What is the treatment for a bee bite?

Treatment for Bee Stings

The treatment for bee stings should focus on rapid removal of the stinger (regardless of method), followed by wound care with mild soap and water, and monitoring for signs of allergic reactions. 1

Immediate Management

• Remove the stinger quickly: The speed of removal is more important than the method. Whether scraped or pinched off, removing the stinger within seconds reduces the amount of venom injected 2
• Clean the area: Wash with mild soap and water to reduce pain and swelling 1
• Apply cold compress: Use ice wrapped in a cloth to reduce swelling and pain
• Elevate the affected limb if possible to reduce swelling 1
• Pain management: Use oral analgesics as needed 1

Local Reaction Management

Local reactions occur in up to 25% of the population 3 and typically include:

• Redness
• Swelling
• Pain
• Itching

Treatment for local reactions:

• Antihistamines (oral) to reduce itching and swelling
• Topical corticosteroids to reduce inflammation
• Analgesics for pain relief
• Monitor for signs of infection (increasing redness, warmth, swelling, pus)

Severe Reaction Management

For large local reactions or signs of infection:

• Amoxicillin-clavulanate (875/125 mg twice daily) is the first-line antibiotic therapy 1
• Alternative antibiotics for penicillin-allergic patients:
  • Clindamycin (300-400 mg three times daily) 1
  • Cephalexin (250-500 mg four times daily) 1
  • Doxycycline (100 mg twice daily) 1

For anaphylaxis (occurs in up to 3.5% of population) 3:

1. Administer epinephrine immediately (0.3-0.5 mg IM for adults, 0.01 mg/kg up to 0.3 mg for children) in mid-outer thigh 1
2. Place patient in supine position with legs elevated if experiencing cardiovascular symptoms 1
3. Establish IV access for fluid resuscitation with normal saline for hypotension 1
4. Administer oxygen for prolonged reactions or patients requiring multiple epinephrine doses 1
5. Consider corticosteroids (methylprednisolone 1-2 mg/kg IV) to prevent protracted or biphasic anaphylaxis 1

Special Considerations

• High-risk patients (immunocompromised, asplenic, advanced liver disease) may require antibiotic therapy even for uncomplicated stings 1
• High-risk locations (hands, face, genitals, near joints) may also warrant antibiotic therapy 1
• Patients with mastocytosis (found in 3-5% of patients with sting anaphylaxis) are prone to very severe reactions 3
• Rare complications to monitor for include:
  • Deep vein thrombosis 4
  • Eosinophilic cellulitis (Wells syndrome) 5

Prevention for Future Stings

• Wear protective clothing (long pants, long sleeves, closed shoes) 1
• Use insect repellents containing DEET 1
• Apply permethrin spray on clothing 1
• Remove insect nests professionally 1
• Avoid bright colors or flowery prints 1
• Consider venom immunotherapy (VIT) for patients with history of systemic allergic reactions 1

Follow-up Instructions

Advise patients to seek medical attention if:

• Symptoms worsen despite 48 hours of treatment
• Fever develops or increases
• Redness or swelling continues to spread
• New symptoms develop 1