Risks and realities of single vial antivenom recommendations for envenoming by Australian elapid snakes

Antivenom dosage for Australian elapid envenoming should be decided by clinical evaluation of individual patients

Snakebite is arguably the most important type of envenoming, both worldwide and in Australia, but evidence‐based management remains unclear and controversial. This is particularly evident in Australia, where it has been advocated that antivenom dosing should be limited to a single vial,1 an opinion that is commonly questioned among physicians treating snakebites. Conducting standardised clinical research on envenoming is challenging, particularly in countries like Australia, where numbers of envenomed people are relatively low and scattered geographically. Globally, snakebite particularly affects the rural poor in developing nations, where surveillance, let alone model clinical research, is problematical. Antivenom remains the cornerstone of management for snakebite, supplemented by other tools such as intensive care medicine, mechanical ventilation and haemodialysis. Antivenom use worldwide is complicated by variability in quality, availability and dosing.