Daboia (Vipera) palaestinae envenomation in 123 horses: Treatment and efficacy of antivenom administration

Envenomation by venomous snakes is life threatening for horses. However, the efficacy of available treatments for this occurrence, in horses, has not yet been adequately determined. The aim of this study was to describe the treatments provided in cases of Daboia palaestinae envenomation in horses and to evaluate the safety and efficacy of antivenom administration. Data regarding 123 equine snakebite cases were collected over four years from 25 veterinarians. The majority of horses were treated with procaine-penicillin (92.7%), non-steroidal anti-inflammatory drugs (82.3%), dexamethasone (81.4%), tetanus toxoid (91.1%) and antivenom (65.3%). The time interval between treatment and either cessation or 50% reduction of local swelling was linearly associated with case fatality (p < 0.001). The overall mortality rate was 20.3%. Treatment with procaine-penicillin was significantly associated with reduced mortality (OR = 0.11). Three horse-derived antivenom products were available during the study period, of which the horses were administered different brands of varying dosages. Administration of the recommended dosage of any of the aforementioned products led to a significant decrease in mortality (p = 0.014), even in severe cases (scoring 2 or greater on the equine snakebite severity scale). No adverse reactions were reported. The results of this study show that species-specific D. palaestinae antivenom administered at the manufacturer-recommended dosage is effective in significantly reducing mortality in cases of envenomation in horses.