What is the management of a wasp sting reaction with localized infection?

Management of Wasp Sting Reaction with Localized Infection

For wasp sting reactions with localized infection, treatment should include thorough wound cleaning with soap and water, antibiotic therapy with amoxicillin-clavulanate 875/125 mg twice daily for 3-5 days, symptomatic relief with antihistamines and possibly corticosteroids, and monitoring for signs of worsening infection. 1

Initial Management

1. Wound Cleaning and Assessment:

   • Clean the wound thoroughly with soap and water
   • Perform copious irrigation with normal saline
   • Explore the wound for foreign bodies or damage to deeper structures 1
   • Remove any remaining stinger (for honeybees specifically) as quickly as possible 1

2. Symptomatic Relief:

   • Apply ice or cold packs to the sting site (with a thin barrier between ice and skin)
   • Elevate the affected limb if significant swelling is present 1
   • Use over-the-counter pain medications such as acetaminophen or NSAIDs (ibuprofen)

Pharmacological Management

Antibiotic Therapy

For localized infection following a wasp sting, antibiotic therapy is indicated:

• First-line antibiotic: Amoxicillin-clavulanate 875/125 mg twice daily for 3-5 days 1
• Alternative options (based on patient factors):
  • Cephalexin: 250-500 mg four times daily
  • Clindamycin: 300-400 mg three times daily (for penicillin-allergic patients)
  • Doxycycline: 100 mg twice daily (particularly useful when Pasteurella species are suspected)
  • Fluoroquinolones (e.g., moxifloxacin): 400 mg daily, plus metronidazole 250-500 mg three times daily 1

Management of Allergic Component

• H1 antihistamines: Diphenhydramine 25-50 mg every 6 hours 1
• H2 antihistamines: Ranitidine 150 mg twice daily 1
• Corticosteroids: Consider prednisone 40-60 mg daily for 2-3 days for significant local reactions 1, 2

Monitoring and Follow-up

• Monitor the bite site for 48-72 hours for signs of infection progression 1
• Follow-up should be considered within 24-48 hours to assess response to treatment
• Tetanus prophylaxis should be considered if vaccination is not current (within 10 years) 1

Indications for Inpatient Management

Consider inpatient management with IV antibiotics for:

• Rapidly spreading infection
• Significant pain or swelling
• Systemic toxicity
• Immunocompromised patients
• Deep tissue involvement 1

Warning Signs Requiring Immediate Medical Attention

• Multiple stings (especially >10)
• Signs of systemic reaction (difficulty breathing, widespread hives, dizziness)
• Stings inside the mouth or throat
• Stings to the eye 1, 3

Special Considerations

• Patients who are immunocompromised, asplenic, or have advanced liver disease may require more aggressive antibiotic therapy 1
• While rare, be aware that wasp stings can occasionally lead to severe systemic complications including vasculitis, neuritis, and even stroke in some cases 4, 5
• Large local reactions (>10 cm in diameter) may last up to 5 days and represent an allergic response to venom proteins 2, 6