Antivenom availability, delays and use in Australia

Antivenom is the main treatment for snake envenoming and there are ongoing concerns about availability in resource poor regions of the world. However, effective antivenom treatment for snake envenoming requires more than improved availability of safe and efficacious antivenoms. Most importantly, antivenom must be administered as early as possible, and within 2–6 h of the bite in Australia. At the same time, it is also important that antivenom not be given to all patients indiscriminately with a suspected snakebite, because of the risk of anaphylaxis. Delays in the administration of antivenom are a significant impediment to effective antivenom treatment and can be divided into pre-hospital and in-hospital delays. These range from delays due to remoteness of snakebite, to delays in diagnosis and administration of antivenom once in hospital. In Australia, antivenom is readily available in most hospitals, and a large portion of patients present to hospital within 2 h of the bite. However, there is on average a further delay of 2.5 h before antivenom is administered. Early diagnosis with accurate bedside tests and rapid clinical assessment of patients with snakebite are key to improving the effective use of antivenom.