[Which antivenom for Cerastes envenoming?].

Area of Science:

• Toxicology
• Pharmacology
• Herpetology

Context:

• Viper envenoming in Africa results in significant mortality, with over 90% of patients surviving even without appropriate antivenom.
• The effectiveness of antivenom treatment is often conflated with patient survival, which is influenced by various factors including patient condition, venom composition, and management delay.

Purpose:

• To evaluate the efficacy of FAV-Afrique antivenom in treating envenoming by Echis and Cerastes vipers.
• To determine if FAV-Afrique antivenom, designed for sub-Saharan African vipers, can neutralize venom components from North African Cerastes species.

Summary:

• FAV-Afrique antivenom rapidly corrects hemostasis disorders in Echis viper envenoming within 12 hours.
• However, the same antivenom required 36 hours and multiple vials to show limited effect on Cerastes envenoming, indicating its inadequacy for this species.
• Cerastes venoms possess enzymes that interfere with hemostasis, necessitating antivenoms specifically targeting these North African viper species.

Impact:

• Highlights the critical need for species-specific antivenoms in managing viper envenoming.
• Suggests that Favirept®, an antivenom adapted to North African vipers (C. cerastes, B. arietans, E. leucogaster, M. deserti, N. haje, N. nigricollis), may be a more appropriate treatment for Cerastes envenoming.