Treatment of snake bites by Bothrops species and Lachesis muta in Ecuador: laboratory screening of candidate antivenoms

Abstract
Bothrops xanthogrammus/asper, B. atrox and Lachesis muta are probably responsible for most cases of severe envenoming in Ecuador. In recent years, the most widely used antivenom ('Myn' Ronti, imported from Mexico) has proved clinically ineffective. There is an urgent need to identify an effective alternative for clinical testing. Five antivenoms with activity against Bothrops venoms were compared using standard World Health Organization rodent and in vitro assays: (i) 'Myn', Ronti Mexico SA ('B. atrox', 'Crotalus terrificus'), (ii) Instituto Butantan (Bothrops polyvalent, Brazil), (iii) Instituto Nacional de Hygiene y Medicina Tropical (Bothrops polyvalent, Ecuador), (iv) Instituto Nacional de Salud (B. asper, C. durissus and Lachesis muta, Colombia), and (v) Laboratorios Probiol (Bothrops, Lachesis and Crotalus, Colombia). The venoms against which these antivenoms were tested were Ecuadorian B. atrox, B. asper and B. xanthogrammus. Brazilian antivenom proved to be the most effective, followed by the Ecudorian and Colombian antivenoms. Mexican antivenom was completely ineffective in neutralizing the lethal effects of Ecuadorian Bothrops venoms. Monospecific Brazilian L. muta antivenom (Instituto Butantan) proved effective against Ecuadorian L. muta venom, but the Colombian polyspecific antivenoms did not. Clinical trials of Brazilian and Ecuadorian antivenoms are planned in the Amazon region of Ecuador in the near future.