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Antibiotics in non-venomous snakebite
  1. Polly Terry, Specialist Registrar,
  2. Kevin Mackway-Jones, Professor
  1. K Mackway-Jones, 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 prophylactic antibiotics reduced the incidence of infection after non-venemous snake bite. Altogether 60 papers were found using the reported search, of which two 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 best papers are tabulated. 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 non-venomous snake. Examination reveals localised swelling and oedema of his right hand and forearm, he is systemically well, has no relevant previous medical history and is fully antitetanus immunised. 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 [fit and well adults who have been bitten by a non venomous snake] do [prophylactic antibiotics] reduce [the incidence of infection]?

Search strategy

Medline 1966–12/01 using the OVID interface. [(exp snake bites OR snake bite$.mp) AND (exp antibiotics OR anti-biotics.mp OR antibiotic$.mp)] LIMIT to human AND English.

Search outcome

Altogether 60 papers of which two were relevant (table 2).

Table 2

Comment(s)

While many studies have identified the variety of potential pathogens from snakebite, few have looked at the role of prophylactic antibiotics and those available are of poor quality. It is interesting to note the low incidence of infection associated with snakebites irrespective of antibiotic treatment or not. Given the low event rate for infection, trials involving larger numbers would need to be undertaken.

CLINICAL BOTTOM LINE

Prophylactic antibiotics are not indicated in the routine treatment of patients with snakebites from non-venomous snakes if no necrosis is present.

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

References

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