Additional pain management interventions include analgesic pain medicine, infiltration of the area with lidocaine, or regional blocks.

Other local wound care includes irrigation, debridement of necrotic tissue, X-ray if there is suspected retained foreign body, and tetanus immunization if needed.

Antibiotics are broadly recommended for wounds that appear infected; prophylactic antibiotic administration is contested except with deep punctures, wounds contaminated with material, or those with significant tissue insult.

Antibiotic selection must cover a multitude of saltwater bacteria, including Vibrio. If chosen, prophylactic antibiotics would be ciprofloxacin or trimethoprim-sulfamethoxazole.

Parenteral antibiotics include cefotaxime, ceftazidime, chloramphenicol, gentamicin, or tobramycin.

Fulminant infections should be treated with imipenem/cilastatin until cultures return.¹⁴

No antivenom is currently available for lionfish venom.

Soft tissue wounds left by lionfish may take weeks or longer to heal.

Other Uses

Once the venomous spines are carefully removed, these fish are reportedly delicious. I saw a cookbook for lionfish that includes lionfish eggs Benedict and lionfish croquettes.

Dr. Hack is chief of the division of medical toxicology and vice chair for research at East Carolina University in Greenville, N.C.

References

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4. Savva I, Chartosia N, Antoniou C, et al. They are here to stay: the biology and ecology of lionfish (Pterois miles) in the Mediterranean Sea. J Fish Biol. 2020;97:148-162.
5. Galloway KA, Porter ME. Predator–prey interactions examined using lionfish spine puncture performance. Integr Org Biol. 2021;3(1):obaa049.
6. Galloway KA, Porter ME. Mechanical properties of the venomous spines of Pterois volitans and morphology among lionfish species. J Exp Biol. 2019;222(6):jeb197905.
7. Resiere D, Cerland L, De Haro L, et al. Envenomation by the invasive Pterois volitans species (lionfish) in the French West Indies—a two-year prospective study in Martinique. Clin Toxicol (Phila). 2016;54:313-318.
8. Vetrano SJ, Lebowitz JB, Marcus S. Lionfish envenomation. J Emerg Med. 2002;23(4):379-382.
9. Kizer KW, McKinney HE, Auerbach PS. Scorpaenidae envenomation. A five-year poison center experience. JAMA. 1985;253(6):807-810.
10. Mouchbahani-Constance S, Lesperance LS, Petitjean H, et al. Lionfish venom elicits pain predominantly through the activation of nonpeptidergic nociceptors. Pain. 2018;159(11):2255-2266.
11. Chuang PS, Shaio JC. Toxin gene determination and evolution in scorpaenoid fish. Toxicon. 2014;88:21–33.
12. Atkinson PRT, Boyle A, Hartin D, et al. Is hot water immersion an effective treatment for marine envenomation? Emerg Med J. 2006;23(7):503-508.
13. Perkins RA, Morgan SS. Poisoning, envenomation, and trauma from marine creatures. Am Fam Physician. 2004;69(4):885-890.
14. Auerbach PS. Marine envenomations. N Engl J Med. 1991;325(7):486-493.

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