The Effectiveness of Antibiotics in Managing Bacterial Infections on Bite Sites following Snakebite Envenomation

Abstract

Snakebite envenomation (SBE) is a life-threatening medical emergency with a high mortality rate. Common secondary complications following SBE, such as wound infections, are significant due to their impact on worsening local tissue damage and causing systemic infection. Antivenoms are not effective to treat wound infections following SBE. Moreover, in several rural clinical settings, broad-spectrum antibiotics are often used without clear guidelines or based on limited laboratory data, resulting in undesirable side effects and exacerbated treatment costs. Therefore, robust antibiotic strategies should be developed to tackle this critical issue. Currently, there is limited information available on the bacterial profiles of SBE-induced infections and antibiotic susceptibility. Hence, it is essential to improve the knowledge of bacterial profiles and their antibiotic sensitivity in SBE victims to develop better treatment strategies. This study aimed to address this issue by examining the bacterial profiles of SBE victims with a specific focus on Russell’s viper envenomation. The most frequently found bacteria in the bites of SBE victims were Staphylococcus aureus, Klebsiella sp., Escherichia coli, and Pseudomonas aeruginosa. Linezolid, clindamycin, colistin, meropenem, and amikacin were some of the most effective antibiotics for commonly grown bacteria in SBE victims. Similarly, ciprofloxacin, ampicillin, amoxiclave, cefixime, and tetracyclin were the least effective antibiotics for common bacteria found in the wound swabs of SBE victims. These data provide robust guidance for infection management following SBE and offer useful insights to aid in designing effective treatment protocols for SBE with serious wound infections in rural areas where laboratory facilities may not be readily available.

Use of Antibiotics following Snakebite in the Era of Antimicrobial Stewardship

“…The description of wound infection associated with SBE is mentioned in many articles, and a considerable percentage of patients developed this complication. Soft tissue infection such as cellulitis or abscess formation was described in 10% to 25% of patients in most studies [ 6 , 9 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ], but its occurrence could be higher depending on the severity of envenoming [ 23 , 24 ]. In contrast, in some settings the prevalence of infections in SBE patients is lower [ 25 , 26 , 27 ], probably related to the type of envenoming and management received by patients in these settings.…”

“…It was found that the incidence of infection was not reduced in patients receiving antibiotics compared to those who did not receive them [ 21 , 29 , 33 ]. Other studies also argue against the use of prophylactic antibiotics in SBE ( Table 1 ) [ 23 , 25 , 26 , 37 ]. Thus, there is a predominant view in the reviewed literature that the prophylactic administration of antibiotics in SBE is not warranted and that they should be used only when there is clinical or bacteriological evidence of infection.…”

Identifying key factors contributing to treatment costs for snakebite envenoming in private tertiary healthcare settings in Tamil Nadu, India

“…Tissue necrosis around the bite site may require operative interventions such as local debridement and fasciotomy along with possible amputation where attempts at limb salvage are not viable or successful [18,19]. A wide range of antibiotics is used to combat bacterial infections arising from SBE and patients who experience acute kidney injury often need dialysis [20,[24][25][26]. Thus, a notable variety of treatment methods is required to counteract the broad spectrum of clinical effects induced by SBE.…”