Antibiotics after rattlesnake envenomation.
To record the outcome, with regard to infection rate, of patients with rattlesnake bites (RSBs) who do not receive prophylactic antibiotics, a prospective observational study was performed of patients with RSBs treated at our institution during a consecutive 18-month period. The inclusion criteria were RSBs <24 h old and completion of follow-up (telephone call, mail reply, medical toxicologist, or private physician examination) 7-10 days following envenomation. Fifty-six consecutive patients (Median age: 32.8 years [range 4-67 years]) were enrolled. One patient was excluded because of presentation 38 h after envenomation and two patients failed to complete the required follow-up. One patient received a dose of antibiotics before transfer. Antibiotics were discontinued upon arrival. Of the total 56 RSB patients, 34 (61%) RSBs involved the upper extremity and 22 (39%) involved the lower extremity. Six patients (11%) applied ice and two (4%) used a tourniquet before evaluation. The mean arrival time was 2.7 h (Range <1-24 h). Forty-three patients (81%) received antivenin. Fifty-three patients (100%) had extremity swelling and 38 patients (72%) had tender proximal lymph nodes. Of the 53 patients who completed the study, 3 (6%) received antibiotics from their primary care physicians at 7-10 day follow-up, with no cases (0%) of documented infection. Prophylactic antibiotics are not indicated in patients with rattlesnake bites.
LoVecchio
Frank
F
Good Samaritan Regional Medical and Poison Control Center, Department of Medical Toxicology, Phoenix, Arizona 85006, USA.
Klemens
Jane
J
Welch
Sharon
S
Rodriguez
Ron
R
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000818:Animals; D000832:Animals, Poisonous; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis / Q000379:methods; D000997:Antivenins / Q000008:administration & dosage*; D001130:Arizona / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D017839:Crotalus; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011336:Probability; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D012909:Snake Bites / Q000188:drug therapy* / Q000453:epidemiology / Q000628:therapy; D016896:Treatment Outcome; D014946:Wound Infection / Q000517:prevention & control*
D000900:Anti-Bacterial Agents; D000997:Antivenins