What is the treatment for a pediatric patient with an infected wasp sting?

Treatment of Infected Wasp Stings in Pediatric Patients

For pediatric patients with infected wasp stings, treatment should include thorough wound cleaning, topical antibiotic ointment application, and oral antibiotics such as cephalexin, amoxicillin-clavulanate, or clindamycin for penicillin-allergic patients. 1

Initial Management of Infected Wasp Stings

1. Wound Care:

   • Irrigate the sting site thoroughly with copious amounts of water 1
   • Clean the area with soap and water to prevent further infection 1
   • Apply antibiotic ointment or cream and cover with a clean occlusive dressing 1
   • Leave any blisters intact and cover loosely with a sterile dressing 1

2. Antibiotic Therapy:

   • For infected stings, oral antibiotics are indicated with first-line options including:
     • Cephalexin (weight-appropriate pediatric dosing)
     • Amoxicillin-clavulanate (weight-appropriate pediatric dosing)
     • Clindamycin for penicillin-allergic patients (weight-appropriate pediatric dosing) 1

3. Pain and Swelling Management:

   • Apply cold compresses to reduce swelling and pain (place barrier between cold pack and skin) 1
   • Use age-appropriate acetaminophen or NSAIDs for pain relief 1
   • Elevate the affected area to reduce swelling 1
   • Oral antihistamines may help reduce itching 1

Monitoring and Follow-up

• Monitor the sting site for 48-72 hours for signs of worsening infection 1

• Follow-up within 24 hours either by phone or office visit 1

• Watch for signs of:

  • Increasing erythema, swelling, or pain
  • Purulent drainage
  • Lymphangitis or lymphadenopathy
  • Systemic symptoms (fever, malaise)

• Consider hospitalization if:

  • Infection progresses despite appropriate antimicrobial therapy
  • Signs of systemic toxicity develop 1

Special Considerations

• Allergic Reactions: While treating the infection, remain vigilant for delayed allergic reactions, which may require additional management 2, 1
• Rare Complications: Though uncommon, be aware that severe wasp stings can lead to compartment syndrome, especially if there is significant swelling of the hand or other extremity 3
• Coagulation Issues: In rare cases, wasp stings can cause isolated prolongation of activated partial thromboplastin time (aPTT), which typically resolves spontaneously 4

Prevention of Future Stings

• Advise on preventive measures:

  • Wearing long sleeves, long pants, and closed shoes
  • Applying DEET-containing repellents (10-30% concentration)
  • Avoiding areas with high uncut grass, weeds, and low brush, especially during warm months 1

• Consider referral to an allergist if:

  • The patient has experienced a systemic reaction to the sting
  • The patient needs education about risk of future reactions
  • The patient might be a candidate for venom immunotherapy 2, 1

Unlike simple wasp stings that typically resolve within hours without treatment 5, infected stings require prompt antibiotic therapy to prevent progression to more serious infections or complications.