What is the treatment for bug bites?

Treatment for Bug Bites

The first-line treatment for bug bites includes removing any stinger immediately, cleaning the wound with soap and water, and applying cold compresses, oral antihistamines, and topical hydrocortisone for symptom relief. 1, 2

Immediate Management

1. Wound Care:

   • Remove stinger immediately if present (speed is more important than method of removal) 1
   • Clean wound thoroughly with soap and water 1
   • Apply ice or cold packs with a thin barrier between ice and skin to reduce pain and swelling 1

2. Symptom Management:

   • Topical treatments:
     • Apply hydrocortisone cream (0.5-1%) to temporarily relieve itching and inflammation 2
   • Oral medications:
     • Antihistamines for itching relief 1
     • Acetaminophen or NSAIDs for pain relief 1

Special Considerations

Allergic Reactions

• Monitor for signs of allergic reactions, which may require immediate medical attention 1
• For systemic allergic reactions:
  • Administer intramuscular epinephrine as first-line treatment (0.3-0.5 mg in adults, 0.01 mg/kg up to 0.3 mg in children) 1
  • H1 antihistamines, H2 antihistamines, and corticosteroids may help with symptoms but should never replace epinephrine 1
  • Observe patients for at least 4-6 hours after anaphylaxis treatment 1

Infection Prevention

• Tetanus prophylaxis is not routinely needed after simple insect stings unless tetanus vaccination is not current 1
• Routine antibiotic prophylaxis is not indicated for uncomplicated insect stings 1
• Consider preemptive antibiotic therapy (3-5 days) for:
  • Immunocompromised patients
  • Asplenic patients
  • Patients with advanced liver disease
  • Moderate to severe injuries, especially to hand or face 1

Antihistamine Selection

While the guideline mentions antihistamines generally, research evidence suggests:

• Cetirizine and levocetirizine appear most effective for reducing both immediate and delayed mosquito bite reactions 3, 4
• Levocetirizine 5mg decreased wheal size by 60% and pruritus by 62%, with greater effect in those with larger bite reactions 4
• Cetirizine is particularly effective against pruritus but may cause more sedation than other options 3

Prevention Strategies

• Have known insect nests removed by professionals 1
• Avoid wearing bright colors or flowery prints 1
• Wear protective clothing (long pants, long sleeves, closed shoes) 1
• Patients with history of systemic reactions should:
  • Carry autoinjectable epinephrine
  • Be educated on proper use
  • Be referred to an allergist-immunologist 1

Common Pitfalls to Avoid

• Delaying removal of stingers (should be removed immediately regardless of method) 1
• Using antihistamines alone for systemic reactions instead of epinephrine 1
• Neglecting to monitor for delayed reactions, which can occur hours after the initial bite 1
• Unnecessary use of antibiotics for uncomplicated bites without signs of infection 1