Antivenoms

• A multitude of antivenoms are produced to varying standards. The quality and accessibility of antivenoms that meet appropriate standards varies widely around the world.
  Great efforts are being undertaken to secure appropriate standards (GMP) and access for people in need
  WHO: Snakebite envenoming - A strategy for prevention and control
  WHO: Antivenoms
  WHO Snakebite Information and Data Platform 

• Antivenoms and antidotes are essential for treating envenoming and poisoning. They are particularly indispensable when the effects of venoms and poisons cannot be managed at all, or not effectively, with supportive therapy alone (e.g. unclottable blood and bleeding in snakebite envenoming). 
  Some effects of venoms and poisons can still be managed with supportive treatment if no antivenom is available or fails (e.g. respiratory failure due to venom-induced disabeling of the neuromuscular junction).
• 'Specific therapeutics' require identification of the culprit. 
  In most cases of envenoming, the culprit has not been seen at all, has only been seen vaguely, has not been reliably identified, or has not been perceived as a threat.  
  In cases where only monospecific antivenoms are available, selecting the correct antivenom can be challenging. A high degree of certainty must be achieved in identifying the culprit using indirect evidence. 
       - the distribution of culprits in the region where the accident occurred; 
       - the behaviour of the culprit and the circumstances of the accident; 
       - clinical envenoming / poisoning patterns.
  If polyspecific antivenoms covering the main culprits in a given region are available, it is less demanding.
• The VAPAGuide does not provide a comprehensive list of the antivenoms available at a national or regional level, nor does it assess their quality or effectiveness. This would be impossible in such a fluid market. 
  The VAPAGuide refers to WHO-approved antivenoms (see above). 
  Antivenoms that are not manufactured to GMP standards or approved by the WHO are used at the attending physician's discretion and responsibility.