title: A locally developed snakebite management protocol significantly reduces overall anti snake venom utilization in West Bengal, India.
abstract: OBJECTIVE
  The purpose of this study was to determine the impact of a nationally developed snakebite treatment protocol on the amount of anti snake venom (ASV) used in treating snakebites in a developing country and its effect on mortality. In addition, basic epidemiology data were collected and analyzed.
  
  
  METHODS
  Experts in Indian snakebites developed a protocol specifically designed for snakebite treatment in India. A training program was implemented in Midnapore Medical College in West Bengal, India, under the direction of the Health Minister to train care providers in the new protocol. After training, data were collected for 839 snakebite victims over a 12-month period and included epidemiological data, ASV volumes administered, and mortality. The results were collated and compared with results calculated from 780 snakebite victims treated during the 12-month period before implementation of the protocol. Treatment prior to protocol implementation was based on knowledge gained by the care providers from western and forensic medicine textbooks.
  
  
  RESULTS
  Protocol-guided treatment resulted in a 66% decline in the amount of ASV administered to victims. Fewer victims received ASV based on rational guidelines for assessing envenomation, dosage and repeat dosage, and clear endpoints to ASV therapy. In addition, there was a trend towards reduced mortality and an absolute reduction of 24%.
  
  
  CONCLUSIONS
  Use of the protocol reduced ASV utilization and the number of deaths. Locally developed protocols should be encouraged by such organizations as the World Health Organization and national and state governments and should be established with significant input from local experts.
authors.affiliation: Midnapore Medical College, West Bengal, Inda.
authors.forename: Soumitra
authors.initials: S
authors.lastname: Ghosh
authors.forename: Indira
authors.initials: I
authors.lastname: Maisnam
authors.forename: Bijoy K
authors.initials: BK
authors.lastname: Murmu
authors.forename: Pradip K
authors.initials: PK
authors.lastname: Mitra
authors.forename: Aniruddha
authors.initials: A
authors.lastname: Roy
authors.forename: Ian D
authors.initials: ID
authors.lastname: Simpson
mesh_terms: D000818:Animals; D000997:Antivenins / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D018570:Risk Assessment; D012909:Snake Bites / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D012910:Snake Venoms / Q000506:poisoning*; D013997:Time Factors
chemical_list: D000997:Antivenins; D012910:Snake Venoms