Antivenoms for Snakebite: Design, Function, and Controversies

Background: Animal-derived antivenoms have been used to treat snake envenomation for more than 100 years. Major technological advantages in the past 30 years have produced antivenoms that are highly purified and chemically modified to reduce the risk of acute hypersensitivity reactions. Like all pharmaceutical manufacture, commercial-scale antivenom production requires making trade-offs between cost, purity, pharmacokinetic profile, and production yield. Scope: This article reviews the current state of the art for antivenom production and development. Particular attention is paid to controversies and trade-offs used to achieve a balance between improved safety and pharmacokinetic performance.