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

Cost Effective Strategies

1. Prescribe antibiotics for envenomations only when secondary bacterial infection occurs.

Empiric antibiotic prophylaxis is not indicated because most of these envenomations do not become secondarily infected. The immediate local swelling, erythema, warmth and pain are due to venom effects and should not be mistaken for infection.

2. Reserve antivenom therapy for the indications discussed in this article.

Antivenom is expensive. Excessive use not only increases cost but also exposes the patient to complications, such as hypersensitivity reactions. Following the clinical pathway for CroFab® administration provided on page 10 will help the clinician to utilize CroFab® appropriately.

3. Not all envenomations require hospital admission. Selected "dry" bites and minor envenomations may be safely discharged from the emergency department after an adequate observation period.

Hospital admission will be reserved for those envenomations with significant clinical toxicity or certain high risk situations (such as delayed neurotoxicity with coral snake envenomation).

4. Avoid the use of expensive and unproven therapies.

For example, hyperbaric oxygen therapy has been recommended for brown recluse spider bites but has not been of proven benefit in animal studies. In addition, the patient is exposed to potential complications of hyperbaric oxygen therapy.

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Last Modified: 08/17/2017
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