What topical ointments are recommended for managing centipede bites?

Centipede Bite Management: Topical Treatment Recommendations

For centipede bites, apply topical antibiotic ointment (such as bacitracin or triple antibiotic) after thorough wound cleaning to prevent secondary bacterial infection, though antibiotic prophylaxis is not routinely necessary for uncomplicated bites. 1, 2

Initial Wound Care

The foundation of centipede bite management is proper wound cleaning and local care:

• Irrigate the wound thoroughly with large volumes of warm or room temperature potable water or sterile saline solution to remove contaminants and venom residue 1
• Clean the bite site with soap and water, avoiding harsh antiseptics during initial irrigation 1
• After cleaning, apply antibiotic ointment or cream (such as bacitracin, neomycin, or triple antibiotic formulation) to the wound 1, 2
• Cover with a clean occlusive dressing to maintain a moist wound environment and prevent contamination 1

Topical Ointment Selection

Based on FDA-approved formulations and wound care guidelines:

• Triple antibiotic ointment (bacitracin zinc, neomycin sulfate, polymyxin B sulfate) is appropriate for centipede bite wounds 2
• These ointments are for external use only and should not be applied to deep puncture wounds, over large body areas, or if allergic to ingredients 2
• Petroleum-based ointments can be safely applied to moist wounds and help maintain optimal healing conditions 1

Pain Management

Centipede bites characteristically cause severe local pain requiring multimodal analgesia:

• Administer oral paracetamol (acetaminophen) or NSAIDs for pain control 3, 4
• Topical lidocaine cream or gel (4-5% formulation) may provide additional local pain relief, similar to its use in other envenomations 5
• Local anesthesia may be needed for severe cases 4
• Systemic corticosteroids (oral prednisone or parenteral hydrocortisone 500mg) are effective for severe local reactions with marked erythema and edema 6, 3, 4

Antibiotic Prophylaxis: Key Evidence

A critical 2021 randomized controlled trial fundamentally changed the approach to centipede bites:

• Prophylactic oral antibiotics (dicloxacillin) showed no benefit over placebo in preventing wound infections (5% vs 0%, P=0.496) 7
• Proper wound care alone is adequate treatment for uncomplicated centipede stings 7
• However, topical antibiotic ointment application remains reasonable as part of standard wound care protocol 1, 2

When Systemic Antibiotics ARE Indicated

Despite prophylaxis being unnecessary, watch for these complications requiring treatment:

• Signs of secondary bacterial infection: progressive erythema, increasing pain, purulent discharge, fever, or lymphangitis 1, 8
• Cellulitis or abscess formation: requires systemic antibiotics (typically anti-staphylococcal coverage) for 7-10 days 6, 8
• Necrotizing fasciitis: rare but reported complication requiring urgent surgical debridement and IV antibiotics 8
• The double fang marks characteristic of centipede bites can help confirm the diagnosis 8

Tetanus Prophylaxis

• Verify tetanus immunization status and administer tetanus toxoid (0.5 mL IM) if outdated or unknown 5, 1
• This is standard care for all contaminated or penetrating wounds 5, 1

Expected Clinical Course

Understanding the typical timeline helps guide follow-up:

• Most symptoms resolve within 2-24 hours after symptomatic treatment (analgesics + corticosteroids if needed) 6
• Local reactions include hyperthermia (100%), pain (64.7%), and paresthesias (52.9%) 6
• Complete remission typically occurs within two weeks with appropriate treatment 3
• Re-evaluate patients at 3-5 days to detect any secondary bacterial infection 7

Critical Pitfalls to Avoid

• Do not use topical antibiotic ointment in eyes, over large body areas, or for deep puncture wounds 2
• Do not continue ointment use beyond 1 week without medical evaluation 2
• Stop use immediately if rash or allergic reaction develops 2
• Do not dismiss severe local reactions—leukocytosis and elevated ESR may occur and warrant systemic corticosteroids 3
• Centipedes have synanthropic habits (living near humans), making bites more common in endemic areas, particularly during dry seasons and at night inside homes 6