What is the recommended treatment for a black widow bite?

Treatment of Black Widow Spider Bites

For black widow spider bites, the recommended treatment includes emergency medical care for severe symptoms, pain management with analgesics and muscle relaxants, and in severe cases, administration of specific antivenom. 1, 2

Initial Assessment and Emergency Care

• Emergency services should be called immediately if the person develops systemic symptoms such as difficulty breathing, muscle rigidity, dizziness, or confusion 1
• Medical care should be sought if pain extends beyond the bite site, becomes severe, is not controlled by over-the-counter pain medications, or if the person experiences systemic symptoms 1
• Observation for at least 8 hours post-envenomation is recommended as most severe reactions occur soon after the bite 2

First Aid and Supportive Care

• Clean the wound with sterile normal saline to remove superficial debris 1
• Ice can be useful for local pain relief, but avoid direct application to the skin (place a thin barrier between ice and skin) 1
• Elevate the affected body part, especially if swollen, to accelerate healing 1
• Ensure tetanus prophylaxis status is current; if outdated or unknown, administer tetanus toxoid (0.5 mL intramuscularly) 1

Pain Management

• Over-the-counter acetaminophen and nonsteroidal anti-inflammatory drugs can be used to alleviate local pain 1
• For moderate to severe pain, prescription opioid analgesics combined with muscle relaxants may be necessary 3
• If the skin is intact, topical lidocaine can be useful to relieve local pain 1

Antivenom Therapy

• The primary and most effective treatment for severe black widow spider envenomation is the administration of specific antivenom (Antivenin Latrodectus mactans) 2, 4
• Antivenom provides the most rapid and complete relief of envenomation syndrome, usually within 30 minutes of infusion 2
• Antivenom is indicated in cases of severe envenomation not responsive to standard therapy, particularly when symptoms include severe pain, muscle cramping, abdominal rigidity, and hypertension 4

Special Considerations

• Abdominal rigidity without tenderness is a hallmark sign of Latrodectus envenomation and may warrant more aggressive treatment 2
• Cats and small animals are particularly sensitive to black widow venom; deaths are common in cats while dogs show severe clinical signs but are considered more resistant 2
• Be aware of the potential for anaphylaxis with antivenom administration, as it is an equine-derived product 5
• Complete recovery from black widow envenomation may take several days to weeks even with appropriate treatment 2

Common Pitfalls to Avoid

• Do not delay seeking medical attention for severe symptoms, as black widow venom contains potent neurotoxins that can cause significant morbidity 3
• Do not underestimate the severity of black widow bites; they can cause significant pain, impairment, and rarely death if untreated 3
• Avoid using ineffective traditional remedies that may delay proper medical care 6
• Be cautious with antivenom administration due to the risk of hypersensitivity reactions, but don't withhold it when clearly indicated for severe symptoms 4