Changratanakorn Chanon, Fasawang Napasawan, Chenthanakit Boriboon, Tansanthong Pakpoom, Mapairoje Chanikarn, Tunud Ratree, Pipopwongpisan Annop, Wittayachamnankul Borwon
Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Department of Emergency Medicine, Wiang Nong Long Hospital, Lamphun, Thailand.
Clin Exp Emerg Med. 2021 Mar;8(1):43-47. doi: 10.15441/ceem.20.110. Epub 2021 Mar 31.
Centipede stings are a common problem in tropical countries. Current treatment guidelines do not include recommendations for antibiotic prophylaxis to prevent the associated bacterial infection since no previous study has assessed the effectiveness of antibiotic treatment in patients bitten by centipedes. Thus, this study aimed to compare the effectiveness of antibiotic prophylaxis over placebo for the skin infections that occur after a centipede sting.
In this randomized, double-blind, multi-center clinical trial conducted in the emergency departments in four hospitals, patients with any history of a centipede sting were prospectively enrolled and divided randomly into two groups. One group received dicloxacillin and the other a placebo. The primary outcome was the incidence of wound infection 3 to 5 days after the centipede sting.
From December 2014 to October 2015, a total of 83 patients were enrolled in the study and were randomized into antibiotic (n=43) and placebo (n=40) groups. Two patients in the antibiotic group developed wound infections, while none showed wound infection in the placebo group (5% vs. 0%). The wound infection rate did not differ significantly between the two groups (P=0.496).
Antibiotic prophylaxis may be unnecessary in cases of centipede stings. Proper wound care is an adequate and appropriate treatment for patients with centipede stings. However, the patient should be re-evaluated for detection of secondary bacterial infection.
蜈蚣蜇伤在热带国家是一个常见问题。目前的治疗指南未包含预防相关细菌感染的抗生素预防性用药建议，因为此前尚无研究评估抗生素治疗蜈蚣咬伤患者的有效性。因此，本研究旨在比较抗生素预防性用药与安慰剂对蜈蚣蜇伤后发生的皮肤感染的有效性。
在四家医院急诊科进行的这项随机、双盲、多中心临床试验中，前瞻性纳入有任何蜈蚣蜇伤史的患者，并随机分为两组。一组接受双氯西林治疗，另一组接受安慰剂治疗。主要结局是蜈蚣蜇伤后3至5天伤口感染的发生率。
2014年12月至2015年10月，共有83例患者纳入研究并随机分为抗生素组（n = 43）和安慰剂组（n = 40）。抗生素组有2例患者发生伤口感染，而安慰剂组无1例出现伤口感染（5% 对0%）。两组间伤口感染率差异无统计学意义（P = 0.496）。
蜈蚣蜇伤病例可能无需进行抗生素预防性用药。对蜈蚣蜇伤患者而言，适当的伤口护理是充分且合适的治疗方法。然而，应对患者进行重新评估以检测是否继发细菌感染。
