Prophylactic Antibiotics Are Not Needed Following Rattlesnake Bites

August, Jessica; Boesen, Kevin; Hurst, Nicholas B.; Shirazi, Farshad; Klotz, Stephen A.

doi:10.1016/j.amjmed.2018.06.006

Cited by 25 publications

(14 citation statements)

References 19 publications

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“…However, in Ecuador, a controlled study suggests that chloramphenicol and gentamicin were ineffective in preventing abscess formation (9 cases among 114 snake bites) given that they are administered for 24 h and less than half of the patients are identified as Bothrops bites [26]. In the United States, prophylactic antibiotic administration is not recommended for treating rattlesnake bites given the low incidence of wound infection (0.98%) [27]. Although the administration of specific antivenom remains the standard of care in the management of snakebites, administration of prophylactic, empiric antibiotics, or both is controversial.…”

Section: Discussionmentioning

confidence: 99%

“…Only three bacterial species recovered from deep tissue or biopsy cultures were also present in the oropharynx swab culture of N. atra, which suggests the requirement of simultaneous determination of both the bite wound and snake oropharynx bacterial microbiota. Given the considerable variability in the incidence of infection in snake bite wounds (1%-81%) [35,36], the causative organisms, and the methods used to isolate a pathogen in variable clinical settings [5,10,27,[37][38][39], an institutional protocol for antibiotic selection during snake bite wound management should be adapted based on the regional microbiology data of both snake bite wounds and snakes.…”

Section: Discussionmentioning

confidence: 99%

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An investigation of conventional microbial culture for the Naja atra bite wound, and the comparison between culture-based 16S Sanger sequencing and 16S metagenomics of the snake oropharyngeal bacterial microbiota

et al. 2021

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Naja atra is a major venomous snake found in Taiwan. The bite of this snake causes extensive wound necrosis or necrotizing soft tissue infection. Conventional microbial culture-based techniques may fail to identify potential human pathogens and render antibiotics ineffective in the management of wound infection. Therefore, we evaluated 16S Sanger sequencing and next-generation sequencing (NGS) to identify bacterial species in the oropharynx of N. atra. Using conventional microbial culture methods and the VITEK 2 system, we isolated nine species from snakebite wounds. On the basis of the 16S Sanger sequencing of bacterial clones from agar plates, we identified 18 bacterial species in the oropharynx of N. atra, including Morganella morganii, Proteus vulgaris, and Proteus mirabilis, which were also present in the infected bite wound. Using NGS of 16S metagenomics, we uncovered more than 286 bacterial species in the oropharynx of N. atra. In addition, the bacterial species identified using 16S Sanger sequencing accounted for only 2% of those identified through NGS of 16S metagenomics. The bacterial microbiota of the oropharynx of N. atra were modeled better using NGS of 16S metagenomics compared to microbial culture-based techniques. Stenotrophomonas maltophilia, Acinetobacter baumannii, and Proteus penneri were also identified in the NGS of 16S metagenomics. Understanding the bacterial microbiota that are native to the oropharynx of N. atra, in addition to the bite wound, may have additional therapeutic implications regarding empiric antibiotic selection for managing N. atra bites.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

An investigation of conventional microbial culture for the Naja atra bite wound, and the comparison between culture-based 16S Sanger sequencing and 16S metagenomics of the snake oropharyngeal bacterial microbiota

et al. 2021

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“…Therefore, the snake should be detached from the bitten area as fast as possible, as this contributes to decreasing the chance of toxin release and breakthrough into the tissues. Likewise, in accidents caused by colubrids, even in accidents by viperid or elapid snakes, the secondary infection of the wound occurs in around 1% of the cases, likely due to the antimicrobial effect of the venom, which explains why no prophylactic antibiotics are used 21 . The use of antibiotics should be supported in microbiological analyses.…”

Section: Discussionmentioning

confidence: 99%

A case of envenomation by the false fer-de-lance snake Leptodeira annulata (Linnaeus, 1758) in the department of La Guajira, Colombia

et al. 2020

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Envenomations by colubrid snakes in Colombia are poorly known, consequently, the clinical relevance of these species in snakebite accidents has been historically underestimated. Herein, we report the first case of envenomation by opisthoglyphous snakes in Colombia occurred under fieldwork conditions at the municipality of Distracción, in the department of La Guajira. A female biologist was bitten on the index finger knuckle of her right hand when she tried to handle a false fer-de-lance snake (Leptodeira annulata). Ten minutes after the snakebite, the patient started to have symptoms of mild local envenomation such as edema, itching, and pain in the wound. After 40 minutes, the edema reached its maximum extension covering the dorsal surface of the right hand and causing complete loss of mobility. The clinical treatment focused on pain and swelling control. No laboratory tests were performed. The patient showed good progress with the total regression of the edema 120 hours after the snake-bite accident and complete recovery of the movement of the limb in one week. Venomous bites of “non-venomous snakes” (opisthoglyphous colubrid snakes) must be considered as a significant public health problem because patients lose their work capability during hours or even days and they are forced to seek medical assistance to treat the envenomation manifestations.

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“…In addition, most of our patients received antibiotics and corticosteroids, which were also used in previous studies 2,5 . However, no evidence has been presented to back the use of antibiotic prophylaxis, as these are only recommended if there are clinical signs of a wound infection 21,22 . There has also been a lack of conclusive evidence regarding the use of corticosteroids 9,16,23,24 .…”

Section: Discussionmentioning

confidence: 99%

Most adder bites in Finland's Lake District caused mild symptoms and severe poisoning was rare

Nurminen

Eskola

2022

Acta Paediatrica

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Aim This study investigated the incidence, clinical picture and treatment of paediatric adder bites in Finland's Lake District. Methods Data were retrospectively collected on all children aged 0–15 years who were bitten by adders from 2006 to 2015 and treated at Tampere University Hospital. The severity was evaluated with the five‐level Poisoning Severity Score. Results We found that 109 children were treated following an adder bite, which was an incidence of 13 per 100,000 children from 0 to 15. Of these, 75 were under 8 years of age, with a median age of 3.5 years, and 34 were 8–15 years, with a median age of 10.3 years. The gender distribution was similar in both ages. Younger children were more likely to be bitten in their yards at home, whereas older children were more likely to be bitten in a forest. Older children reported more pain than younger patients. Most children were bitten on a lower limb, with minor symptoms such as localised redness and swelling, and received conservative treatment. Antivenom treatment was rarely administered and then only in severe cases or if symptoms progressed. Conclusion Adder bites mostly caused mild symptoms, severe poisoning was rare and antivenom was rarely given.

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Prophylactic Antibiotics Are Not Needed Following Rattlesnake Bites

Cited by 25 publications

References 19 publications

An investigation of conventional microbial culture for the Naja atra bite wound, and the comparison between culture-based 16S Sanger sequencing and 16S metagenomics of the snake oropharyngeal bacterial microbiota

An investigation of conventional microbial culture for the Naja atra bite wound, and the comparison between culture-based 16S Sanger sequencing and 16S metagenomics of the snake oropharyngeal bacterial microbiota

A case of envenomation by the false fer-de-lance snake Leptodeira annulata (Linnaeus, 1758) in the department of La Guajira, Colombia

Most adder bites in Finland's Lake District caused mild symptoms and severe poisoning was rare

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