Preliminary evaluation of Vipera palaestinae snake bite treatment in accordance to the severity of the clinical syndrome.

The intravenous administration of a 60 ml dose of Vipera palaestinae antivenin was the suggested standard treatment of every bitten patient. In this study 85 Vipera palaestinae bitten patients where selectively treated with antivenin depending on the severity of the clinical picture. Patients who developed systemic or severe local signs received 20 ml of antivenin over 30 min. If symptoms were still present, an additional 10 ml of antivenin was given until systemic signs subsided. Repeated doses of 10 ml of antivenin was administered in each case of systemic symptom relapse. 49% of patients did not exhibit any systemic symptoms and did not receive antivenin treatment. In 63% of antivenin treated cases symptoms were aborted by a single dose of 20 ml of antivenin. 23% of the antivenin treated patients needed 30-40 ml, 19 needed 50-60 ml and only 1 patient (2%) received 80 ml of drug. Serum sickness complications were found in 44% of antivenin treated patients. The results of this study show that antivenin treatment based on systemic symptoms is effective, required less antivenin than the treatment with fixed dose for each patient and reduces the incidence of serum sickness.