Treatment of Centipede Bite
For a patient presenting with a centipede bite, provide immediate symptomatic treatment with cold compresses, oral analgesics, and oral antihistamines for pain and local swelling, while monitoring closely for signs of secondary bacterial infection or necrosis that would require antibiotics and possible surgical debridement. 1, 2
Initial Assessment and Wound Care
Examine the bite site for characteristic double puncture marks from the centipede's fangs to confirm the diagnosis. 2 The bite typically presents with:
- Intense local pain (present in virtually all cases) 1
- Erythema and edema at the bite site 3, 4
- Swelling that may extend beyond the immediate wound area 4
Irrigate the wound copiously with warm or room temperature potable water, similar to management principles for other arthropod bites. 5, 6 After thorough cleaning, cover with antibiotic ointment or cream and a clean occlusive dressing. 5, 6
Symptomatic Treatment
Apply cold compresses to reduce local pain and swelling, limiting each application to 10-20 minutes to prevent cold injury. 5
Administer oral analgesics for pain control, as pain is the predominant symptom and can be severe. 1, 4
Prescribe oral antihistamines to reduce itching and local inflammatory response. 5, 1
Antibiotic Considerations
Do not routinely prescribe antibiotics unless there is clear evidence of secondary bacterial infection. 5 However, be aware that:
- Bacterial superinfection with Gram-positive cocci can occur, potentially leading to cellulitis or even necrotizing fasciitis 2
- The majority of patients in clinical series were empirically treated with antibiotics 1
- If signs of infection develop (increasing erythema, warmth, purulent drainage, systemic symptoms), initiate antibiotic therapy immediately 2
Monitoring and Follow-up
Warn patients about potential delayed complications:
- Skin necrosis can develop in rare cases 1, 3
- Delayed hypersensitivity reactions with pruritus and recurrent swelling may occur days after the initial bite 1
- Approximately 11% of patients may re-attend for these delayed symptoms 1
Instruct patients to return immediately if:
- Pain becomes severe and uncontrolled
- Swelling progresses rapidly
- Signs of infection develop
- Blistering or skin discoloration appears
Special Considerations
Verify tetanus immunization status and update if needed, as with any penetrating wound. 2
If necrosis or necrotizing fasciitis develops, urgent surgical debridement is required along with parenteral antibiotics. 2
Hospital admission may be necessary for severe cases with extensive swelling, severe pain requiring parenteral analgesia, or signs of deep tissue infection. 4