From the Guidelines
The recommended treatment for bug bites typically involves cleaning the affected area with soap and water, then applying an over-the-counter hydrocortisone cream (0.5-1%) up to four times daily for 1-3 days to reduce inflammation and itching. Oral antihistamines like diphenhydramine (Benadryl) 25-50mg every 4-6 hours or non-sedating options like cetirizine (Zyrtec) 10mg daily can also help control itching, as suggested by the practice parameter update 2011 1. Cold compresses applied for 15-20 minutes several times a day can reduce swelling and numb the area. For pain relief, acetaminophen (Tylenol) 325-650mg every 4-6 hours or ibuprofen (Advil) 200-400mg every 6-8 hours can be effective. These treatments work by reducing the body's inflammatory response to insect saliva or venom injected during the bite. It's essential to avoid scratching to prevent secondary infection. If signs of infection develop (increasing redness, warmth, swelling, or pus), or if you experience severe allergic reactions like difficulty breathing or widespread hives, seek immediate medical attention as these may require prescription antibiotics or emergency treatment, as highlighted in the management of acute reactions to stings 1. In cases of large local reactions, treatment can include antihistamines, cold compresses, and in severe cases, a short course of oral corticosteroids, with antibiotics usually not necessary 1. For patients with a history of systemic reactions, referral to an allergist-immunologist for skin testing or in vitro testing for specific IgE antibodies to insects is recommended, with consideration for immunotherapy if test results are positive 1. The optimal duration of immunotherapy is typically at least 3 to 5 years, with the decision to stop based on individual patient factors and the risk of relapse 1.
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 recommended treatment for bug bites is to apply hydrocortisone to the affected area not more than 3 to 4 times daily for adults and children 2 years of age and older, to temporarily relieve itching associated with minor skin irritations and inflammation 2 2.
- For children under 2 years of age, ask a doctor.
- For children under 12 years of age with external anal and genital itching, ask a doctor 2.
From the Research
Bug Bite Treatment
The recommended treatment for bug bites varies depending on the severity of the reaction.
- For simple insect bites, treatment is often based on expert opinion and clinical experience, as there is a lack of evidence for the efficacy of available treatments 3.
- Antihistamines and topical corticosteroids are commonly used to treat insect bites, but their effectiveness is not well supported by evidence 3.
- In cases of allergic reactions to insect stings, treatment may include adrenaline, antihistamines, and corticosteroids 4.
- For massive local reactions and urticaria, antihistamines are often sufficient 4.
- Hyposensitization with insect venom preparations can eliminate the risk of systemic insect sting reactions in patients with demonstrated IgE-sensitization and generalized reactions 4.
Prevention and Management
- Prevention of mosquito bites is key, using physical barriers or chemical repellents 5.
- Treatment of mosquito bites consists of second-generation antihistamines and topical corticosteroids 5.
- Further research is needed on topical treatments that target neural-mediated itch 5.
- In general practice, insect bite consultations often result in antibiotic prescriptions, but this may be an overuse of antibiotics, and patients could make more use of antihistamines for itch before consulting 6.