What is the treatment for a bee sting?

Treatment of Bee Stings

For bee stings, immediately remove the stinger within 10-20 seconds by flicking or scraping it away with a fingernail to prevent additional venom injection, then clean the area with soap and water and apply ice or cold compresses for 10-15 minutes several times daily to reduce pain and swelling. 1

Immediate Management of Bee Stings

1. Stinger Removal

   • Remove the stinger as quickly as possible (within 10-20 seconds) to prevent additional venom injection
   • Method of removal (scraping or pinching) is less important than speed of removal 1, 2
   • Avoid grasping the venom sac if possible 1

2. Local Wound Care

   • Clean the area by washing with soap and water to prevent secondary infection 1
   • Apply ice or cold compresses for 10-15 minutes several times daily to reduce pain and swelling 1

3. Symptom Management for Local Reactions

   • For pain and itching: Apply topical corticosteroids and oral antihistamines 1
   • For localized swelling: Continue ice application and consider elevation if possible 1

Management Based on Reaction Severity

For Local Reactions (Most Common)

• Localized pain, redness, and swelling at sting site
• Treatment:
  • Follow immediate management steps above
  • Monitor for 1-2 hours to ensure reaction remains localized
  • Most local reactions resolve within a few hours without treatment 3

For Regional Reactions

• Swelling extending beyond the sting site
• Treatment:
  • Oral antihistamines (H1 antagonists)
  • Oral or topical corticosteroids 1
  • Continue monitoring for progression to systemic symptoms

For Systemic/Anaphylactic Reactions (Emergency)

• Signs: Difficulty breathing, tongue/throat swelling, lightheadedness, vomiting, disseminated hives 1
• Treatment:
  • Administer immediate intramuscular epinephrine as first-line treatment
    • Adults: 0.3-0.5 mg
    • Children: 0.01 mg/kg (up to 0.3 mg) 1, 4
  • Repeat epinephrine dosing may be required for persistent symptoms 1
  • Provide supportive care: position appropriately, establish IV access, administer oxygen if needed 1
  • Seek emergency medical attention immediately

Prevention of Complications

1. Infection Prevention

   • Monitor for signs of infection (increasing redness, warmth, swelling, or tenderness) 4
   • Consider antibiotics for signs of secondary infection:
     • Cephalexin 250 mg four times daily
     • Clindamycin 300-400 mg three times daily (for penicillin-allergic patients)
     • Amoxicillin-clavulanate 875/125 mg twice daily 1

2. Follow-up Care

   • Reevaluate in 48-72 hours if there is no improvement 1
   • Refer patients who have experienced systemic reactions to an allergist-immunologist 1
   • Consider prescribing EpiPens for patients with previous systemic reactions 1

Special Considerations

• Rare Complications: Tissue necrosis can occur if severe local reactions are left untreated 5
• Multiple Stings: Unlike allergic reactions, toxic reactions can occur with multiple stings (estimated lethal dose: 20 stings/kg) 3
• Unusual Sting Locations: Stings to sensitive areas like eyes require specialized care and may need surgical intervention 6, 7

Patient Education

• Educate on insect avoidance strategies:
  • Remove known nests near home
  • Avoid bright clothing and strong scents
  • Wear protective clothing when outdoors 1
• For patients with known allergies, consider venom immunotherapy (VIT) to reduce risk of future systemic reactions 1
• Warn patients with good initial response about possibility of symptom recurrence 4