Insect Stings, Scorpion Stings and Spider Bites
Description Medicine Treatment Referral ICD-10 code: T63.2-4 + External Cause Code (V, W, X, Y) Poisons Information Helpline: 0861555777 See: Exposure to poisonous substances . DESCRIPTION Spider bites and stings by bees, wasps, scorpions and other insects. Symptoms are usually localised such as pain, redness, swelling and itching. Bees and wasps Venom is usually mild but may provoke severe
ICD-10 code: T63.2-4 + External Cause Code (V, W, X, Y)
Poisons Information Helpline: 0861555777
See: Exposure to poisonous substances.
DESCRIPTION
Spider bites and stings by bees, wasps, scorpions and other insects. Symptoms are usually localised such as pain, redness, swelling and itching.
Bees and wasps
- Venom is usually mild but may provoke severe allergic reactions (see: Anaphylaxis).
Spiders and scorpions
- Most are non-venomous or mildly venomous, but some may be extremely venomous resulting in neurotoxicity and constitute a medical emergency.
MEDICINE TREATMENT
Emergency treatment:
Treat anaphylaxis (bee/wasp stings). See: Anaphylaxis.
Local symptoms:
- Calamine lotion, apply when needed.
If severe itch:
Children
- Chlorphenamine, oral, 0.1 mg/kg/dose 6–8 hourly. See: Dosing table.
Adults
- Chlorphenamine, oral, 4 mg, 6–8 hourly.
AND
If there is a wide local response to insect bite with inflamed lesion, see: Papular urticaria.
Pain:
Children
- Paracetamol, oral, 10–15 mg/kg/dose 6 hourly when required. See: Dosing table.
Adults
- Paracetamol, oral, 500mg -1 g 4–6 hourly when required (to a maximum of 4 g in 24 hours).
- Maximum dose: 15 mg/kg/dose.
Very painful scorpion stings:
- Lidocaine 2%, 2 mL injected around the bite as a local anaesthetic.
Local application of ice, if tolerated.
Cytotoxic lesions:
Avoid giving prophylactic antibiotics for bites and stings.
If secondary skin infection (site red, swollen, hot, tender, pus may be present), manage as cellulitis. See: Cellulitis.
Spider bites and scorpion stings:
Tetanus prophylaxis:
ICD-10 code: Z23.5
If not immunised within the last 5 years:
- Tetanus toxoid vaccine (TT), IM, 0.5 mL.
REFERRAL
- For possible antivenom (neurotoxic spider bites or scorpion stings), if applicable, and intensive care, if necessary.
- Presence of systemic manifestations:
- weakness
- double vision
- drooping eyelids
- muscle cramps
- hypersalivation
- paraesthesia
- sweating
- difficulty in breathing
- difficulty in swallowing and speaking
- agitation/restlessness in children
Note:
Send the spider or scorpion with the patient, if available.
- Secondary infection of bite/sting that is not responding to 1st line antibiotics.
For guidance on the identification and clinical management of snake/spider/scorpion bites, contact:
Poisons Information Helpline: 0861555777
For procurement of snake/spider/scorpion antivenom, contact:
South African Vaccine Producers (SAVP): Telephone (011) 386 6062/6063/6078 (0ffice hours only) or
Email: Benita.mouton@nhls.ac.za
In the rare event that antivenom needs to be released/procured afterhours:
Tel 071 680 9897
Click here for the NEMLC Recommendations for medicine amendments (2020-4 review cycle).
Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-4_Version 1.1_October 2024
Chapter 21: Emergencies and Injuries