What is the treatment for insect bites?

Treatment for Insect Bites

For simple insect bites, clean the area with mild soap and water, apply topical hydrocortisone cream for itching, and use oral antihistamines for more significant symptoms. 1, 2

Immediate Management of Simple Insect Bites

1. Clean the bite area:

   • Wash with mild soap and water to reduce pain and swelling 1
   • Remove any stinger if present (particularly for bee stings) by scraping with a flat-edged object

2. Topical treatments:

   • Apply hydrocortisone cream (0.5-1%) to temporarily relieve itching associated with insect bites 2
   • Cold compresses can reduce swelling and numb the area
   • Concentrated heat application has shown promising results in reducing swelling, pain, and pruritus after insect bites/stings 3

3. Oral medications:

   • Over-the-counter antihistamines can help control itching and swelling
   • Oral analgesics (acetaminophen, ibuprofen) for pain management 1

Management of Infected Insect Bites

If signs of infection develop (increasing redness, warmth, swelling, pus, or fever), antibiotic therapy may be necessary:

• Oral antibiotics options:

  • Amoxicillin-clavulanate 875/125 mg twice daily (first-line) 1
  • Cephalexin 250-500 mg four times daily 1
  • Clindamycin 300-450 mg three times daily (for penicillin-allergic patients) 1
  • Doxycycline 100 mg twice daily (particularly useful when Pasteurella species are suspected) 1
  • TMP-SMX 1-2 double-strength tablets twice daily (if MRSA is suspected) 1

• For severe infections requiring IV therapy:

  • Ampicillin-sulbactam 1.5-3.0 g every 6-8 hours 1
  • Piperacillin-tazobactam 3.37 g every 6-8 hours 1
  • Add vancomycin if MRSA is suspected 1

Management of Severe Allergic Reactions

For anaphylaxis (difficulty breathing, swelling of face/throat, rapid heartbeat, dizziness, severe rash):

• Immediate epinephrine administration:

  • Adult dose: 0.3-0.5 mg IM in mid-outer thigh 1, 4
  • Pediatric dose: 0.01 mg/kg up to 0.3 mg IM 1
  • May repeat every 5 minutes based on clinical response 1

• Additional measures:

  • Place patient in supine position with legs elevated if experiencing cardiovascular symptoms 1
  • Administer oxygen for prolonged reactions or patients requiring multiple doses of epinephrine 1
  • Establish IV access for fluid resuscitation with normal saline for hypotension 1
  • Consider corticosteroids (methylprednisolone 1-2 mg/kg IV) to prevent protracted or biphasic anaphylaxis 1

Prevention Strategies

• Wear protective clothing (long pants, long sleeves, closed shoes) 1
• Use insect repellents containing DEET (safe for children >2 months when used as directed) 1
• Apply permethrin spray on clothing 1
• Avoid perfumes and colognes, which can attract insects 5
• Keep doors and windows closed at night in areas with high insect populations 5

Follow-up Recommendations

Return for medical evaluation if:

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

Special Considerations

• High-risk patients (immunocompromised, asplenic, advanced liver disease) may require prophylactic antibiotic therapy for insect bites 1
• Consider venom immunotherapy (VIT) for patients with a history of systemic allergic reactions to insect stings 1
• Tetanus prophylaxis is not routinely needed after simple insect stings unless tetanus vaccination is not current 1