title: Comparative cost and efficacy trial of Pakistani versus Indian anti snake venom.
abstract: OBJECTIVE
  To compare the efficacy, safety and cost of Pakistani anti-snake venom with that imported from India
  
  
  METHODS
  The comparative cross-sectional study was conducted from June to September 2010 and comprised patients hospitalised following Krait snake bite in Mithi and Umerkot hospitals of Tharparker district who had incoagulable blood test on admission (20-minute whole blood clotting time). Basic demographies of patients, the site of bite and swelling around the bite and joints were entered in a proforma. For blinding, the liquid anti-snake venoms were packed in opaque polythene bags and marked as "A" and "B", and refrigerated. Four ampoules of the venom were mixed in a drip and given over one hour while looking for adverse reactions. In case of milder reactions, the venom was temporarily stopped and anti-histamines and analgesics were given. For more severe reactions intramuscular adrenaline was recommended. Coagulation was again checked after 6 hours and, if blood was still incoagulable, the dose of the venom was repeated after 6 hours. Once coagulation was confirmed on two occasions, the patient was discharged. Total doses of the venom given to achieve coagulation, the reactions and the cost of the venom were analysed at the end to see the response and cost-effectiveness.
  
  
  RESULTS
  Of the 80 cases - 40 (50%) from each hospital - 6 (7.5%) had to be excluded for lack of data. Out of the remaining 74 (92.5%) patients, 38 (52.35%) received Pakistani anti-snake venom (A), and 36 (48.64%) received Indian anti-snake venom (B). Immediate reaction to the venom was seen in 23 (60.5%) cases with "A" and 25 (69.4%) with "B". In terms of evenomation, 23 (60.5%) cases with "A" attained restoration of coagulation with the first dose, compared to 13 (36.11%) with "B", showing a significantly better response with "A" (p < 0.035). Mean of 1.66 doses of "A" and 1.94 of "B" were used to neutralise venom, again showing lesser doses of Pakistani anti-snake venom. Cost-wise "A" was 2.5 times cheaper than the imported "B".
  
  
  CONCLUSIONS
  Pakistani anti-snake venom was significantly quicker and better as well as cheaper than the Indian anti-snake venom.
authors.affiliation: Pakistan Medical Research Council, Islamabad.
authors.forename: Huma
authors.initials: H
authors.lastname: Qureshi
authors.affiliation: PMRC Research Centre, Jinnah Postgraduate Medical Centre.
authors.forename: Syed Ejaz
authors.initials: SE
authors.lastname: Alam
authors.affiliation: NICH, Karachi.
authors.forename: Muhammad Ayaz
authors.initials: MA
authors.lastname: Mustufa
authors.affiliation: Biological Production Division, National Institute of Health, Islamabad,
authors.forename: Nasreen Khalid
authors.initials: NK
authors.lastname: Nomani
authors.affiliation: Civil Hospital Mithi.
authors.forename: Jawahar Lal
authors.initials: JL
authors.lastname: Asnani
authors.affiliation: Civil Hospital Umar Kot, Sindh.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Sharif
mesh_terms: D000328:Adult; D000818:Animals; D000997:Antivenins / Q000191:economics*; D003430:Cross-Sectional Studies; D004311:Double-Blind Method; D006801:Humans; D007194:India; D010154:Pakistan; D012909:Snake Bites / Q000188:drug therapy*; D012910:Snake Venoms / Q000191:economics*; D016896:Treatment Outcome
chemical_list: D000997:Antivenins; D012910:Snake Venoms