactions due to ASVS. 7.4% patients required mechanical ventilation. Overall mortality in our study was 9.4%. Mortality was higher (50%) where the time interval between the snakebite and initiation of treatment was >6 hours. Out of total 15 patients who required mechanical ventilation, n=10 (66.6%) patient died.

Conclusions: In our study, mean dose of ASVS used was as per WHO guidelines. Less incidence of adverse drug reaction due to ASVS may be because of co-administration of corticosteroids and anti-histaminics. Delay in getting treatment with ASVS, neurotoxic envenomation and respiratory failure, were the risk factors associated with adverse prognosis due to snake bite in our set up.


Halesha BR, Harshavardhan L, Venkat KB. A study on the clinico-epidemiological profile and the outcome of snake bite victims in a tertiary care centre in southern India. J Clin Diagn Res. 2013;7(1):122-6

World Health Organization.Rabies and envenomings: A neglected public health issue. Geneva. WHO;2007.

Mohapatra B, Warrell DA, Suraweera W, Bhatia P, Dhingra N, Jotkar RM. Snakebite mortality in India: A nationally representative mortality survey. PLoS Negl Trop Dis. 2011;5:1018.

Warrell DA. Epidemiology of snake-bite in South-East Asia Region. In: Warrell DA (editor). Guidelines for the management of snakebite.New Delhi: WHO regional office for Southeast Asia. 2010;35-45.

Simpson ID, Norris RL. Snakes of Medical Importance in India: Is the Concept of the “Big 4” Still Relevant and Useful? Wilderness Environ Med. 2007;18:2-9.

Sharma SK, Chappuis F, Jha N, Bovier PA, Loutan L, Koirala S. Impact of snake bites and determinants of fatal outcomes in southeastern Nepal. The American journal of tropical medicine and hygiene. 2004;71(2):234-8.

Snow RW. The prevalence and morbidity of snake bite and treatment-seeking behaviour among a rural Kenyan population. Ann Trop Med Parasitol 1994;88:665-71.

Bawaskar HS, Bawaskar PH. Snake bite poisoning. Journal of Mahatma Gandhi Institute of Medical Sciences. 2015;20(1):5.

Bawaskar HS. Snake venoms and antivenoms: critical supply issues. J Assoc Physicians India. 2004;52:11-3.

Kumar BK, Nanda SS, Venkateshwarlu P, Kumar YK, Jadhav RT.Antisnake venom serum. Int J Pharm Biomed Res. 2010;1:76‑89.

Pore SM, Ramanand SJ, Patil PT, Gore AD, Pawar MP, Gaidhankar SL, et al. A retrospective study of use of polyvalent anti-snake venom and risk factors for mortality from snake bite in a tertiary care setting. Indian J Pharmacol. 2015;47:270-4.

Punde DP. Management of snake-bite in rural Maharashtra: A 10-year experience. Nat Med J India 2005;18:71-5.

Brunda G, Sashidhar RB. Epidemiological profile of snake-bite cases from Andhra Pradesh using immunoanalytical approach. Indian J Med Res. 2007;125:661-8.

Meenatchisundaram S, Michael A. Snake bite and therapeutic measures: Indian scenario. Indian Journal of Science and Technology. 2009;2:69-73.

Narvencar K. Correlation between timing of ASV administration and complications in snake bites. J Assoc Physicians India. 2006;54:717-9.

Mulay D, Kulkarni V, Kulkarni S, Kulkarni N, Jaju R. Clinical profile of snakebites at SRTR Medical College Hospital, Ambajogai (Maharashtra). Ind Medl Gaz. 1986;131:363-6.

Agrawal P, Aggarwal A, Gupta D, Behera D, Prabhakar S, Jindal S. Management of respiratory failure in severe neuroparalytic snake envenomation. Neurol India. 2001;49:25-8.

Anil A, Singh S, Bhalla A, Sharma N, Agarwal R, Simpson ID. Role of neostigmine and polyvalent antivenom in Indian common krait (Bungarus caeruleus) bite. J Infect Public Health. 2010;3:83-7.

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.

Zulkifli A, Hashim M, Kharal Anuar A. Snake bites in kelantan, Peninsular Malaysia. Trop Biomed. 1995;12:1-4.

Jamaiah I, Rohela M, Ng T, Ch′ng KB, Teh YS, Nurulhuda AL, et al. Retrospective prevalence of snakebites from Hospital Kuala Lumpur (HKL)(1999-2003). Southeast Asian J Trop Med Public Health. 2006;37:200-5.

Kulkarni ML, Anees S. Snake venom poisoning, experience with 633 patients. Indian Paediatr. 1994;31:1239‑43.

Sharma N, Chauhan S, Faruqi S, Bhat P, Varma S. Snake envenomation in a north Indian hospital. Emerg Med J. 2005;22:118-20.

Denker BM, Brenner BM. Azotemia and urinary abnormality. Harrison′ s Principles of Internal Medicine. 2008;17:271.

Kasturiratne A, Wickremasinghe AR, De Silva N, Gunawardena NK, Pathmeswaran A, Premaratna R, et al. The global burden of snakebite: A literature analysis and modelling based on regional estimates of envenoming and deaths. PLoS Med. 2008;5:218.

Naik RS, Tirpude BH, Khajuria BK. Mortality and morbidity patternin snake bite at MGIMS Sevagram, Wardha: A rural area. Indian Pract. 1997;50:31‑5.

Patil VC, Patil HV, Patil A, Agrawal V. Clinical Profile and outcome of envenomous snake-bite at tertiary care centre in western Maharashtra. International Journal of Medicine and Public Health. 2011;1:28.

Reddy KS. Organic irritant poisons. In: Essentials of forensic medicine and toxicology. 27th ed. Hyderabad: Laxmi Printers; 2008;487‑99.

Hansdak SG, Lallar KS, Pokharel P, Shyangwa P, Karki P, Koirala S.A clinico‑epidemiological study of snake bite in Nepal. Trop Doct. 1998;28:223‑6.

Kumar V, Gudge S, Mithare S, Mudbi S, Kulkarni S. a trial of low dose anti snake venom in the treatment of poisonous snake bites in brims teaching hospital, Bidar. Journal of Evolution of Medical and Dental Sciences. 1(3):8544-51.

Theakston RDG, Phillips RE, Warrell DA, Galagedera Y, Abeysekera DTDJ, Dissanayaka P, et al. Envenoming by the common krait (Bungarus caeruleus) and Sri Lankan cobra (Naja naja): Efficacy and complications of therapy with Haffkine antivenom.Trans R Soc Trop Med Hyg. 1990;84:301-8.

Gawarammana IB, Kularatne SA, Dissanayake WP, Kumarasiri RP, Senanayake N, Ariyasena H. Parallel infusion of hydrocortisone±chlorpheniramine bolus injection to prevent acute adverse reactions to antivenom for snakebites. Med J Aust. 2004;180(1):20-3.

Suchithra N, Pappachan JM, Sujathan P. Snakebite envenoming in Kerala, South India: Clinical profile and factors involved in adverse outcomes. Emerg Med J. 2008;25:200‑4.

Sharma SK, Koirala S, Dahal G ,Sah C. Clinico-epidemiological features of snakebite: a study from Eastern Nepal. Tropical Doctor. 2004;34:20-2.

Gold BS, Dart RC, Barish RA. Bites of venomous snakes. New England Journal of Medicine. 2002;347(5):347-56.

Sharma SK, Khanal B, Pokhrel P, Khan A, Koirala S. Snakebite-reappraisal of the situation in Eastern Nepal. Toxicon. 2003;41:285-9.

Pe T, Myint AA, Kyu KA, Toe MM. Acceptability study of protective boots among farmers of Taungdwingyi Township. Myanmar Health Sciences Research Journal. 1998;10(2):57-60.

Bawaskar HS, Bawaskar PH. Profile of snakebite envenoming in western Maharashtra, India. Trans R Soc Trop Med Hyg. 2002;96:79‑84.

Warrell DA, Gutiérrez JM, Calvete JJ, Williams D. New approaches and technologies of venomics to meet the challenge of human envenoming by snakebites in India. Indian J Med Res. 2013;138:38-59.

Bhattacharya S, Chakraborty M, Mukhopadhyay P, Kundu PP, Mishra R. Viper and cobra venom neutralization by alginate coated multicomponent polyvalent antivenom administered by the oral route. PLoS Negl Trop Dis. 2014;8:3039.




How to Cite

Inamdar, K., Parhate, S. M., & Randad, R. D. (2017). Pharmacotherapeutic study of efficacy, safety and prognostic analysis of anti snake venom serum in snake bite patients. International Journal of Basic & Clinical Pharmacology, 6(4), 906–912.



Original Research Articles