[Which antivenom for Cerastes envenoming?]

During Echis viper envenoming, the administration of a single FAV-Afrique(®) antivenin vial generally corrects hemostasis disorders in less than twelve hours. The correction of hemostasis after 36 hours by 4 vials of FAV-Afrique(®) is thus not in favor of the usefulness of this antivenin for Cerastes envenoming . Mortality due to viper envenoming in Africa is high, but more than 90 % of poisoned patients survive despite the absence of appropriate antivenom. The severity of poisoning depends on several factors: age and condition of the patient, location of the bite, composition and amount of injected venom, management delay, and therefore, survival is not necessarily synonymous of effectiveness of antivenom treatment. Cerastes venoms contain many enzymes that disrupt various stages of hemostasis. It remains to prove that FAV-Afrique(®), a polyvalent antivenom adapted to venom of the main species responsible for envenoming in sub-Saharan Africa, (Bitis, Echis, Naja and Dendroaspis), is able to neutralize these specific proteins. The most logical approach of Cerastes envenoming is the administration of an antivenin adapted to species found in North Africa: Favirept(®) (Sanofi Pasteur) is a polyvalent antivenom adapted to the venoms of C. cerastes, Bitis arietans, Echis leucogaster, Macrovipera deserti, Naja haje and Naja nigricollis.