Snake envenomation accounts for 91 deaths in the Philippines (Roberts et. al., 2021). The management of snakebite envenomation poses a critical challenge, particularly in settings with limited antivenom supplies. This study determines the symptom severity of snakebite envenomation and treatment outcomes of snakebite patients admitted in Northern Mindanao Medical Center from October 2017 to October 2022, who received lower doses of cobra antivenom with or without Neostigmine.

This was a single center descriptive study that reviewed 82 medical records of admitted snakebite patients at NMMC. Data were analyzed using descriptive statistics.

Admitted snakebite patients came from Bukidnon (42%), Misamis Oriental, Cagayan de Oro City, Lanao del Norte, Lanao del Sur, and Misamis Occidental. Those affected were predominantly 19-59 years old (mean age of 33), mostly male (73%), living in rural areas, and working in agriculture. At least half of the patients (45%) with signs of neurologic envenoming received less than the standard protocol dose of Cobra antivenom. The rest received Neostigmine (1%), both Cobra antivenom and Neostigmine (11%), and neither (43%). Moderate envenomation predominated (46%), followed by mild (43%) and severe (11%) envenomation. Regardless of symptom severity, most patients received 1-2 ampules (28 patients) or 3-5 ampules (14 patients); only four `patients received 6-10 ampules. Moderate and severe envenomation could be managed with reduced antivenom. Patients stayed in the hospital for 3-6 days (55%). The majority were discharged improved (96%). No mortality was noted. Only four patients experienced adverse effects from Cobra antivenom (skin rash and dyspnea) and Neostigmine (skin rash). 

Most cases occurred in the rural province of Bukidnon, primarily affecting males aged 19-59 (mean age 33) working in agriculture. Moderate and severe envenomation were effectively managed, fully reversing envenomation symptoms with reduced antivenom doses (1-5 ampoules), contrary to established guidelines recommending higher doses. The use of Neostigmine as an adjunct therapy appears promising for addressing antivenom supply shortages. Majority were discharged improved and a low incidence of adverse reactions.