Effectiveness of antibiotic prophylaxis in patients with centipede stings: a randomized controlled trial

OBJECTIVE: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.