Snakebite envenomation is a common cause of morbidity and mortality in agricultural regions in the Philippines, like the Bicol region. This is because snake venom contains neurotoxins that can cause paralysis and death due to respiratory failure and paralysis of the respiratory muscles.
As there are more than 60 species of snakes in the country, seven of which are venomous. By far, the most popular local snake is the Philippine Cobra. And the available antivenin in the Philippines is specific for cobra bites.
BMC PCC's Snakebite Census
The Bicol Medical Center Poison Control Center's (BMC PCC) annual snakebite census ranges from 45-76 cases annually. The majority are adult patients.
For the year 2020, there were sixty-five (65) admissions, twenty-seven (27) with envenomation, and four (4) mortalities.
Last year, 2021, we had forty-two (42) cases, 29 with envenomation with three mortalities. The three mortalities were the 66-year-old male from Tarusanan, Camaligan, a 40-year-old male from Libmanan, and a nine-year-old male from San Felipe, Naga City, bitten on her right shoulder.
Unavailability of antivenin despite purchase attempt
The BMC PCC purchased 120-200 ampules of antivenin from Research Institute for Tropical Medicine (RITM) annually. The last purchase was in September 2020, which lasted for seven months. We have been regularly coordinating with RITM for the availability of the cobra antidote. However, RITM informed us that the antivenin would not be available at once due to factors beyond their control. Hence, we opted to purchase the medicine we could give to patients if cobra antivenin is unavailable.
The BMC Pharmacy Section purchased pyridostigmine 60 mg tablets. Since September 2021, this medicine was given to six patients with cobra bite envenomation. The six patients recovered and were eventually discharged.
At present, there is still no available cobra antivenin in BMC and other poison centers in the country, even in RITM, Alabang Muntinlupa (RITM - the sole manufacturer of cobra antivenin). Therefore, the antivenin used for the recent snakebite patient from Pagatpat, Calabanga, was sourced from the available antivenin supplies of Catanduanes and Sorsogon.
BMC PCC warns against 'tambal' and the use of tourniquet, et. al
While timely administration of effective antivenin remains the mainstay of management, BMC PCC would like to reiterate the potential harm of traditional first aid like "tambal." Therefore, snakebites and patients and their families should refrain from seeking this kind of first aid or care.
Also, PCC warns the public against the use of tourniquet, cutting and suctioning of a wound, or applying chemicals that have no value and are detrimental to the patient.
Instead, the center strongly recommends that snakebite patients access prompt care from health facilities and hospitals like BMC, which has a dedicated Poison Control Center.