Is there a benefit for administration of antivenom following local and mild systemic reactions to Daboia (Vipera) Palaestinae snake bites?

Background: Daboia (Vipera) palaestinae envenomation (DPE) is the most common snake-bite in Israel. Current practice has supported antivenom treatment, including those with local or systemic manifestations. Objective: To evaluate a conservative approach vs. fixed dose D. palaestinae antivenom for patients with advance local (AL)/mild systemic (MS) manifestations. Methods: Retrospective analysis of 41 patients bitten by D. palaestinae who were treated with expectant management or administration of a fixed-dose of 50 mL antivenom. Results: Antivenom was withheld in 16/21 patients (76%) with AL or MS reaction. After expectant management, no adverse events were recorded. Conclusion: We found that a selective approach towards antivenom administration yields similar clinical outcomes in patients following DPE.