Table 2.
Viability analysis of convenient SBE therapy routes of delivery listed in descending order of cumulative viability score. Individual scores for each parameter were assigned as 0 = none, 1 = low, 2 = moderate, and 3 = high. The anatomical routes of therapy administration considered in this analysis are oral (OP), buccal (BUC), sublingual (SL), rectal (REC), nasal (NAS), intradermal (ID), subcutaneous (SC), intramuscular (IM), intravenous (IV), transdermal (TD), topical (TOP), and pulmonary inhalation (INH). IV administration is shown for comparison but would require specialized training. Parameters for evaluation were selected as relevant for adjunctive SBE therapies given in the field immediately after envenoming and scores were assigned based adaptations from previous work(Jain, 2020; Jin et al., 2015; Jonaitis et al., 2021).
| Route of Delivery | Ease of Self-Admin. | Dose Control | Volumn greater 1 mL/1g | Bioavail. | Avoid Deg. (Stomach/Liver) | Rapid Systemic Dist. | Onset of Action | Protection from infection | Tolerate Biologics | Rapid Dist. Locally | Uncon. Admin. | Pain Free | Viabililty Score |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Intramuscular (IM) | 2 | 3 | 3 | 3 | 3 | 2 | 2 | 2 | 3 | 3 | 3 | 1 | 30 |
| Subcutaneous (SC) | 2 | 3 | 2 | 3 | 3 | 2 | 2 | 2 | 3 | 3 | 3 | 1 | 29 |
| Nasal (NAS) | 3 | 1 | 1 | 2 | 3 | 2 | 3 | 3 | 2 | 2 | 3 | 3 | 28 |
| Intravenous (IV) | 0 | 3 | 3 | 3 | 3 | 3 | 3 | 1 | 3 | 2 | 3 | 1 | 28 |
| Buccal (BUC) | 3 | 2 | 3 | 2 | 2 | 2 | 2 | 3 | 1 | 1 | 3 | 3 | 27 |
| Sublingual (SL) | 3 | 2 | 3 | 2 | 2 | 2 | 2 | 3 | 1 | 1 | 2 | 3 | 26 |
| Resp. Inhilation (INH) | 3 | 2 | 1 | 2 | 3 | 2 | 3 | 3 | 3 | 2 | 0 | 2 | 26 |
| Rectal (REC) | 2 | 1 | 3 | 2 | 2 | 2 | 2 | 3 | 1 | 2 | 3 | 2 | 25 |
| Intradermal (ID) | 3 | 2 | 0 | 2 | 3 | 1 | 1 | 2 | 3 | 1 | 3 | 2 | 23 |
| Oral (PO) | 3 | 3 | 3 | 2 | 0 | 2 | 2 | 3 | 0 | 1 | 0 | 3 | 22 |
| Topical (TOP) | 3 | 1 | 1 | 1 | 3 | 0 | 1 | 3 | 1 | 1 | 3 | 3 | 21 |
| Transdermal (TD) | 3 | 1 | 0 | 1 | 3 | 1 | 1 | 3 | 0 | 2 | 3 | 3 | 21 |