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Treatments for Latrodectism—A Systematic Review on Their Clinical Effectiveness

Clinical Toxicology Research Group, School of Medicine and Public Health, The University of Newcastle, Newcastle 2298, Australia
Sydney Medical School, University of Sydney, Sydney 2006, Australia
Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne 3800, Australia
Author to whom correspondence should be addressed.
Academic Editor: Wayne Hodgson
Toxins 2017, 9(4), 148;
Received: 21 February 2017 / Revised: 31 March 2017 / Accepted: 10 April 2017 / Published: 21 April 2017
(This article belongs to the Special Issue Use of Antibodies/Antivenom Against Envenoming)
PDF [762 KB, uploaded 21 April 2017]


Latrodectism or envenomation by widow-spiders is common and clinically significant worldwide. Alpha-latrotoxin is the mammalian-specific toxin in the venom that results in toxic effects observed in humans. Symptoms may be incapacitating and include severe pain that can persist for days. The management of mild to moderate latrodectism is primarily supportive while severe cases have variously been treated with intravenous calcium, muscle relaxants, widow-spider antivenom and analgesic opioids. The object of this systematic review is to examine the literature on the clinical effectiveness of past and current treatments for latrodectism. MEDLINE, EMBASE and Google Scholar were searched from 1946 to December 2016 to identify clinical studies on the treatment of latrodectism. Studies older than 40 years and not in English were not reviewed. There were only two full-publications and one abstract of placebo-controlled randomised trials on antivenom use for latrodectism. Another two randomised comparative trials compared the route of administration of antivenom for latrodectism. There were fourteen case series (including two abstracts), fourteen case reports and one letter investigating drug treatments for latrodectism with the majority of these also including antivenom for severe latrodectism. Antivenom with opioid analgesia is often the major treatment reported for latrodectism however; recent high quality evidence has cast doubt on the clinical effectiveness of this combination and suggests that other treatments need to be investigated. View Full-Text
Keywords: red-back spider; widow spider; envenomation; antivenom; treatment red-back spider; widow spider; envenomation; antivenom; treatment

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Ryan, N.M.; Buckley, N.A.; Graudins, A. Treatments for Latrodectism—A Systematic Review on Their Clinical Effectiveness. Toxins 2017, 9, 148.

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