Corticosteroids and Snakebites: A Persistent and Dangerous Medical Error

Article by Damien Lecouvey, herpetologist and field safety consultant

que faire en cas de morsure de serpents

Introduction

Snakebites, especially in tropical or remote environments, often trigger emergency decisions under pressure. One practice still seen too often is the immediate administration of corticosteroids. Although often well-intentioned, this intervention is unsupported by science and may delay proper treatment. In this article, we examine why corticosteroids are not recommended for snakebites, the dangers they pose, and the evidence-based protocols to follow instead.

1. Why are corticosteroids still used?

Many practitioners continue to use corticosteroids like dexamethasone or prednisone in the hope of reducing swelling, preventing allergic shock, or slowing venom diffusion. These practices are based on outdated assumptions rather than current evidence. Despite decades of data, these drugs are still used in many health centers around the world.

Yet, they have no neutralizing effect on venom and do not improve patient outcomes.

2. Scientific consensus and official guidelines

The World Health Organization (WHO) and numerous peer-reviewed studies have made their stance clear: corticosteroids are not recommended for the routine management of snakebite envenoming.

“Corticosteroids are not recommended for the routine management of snakebite envenoming.”
– WHO Guidelines for the Management of Snakebites, 2nd Edition, 2016

Research by Warrell (2010), Chippaux (2017), and others confirms the lack of efficacy and highlights the risk of masking serious clinical signs.

3. The real risks of corticosteroids after snakebite

Inappropriate use of corticosteroids in snakebite cases can lead to:

  • Delayed administration of antivenom

  • Suppression of early warning signs (e.g. edema, necrosis)

  • Increased risk of secondary infection

  • Metabolic complications (hyperglycemia, fluid retention, immunosuppression)

  • A false sense of safety for both patient and practitioner

4. What to do instead?

Appropriate treatment depends on the type of venom (neurotoxic, hemotoxic, cytotoxic), but core principles apply universally:

  • Immobilize the affected limb

  • Keep the patient calm and under observation

  • Transport rapidly to a facility with access to specific antivenom

  • Provide supportive care as symptoms evolve

  • Avoid traditional practices like cutting, sucking, or applying tourniquets

  • Do not administer corticosteroids routinely

5. In the field: a widespread issue

In many field situations — from South America to sub-Saharan Africa or Southeast Asia — I’ve witnessed corticosteroids being given reflexively, even in the absence of severe allergic symptoms. This is often due to outdated training or lack of up-to-date resources.

As a field herpetologist and expedition safety leader, I’ve seen first-hand how misinformation can delay effective care and worsen outcomes. Education and clear protocols are the key to changing these habits.

Conclusion

Corticosteroids are not an appropriate or effective treatment for snakebite envenoming. Their continued use reflects a critical gap in medical education, especially in remote or under-resourced areas. By following WHO guidelines and updated clinical research, we can improve survival and reduce complications in snakebite incidents — whether in the jungle or the emergency room.

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