Providers should adhere to the 29 antivenoms and dosing recommended in this CPG for use by military personnel, which have been evaluated by a multidisciplinary, mixed panel of leading civilian and military subject matter experts for safety, efficacy, and suitability for use in the unique environment of operational and austere medicine.

Note: If unable to source the recommended antivenoms and considering use of a non-recommended antivenom in an emergency context (or in the case of any general questions regarding antivenom use), contact the DoD ADVISOR line (+1 (833) 238-7756 (1-833-ADVSRLN) DSN: (312) 429-9089) and request toxicology consult ASAP. Many non-recommended products carry significant risks and toxicology consult is critical to avoiding preventable death or disability.

The global landscape of antivenoms is complex, fragmented, and characterized by a wide range of safety, efficacy, tolerability, and clinical evidence across the more than 110 distinct antivenoms currently manufactured worldwide.²⁶⁴ This is further complicated by the logistical and ethical barriers which make it extraordinarily difficult to conduct randomized clinical trials and nearly impossible to do so with placebo control, the lack of universal definitions of severity (making it difficult to interpret the context of efficacy when studies are performed), and many other challenges.²⁶⁵ The end result is chaotic, poorly controlled, and difficult to interpret: some products are widely relied upon by local clinicians and experts despite the lack of any formal trials; others are marketed as safe and effective based solely off of preclinical “test tube” studies conducted despite well-documented translational gaps between preclinical findings and real world effectiveness; some local formulations may enter the market without any studies whatsoever.^266,267 Unfortunately, this has led to widespread confusion, frequent misinformation, and sensationalistic media reports which inaccurately characterize effective products as ineffective (despite published clinical evidence demonstrating otherwise) or ineffective and potentially dangerous products as effective (despite either a lack of any clinical data or the existence of initial data indicating inefficacy and potentially dangerous dose-dependent toxicity).^268–271