Optimizing Anti-Snake Venom Strategies for Hemotoxic Envenomation in Northern India: Clinical Outcomes and Regional Challenge.

Snakebite envenomation, especially from hemotoxic species such as Daboia russelii and Echis carinatus, remains a significant public health challenge in the northern Indian states of Punjab, Haryana, Uttar Pradesh, Uttarakhand, and Himachal Pradesh. Despite the availability of polyvalent anti-snake venom (ASV), inconsistent dosing strategies, delayed administration, and disparities in healthcare contribute to high morbidity and mortality rates. This review examines optimal ASV dosing protocols, clinical outcomes, and host-specific factors that influence the therapeutic efficacy in hemotoxic envenomation. Drawing from regional epidemiological data, toxicological insights, and clinical studies, the review underscores the influence of bite-to-needle intervals, ASV administration routes, and infrastructural readiness on patient survival. Notably, intravenous administration proves superior, while early intervention significantly reduces systemic complications. The study identifies key gaps in national guidelines, particularly the mismatch between regional venom variability and available ASV formulations. It also explores emerging alternatives like Varespladib and monoclonal antivenoms. Methodologically, the review adopts a narrative synthesis of peer-reviewed literature and policy frameworks. It concludes that standardizing ASV treatment based on regional evidence, enhancing healthcare capacity, and integrating public health education are essential to improving outcomes. The findings support the need for locally tailored, patient-centric treatment protocols and stronger public health systems to mitigate snakebite-related burdens.