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The use of antibiotics in venomous snake bite
  1. Polly Terry,
  2. Kevin Mackway-Jones
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
  1. kevin.mackway-jones{at}man.ac.uk

Abstract

A short cut review was carried out to establish whether antibiotics reduce the incidence of infection after venomous snake bite. Altogether 60 papers were found using the reported search, of which three presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are shown in table 3. A clinical bottom line is stated.

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Report by Polly Terry, Specialist Registrar
 Checked by Kevin Mackway-Jones, Professor

Clinical scenario

A 26 year old man attends the emergency department having been bitten on his right hand 30 minutes previously by his pet a venomous snake. Examination reveals extensive swelling of his forearm with lymphangitis, hypotension and gingival bleeding. He has no relevant previous medical history and is fully immunised against tetanus. You know there is the potential for infection from the snakes fangs and oropharynx, as well as contamination from the victim's skin and clothing. You thoroughly clean the wound with local wound toilet, and are happy that there is no fang left in situ. You wonder if prophylactic antibiotics are indicated to reduce the risk of infection.

Three part question

In [well adults who have been bitten by a venomous snake] do [prophylactic antibiotics] reduce [the incidence of infection]?

Search strategy

Medline 1966–10/01 using the OVID interface. {(exp snake bites OR snake bite$.mp) AND (exp antibiotics OR anti-biotics OR antibiotic$.mp)} LIMIT to human AND English.

Search outcome

Altogether 60 papers of which three were relevant to the original question.

Comment(s)

Most of the trials involved small numbers and were affected by the use of antivenin, which in itself has antibactericidal activity. There is concern that use of antibiotics prophylacticaly will have little impact on further infection but may give rise to side effects, is not cost effective and may select out more resistant organisms. These studies again confirm the low event rate for infection after snake bite from venomous snakes.

CLINICAL BOTTOM LINE

Prophylactic antibiotics are not required in snake bites from venomous snakes.

Report by Polly Terry, Specialist Registrar
 Checked by Kevin Mackway-Jones, Professor

References

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