Centipede Bite Management
There is no specific antidote for centipede bites; treatment is symptomatic with oral antihistamines for local reactions and intramuscular epinephrine (0.01 mg/kg up to 0.3 mg in children, 0.3-0.5 mg in adults) for systemic anaphylaxis.
Treatment Algorithm
For Local Reactions (Most Common)
- Oral antihistamines at standard dosing to reduce itching and swelling 1, 2
- Cold compresses for pain and swelling reduction
- Analgesics for pain control
- No specific antidote exists for centipede venom
For Systemic Anaphylaxis (Rare but Life-Threatening)
Epinephrine is the drug of choice 3, 4:
- Children: 0.01 mg/kg (maximum 0.3 mg) intramuscularly in anterolateral thigh 5
- Adults: 0.3-0.5 mg intramuscularly in anterolateral thigh, depending on severity 5
- Repeat dosing may be required for persistent symptoms
- Antihistamines and corticosteroids are NOT substitutes for epinephrine 5
Clinical Context
Centipede envenomation typically causes localized pain, erythema, and edema that is self-limited 1, 2. However, centipede venoms contain allergenic proteins capable of triggering systemic anaphylaxis with generalized urticaria, respiratory distress, and cardiovascular compromise 3, 4. One case documented systemic anaphylaxis with abdominal pain requiring adrenaline administration 4, while another pediatric case showed generalized urticaria and facial swelling within 10 minutes of multiple bites 3.
Important Caveats
- No contraindication to epinephrine in anaphylaxis, even in patients with cardiovascular disease or those taking β-blockers 5
- Delayed epinephrine administration is associated with fatal outcomes 5
- Intramuscular injection in the anterolateral thigh achieves more rapid plasma concentrations than subcutaneous or arm injection 5
- Consider prescribing epinephrine auto-injector for patients with prior systemic reactions, as repeat exposure risk exists in endemic areas 3
- Residual symptoms (numbness, swelling, limited range of motion) may persist for months 1
Pitfall to Avoid
Do not rely on antihistamines alone for systemic reactions—they provide symptomatic relief but do not address the life-threatening cardiovascular and respiratory components of anaphylaxis that only epinephrine can reverse 5.