How to Use Taiwanese Antivenoms

Taiwan’s multi-antivenom approach relies on knowing the species responsible for the bite. Identifying the culprit species in Asia is more useful than in any other region. Taiwanese clinicians use snake-identification posters and venom detection kits to help choose the proper antivenom. A detailed history from the victim regarding the behavior and appearance of the snake is important. Description of the habitat (mountainous, coastal flats, agricultural, etc.) is also important and can help identify the culprit. For assistance in identifying Taiwan venomous snakes, refer to the above images.

The Taiwan bivalent viper antivenom (NIPM-PTBV) will likely be used most frequently, followed by the Taiwan neuro bivalent (NIPM-NBB; indicated not only for neurotoxic krait bites but also cytotoxic cobra bites). The monovalent antivenoms will be needed for bites from suspected sharp-nosed vipers (NIPM-SNV) and Russell’s vipers (NIPM-RV) and this is addressed in the algorithm.

Start at Regional Antivenom Flowchart: INDOPACOM and Antivenom Dosing By Product Table (in CPG)

Because broad-spectrum, field stable polyvalents (TRC-NPAV and TRC-HPAV) have gaps outside Southeast Asia, the CPG includes region tailored decision points for Taiwan, Japan, the Korean Peninsula, East China, and other areas where local monovalents or mixed coverage strategies may be required. In these subsections, location/elevation/habitat plus syndrome often narrows to a logical presumptive ID even when the snake was not seen. Use those boxes first when working in these areas.