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<< Bites and Stings – Snakes, Spiders, and Scorpions in the United States

Spiders: Treatment

Latrodectus

After routine wound care and support of respiratory and cardiovascular function, control of pain and muscle cramping is the usual priority. A combination of intravenous opioids and benzodiazepines provides analgesia, anxiolysis, sedation, and muscle relaxation.29 Tetanus status should be updated.

Indications For The Use Of Latrodectus Antivenin®

Latrodectus Antivenin® is a whole IgG antibody produced by Merck Pharmaceuticals. The administration of Latrodectus Antivenin® may be complicated by hypersensitivity reactions and serum sickness.54 Controversy exists in treating patients with the antivenom because, although morbidity is high (pain, cramping, and autonomic dysfunction), mortality is low. There are case series supporting the efficacy and safety of this product in decreasing duration of illness.61,62 The antivenom can be considered in high risk patients and those with severe toxicity, such as extreme muscle pain and cramping, hypertension, respiratory distress, and priapism, that is unresponsive to other therapy.29,61,63

It is important to note that Latrodectus Antivenin® carries risk for serum sickness and needs careful consideration prior to administration to patients. Many experts believe that the antivenom has too high of a risk-benefit ratio to justify its use, since the mortality of Latrodectus bites is so low. Therefore, the indications for possible use of antivenom include severe muscle cramping, hypertension, diaphoresis, nausea, vomiting, and respiratory difficulty that is unresponsive to other therapy.29,61 There is a Fab antivenom product which is currently being studied but is not yet available on the market.

Loxoceles

Most brown recluse spider bites are mild and require no specific treatment. Appropriate treatment for dermal lesions includes rest and elevation to minimize inflammation and venom spread. Antihistamines can minimize pruritis, and analgesics are frequently required for pain control.55 Tetanus status should be updated. Treatment for systemic symptoms is supportive and vigorous hydration should be maintained.

In the past, treatment of L. reclusa bites has included steroids, antibiotics, dapsone, and hyperbaric oxygen therapy. However, none of these treatments have been proven to be effective in human trials.30 Thus, most therapy remains supportive, including adequate pain control and wound debridement, if necessary.

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Last Modified: 05/26/2017
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