From the Guidelines
To treat bed bug bites, washing the affected area with soap and water, applying an over-the-counter corticosteroid cream, and taking an oral antihistamine are recommended. The treatment of bed bug bites prioritizes reducing inflammation, itching, and the risk of infection. According to the most recent guidelines, such as those from the 2024 American Heart Association and American Red Cross guidelines for first aid 1, over-the-counter oral antihistamines and topical corticosteroids can be used to alleviate local itching.
Treatment Approach
- Wash the affected area with soap and water to reduce the risk of infection, as suggested by the guidelines 1.
- Apply an over-the-counter corticosteroid cream like 1% hydrocortisone to reduce inflammation and itching.
- Take an oral antihistamine such as diphenhydramine (Benadryl) 25-50mg every 4-6 hours or cetirizine (Zyrtec) 10mg once daily to help control itching.
- For pain relief, consider acetaminophen (Tylenol) 500-1000mg every 6 hours or ibuprofen (Advil) 200-400mg every 4-6 hours as needed, based on the recommendation for alleviating local pain 1.
- Avoid scratching the bites to prevent secondary infection.
Addressing the Infestation
It's also crucial to address the bed bug infestation in the home through thorough cleaning, washing bedding in hot water, and possibly using professional pest control services to prevent further bites. This comprehensive approach ensures that the treatment not only focuses on the symptoms but also on eliminating the cause of the bites.
Severe Reactions
If severe allergic reactions occur, such as difficulty breathing, facial swelling, or hives spreading beyond the bite area, immediate medical attention is necessary. The guidelines emphasize the importance of activating the emergency response system in cases of anaphylaxis due to insect stings 1, which can be applicable to severe reactions from bed bug bites as well.
From the FDA Drug Label
Uses temporarily relieves itching associated with minor skin irritations, inflammation, and rashes due to: ... insect bites Directions for itching of skin irritation, inflammation, and rashes: adults and children 2 years of age and older: apply to affected area not more than 3 to 4 times daily The treatment for bed bug bites is applying hydrocortisone (TOP) to the affected area, not more than 3 to 4 times daily for adults and children 2 years of age and older, to relieve itching associated with minor skin irritations and inflammation. For children under 2 years of age, a doctor should be consulted 2 2.
From the Research
Treatment for Bed Bug Bites
- The treatment for bed bug bites is mainly symptomatic, as reactions to bed bug bites are self-limited 3.
- Topical pramoxine and oral antihistamines can be used to alleviate pruritus 3.
- Topical corticosteroids can be used for significant eruptions to control inflammation and pruritus, and to hasten resolution of the lesions 3.
- A variety of empirical treatments, including antibiotics, antihistamines, topical and oral corticosteroids, and epinephrine, have been used for bite reactions with varying results 4.
- There is no evidence that outcomes differ significantly from those receiving no treatment for cutaneous and systemic reactions from bed bug bites 4.
Management of Bed Bug Infestations
- Integrated pest management programs involving housing managers, residents, and professional pest exterminators provide both chemical and nonchemical solutions for eradication of bed bug infestations 3, 5.
- Nonchemical interventions include keeping affected areas clean and free of clutter, vacuuming, washing linens with hot water, caulking wall holes and cracks where bugs can hide, proper disposal of highly infested items, and placement of bed bug traps/interceptors at the base of beds and furniture 3.
- Chemical interventions involve the use of insecticides such as synthetic pyrethroids, silicates, insect growth disruptors, carbamates, organophosphates, neonicotinoids, diethyl-meta-toluamide, chlorfenapyr, fipronil and plant essential oils, but should be used with caution to prevent over-exposure and toxicity 3.