Health & Safety in Mexico
By Robert H. Page, MD and Curtis P. Page, MD
October 24, 2008 San Miguel de Allende

Stings, bites and scratches from animals and insects

Visitors to Mexico should be aware that problems may arise when bites, stings or scratches occur. We have reviewed the main causes below, along with suggestions for how to treat them. As always, when possible consult with a physician if first aid is not enough. 

Human and animal bites

Unlike other cuts or wounds, a human or animal bite that breaks the skin may transfer large quantities of bacteria that can cause a spreading infection of the skin called “cellulitis.” Teeth can also puncture deep into the skin, depositing bacteria that cannot drain to the surface or be reached with topical remedies. These bacteria may be so aggressive and hard to reach that oral antibiotics are necessary to prevent more serious infection. 

We treat these wounds with ampicillin/sulbactam (Augmentin, 875 mg/125 mg). If you are allergic to penicillin, use cefuroxime (Ceftin) or cefprozil (Cefzil). (See www.medtogo.com for medication guidelines.) If you have not received a tetanus shot in the previous five years, ask a local doctor for a tetanus booster. 

Keep the wound clean and dry. If the bite is on an arm or leg, elevate the limb above the level of the heart. Use light, sterile bandages rather than constricting wraps. Most bites are on a limb; soak the affected area in warm, soapy water two or three times a day to assist in recovery. If superficial or deep tissue infection develops despite oral antibiotic therapy, consult a local physician immediately. Deep puncture wounds are more susceptible to aggressive, spreading infection that may require intravenous antibiotics or surgery.

If your immune system is weakened, or if you have chronic medical problems such as diabetes, poor circulation or severe heart disease, always consult with a physician about skin infections because they can develop into more serious problems. 

Animal control and rabies vaccinations are less rigorously enforced in Mexico than in the US. Therefore, always assume a risk of rabies in an undomesticated, stray or unhealthy animal, as well as in bat, raccoon, fox or skunk bites. Consult with a physician to receive the appropriate rabies treatment. 


Spider bites

Most spider bites, although painful, are harmless. Brown recluse, black widow and some rare species may, however, cause skin damage from venom and are therefore worth mentioning. 

The brown recluse spider injects venom that can cause local skin and tissue death. Symptoms start about three to four hours after the bite with exaggerated pain, itching, swelling and redness. If left untreated, the process may stop there on its own or, in more severe cases, may result in extended tissue and nerve damage. If you suspect you have been bitten by a brown recluse spider, consult with a physician. Early treatment with Dapsone may halt the process. Cold compresses, wound cleansing, antihistamines (for itching), anti-inflammatory medications (e.g. Ibuprofen, Naproxen) and limb elevation are components of basic treatment. Always attempt to capture the spider for identification.

Black widow spider bites are identified as side-by-side pinpricks surrounded by small areas of redness and swelling. Many bites do not cause problems, but the ones that do start with painful muscle cramping of the affected limb within one hour of the bite. It is rare for severe problems to follow. If you suspect a black widow spider from the classic bite pattern and painful muscle cramping, seek medical attention. Antivenom is available in the US but we have not documented availability at specific hospitals in Mexico. Again, always attempt to capture the spider for identification. 


Bee, wasp, hornet and fire ant stings

Stings from these insects are typically limited to annoying pain, itching and redness. Applying ice and taking acetaminophen (Tylenol) may relieve pain and discomfort, and over-the-counter antihistamines such as diphenhydramine (Benadryl) or clemastine (Tavist) can help reduce itching. If local yet mild symptoms persist, you may apply 1% hydrocortisone cream or make a paste of baking soda and water and apply it to the skin. Do this at least twice daily to relieve your symptoms, which should ease after two days. If the redness spreads to more than two inches from the site of the bite, seek medical attention. 

Rarely, individuals may develop potentially life-threatening allergic reactions to stings. If you develop difficulty breathing, a rapid heart rate, swelling about the face or mouth, nausea and/or vomiting, hives, dizziness or mental confusion after an insect bite, seek medical attention immediately. 


Anyone with a history of such reactions should always carry epinephrine for injection. If you do not start treatment shortly after the sting, you may experience severe breathing difficulties, blood pressure collapse and, in some cases, death. Most epinephrine kits contain injection instructions (see www.medtogo.com for epinephrine/epipen guidelines).

Robert H. Page, MD and Curtis P. Page, MD are authors of the MEXICO: Health and Safety Travel Guide and the Healthy Traveler Regional Series. For more information visit medtogo.com. Copyright 2008 MedToGo, LLC. Reproduced with permission.

Hospice and pain control
By Hospice staff

Some kinds of cancer are more painful than others. There has been much research in the science of pain control in the terminal patient and, except in very rare cases, there is no reason why a cancer patient has to die with pain. There are several basic principles of pain management taught by hospices to all caregivers to keep the patient’s pain controlled.

Pain is what a patient says it is. No one can judge another’s level of pain. Some people have a high pain tolerance, while others have difficulty tolerating even a slight amount of pain. Hospice uses a variety of methods to determine the patient’s perception of his or her own pain. Under a physician’s supervision, these methods and scales help in adjusting pain medication so that pain is controlled to a level the patient considers adequate.

Chronic cancer pain is different from acute pain (as in surgery). Controlling chronic pain requires special attention from the hospice team. Team members address pain issues on every visit made to the patient.

There is no such thing as “too much medication” when it comes to pain control, as long as the patient is experiencing relief with minimal side effects. It is important for patients to know that as long as the pain continues to increase, the medication dosage can increase as well in order to maintain control.

Addiction is not an issue with cancer pain control. Pain “burns up” a certain amount of medication. If the amount of medication matches up to the amount burned up, a balance is achieved and the pain is brought under control. Hospice nurses observe patients carefully for signs that an increase in pain medication may be needed.

Pain is a major robber of quality of life. It distracts and drains energy. There is no logical reason to leave a cancer patient in pain.