What is the treatment for a spider bite?

Treatment for Spider Bites

For spider bites, first aid treatment should include wound care, over-the-counter pain medications, and monitoring for systemic symptoms that require emergency medical attention. 1

Initial Assessment and Triage

• Identify the type of spider if possible (especially black widow or brown recluse in the US)
• Assess for severity of symptoms:
  • Local symptoms: pain, redness, swelling at bite site
  • Systemic symptoms: difficulty breathing, muscle rigidity, dizziness, confusion

When to Seek Emergency Care

Call emergency services immediately if the person develops 1:

• Difficulty breathing
• Muscle rigidity
• Dizziness or confusion
• Pain extending beyond the bite site
• Severe pain not controlled by over-the-counter medications
• Development of an open wound
• Any systemic symptoms

Treatment by Spider Type

General Spider Bites (Non-venomous or Unknown)

1. Clean the wound

   • Thoroughly irrigate with warm or room temperature potable water 1
   • Soap may be used

2. Pain management

   • Apply ice for local pain relief 1
   • Use over-the-counter acetaminophen or NSAIDs 1

3. Wound care

   • Cover with a clean, sterile dressing
   • Monitor for signs of infection

Black Widow Spider Bites

Black widow bites cause severe crampy pain, muscle rigidity, diaphoresis, and hypertension, with minimal local tissue injury 1, 2.

1. First aid measures:

   • Clean the wound with soap and water
   • Apply ice to reduce pain 1
   • Use over-the-counter pain medications (may be insufficient for moderate to severe cases) 2

2. Hospital treatment (for moderate to severe symptoms):

   • Black widow spider antivenom for severe symptoms 2
   • Alternative treatments include IV opioid analgesics with benzodiazepines for muscle relaxation 2
   • Calcium gluconate may be helpful 3

Brown Recluse Spider Bites

Brown recluse bites can cause painful ulcerated wounds that progress over days to weeks, sometimes with hemolysis and rhabdomyolysis 1.

1. First aid measures:

   • Rest and ice compresses 3
   • Clean the wound
   • Over-the-counter pain medications

2. Medical treatment:

   • Antibiotics to prevent secondary infection 3
   • Wound care with appropriate dressings
   • For established necrotic wounds, surgical debridement may be needed, but is typically delayed for several weeks 3
   • Dapsone may be prescribed by a physician 3

Special Considerations

Infection Risk

• Monitor for signs of infection (increasing redness, warmth, swelling, pus)
• Be aware that spider bite wounds can become infected with resistant bacteria
• Recent research shows spider bite wounds may become infected with MRSA, requiring aggressive treatment with appropriate antibiotics and possibly surgical debridement 4

Hyperbaric Oxygen Therapy

• For non-healing wounds from brown spider bites, hyperbaric oxygen therapy may be beneficial even months after the bite 5

Common Pitfalls to Avoid

1. Misdiagnosing infected wounds as spider bites

   • Many "spider bites" are actually other conditions like MRSA infections

2. Delaying medical care for systemic symptoms

   • Black widow venom can cause serious systemic effects requiring prompt medical attention

3. Inappropriate use of antibiotics

   • Antibiotics are only indicated if there is evidence of secondary infection 1

4. Premature surgical intervention

   • For brown recluse bites, surgery is typically delayed for several weeks 3

5. Failure to update tetanus immunization

   • Ensure tetanus immunization is current 2

By following these guidelines, most spider bites can be managed effectively with minimal complications.