Treatment for Spider Bites
The treatment for spider bites should include thorough wound irrigation with copious amounts of clean water, application of ice for pain relief (with a barrier between ice and skin), and over-the-counter pain medications, while avoiding suction or tourniquets. 1, 2
Initial Assessment and First Aid
- Thoroughly irrigate the bite wound with copious amounts of clean water to reduce venom load and prevent infection 1, 2
- Remove rings and other constricting objects from the bitten extremity as swelling may occur 2
- Apply ice to the bite site for pain relief, but place a thin barrier between the ice and skin to prevent tissue damage 1, 2
- Do not apply suction to the bite site as this is ineffective and potentially harmful 1, 2
- Do not apply tourniquets or pressure immobilization bandages as these may worsen tissue injury 2
Medical Management Based on Spider Type
Brown Recluse Spider Bites
- For brown recluse spider bites, which can cause dermonecrosis within 72-96 hours, treatment should include rest, ice compresses, and antibiotics 3
- Dapsone may be beneficial for controlling brown recluse necrotic lesions 3, 4
- Delay surgical intervention for several weeks to allow demarcation of necrotic tissue 3
- Systemic corticosteroids may be helpful in treating rare systemic loxoscelism, which presents with minimal skin changes but massive hemolysis 3
Black Widow Spider Bites
- Black widow bites primarily produce muscle cramping, pain, and neuromuscular symptoms rather than marked skin changes 3
- Treatment includes pain control, muscle relaxants, and calcium gluconate 3, 5, 4
- Specific black widow antivenin is available but should be reserved for severe reactions 5, 4
- Intravenous fluids may be sufficient for mild to moderate cases 6
When to Seek Medical Attention
- Seek immediate medical attention if systemic symptoms develop, including difficulty breathing, muscle rigidity, dizziness, or confusion 7, 2
- 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 an open wound develops 7
- Hospitalization may be necessary if lesions enlarge rapidly or there are signs of systemic poisoning 5
Pain Management
- Over-the-counter acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are recommended for pain relief 7, 2
- For more severe pain, prescription analgesics may be necessary 5
- Topical lidocaine (5%) can be applied if the skin is intact to provide significant pain reduction 7
Common Pitfalls to Avoid
- Do not assume antibiotics are needed for swelling around the bite site, as swelling is typically caused by mediator release, not infection 7
- Avoid routine prophylactic antibiotics unless signs of infection are present 7
- Do not attempt to identify the spider yourself - many spider bites are misdiagnosed because the spider is not seen at the time of the bite 8
- Do not delay seeking medical attention if symptoms worsen or systemic effects develop 7, 2