What medication is recommended for a non-venomous insect bite with itching?

Management of Non-Venomous Insect Bite with Itching

For non-venomous insect bites with itching, topical hydrocortisone 1% cream is the recommended first-line treatment to provide effective relief. 1

First-Line Treatments

Topical Options

• Hydrocortisone 1% cream: FDA-approved for temporarily relieving itching associated with insect bites 1
  • Apply a thin layer to affected area 2-4 times daily
  • Safe and effective for most patients
  • Works by reducing inflammation and suppressing the immune response that causes itching

Oral Options

• Non-sedating second-generation antihistamines for daytime use 2:
  • Loratadine 10 mg daily
  • Fexofenadine 180 mg daily
• First-generation antihistamines for nighttime use 2:
  • Diphenhydramine 25-50 mg
  • Hydroxyzine 25-50 mg

Supportive Measures

• Clean the affected area with mild soap and water 2
• Apply cold compresses to reduce swelling and inflammation
• Elevate the affected limb if possible to reduce swelling 2

Treatment Algorithm

1. Initial management:

   • Clean the area with mild soap and water
   • Apply hydrocortisone 1% cream to the affected area
   • Consider oral antihistamines if itching is severe or widespread

2. For persistent symptoms:

   • Continue hydrocortisone application for up to 7 days
   • Use oral antihistamines as needed for itching
   • Consider topical pramoxine 1% for additional itch relief 3, 4

3. For severe reactions:

   • If significant swelling or discomfort persists, oral corticosteroids may be considered (0.5-2 mg/kg daily) for temporary relief 2

Special Considerations

Cautions

• Avoid long-term use of sedative antihistamines except in palliative care, as they may predispose to dementia 2
• Application of topical corticosteroids to sites of positive immediate-type allergy skin tests does not provide relief of itching and should not be used for this purpose 5
• Hydrocortisone should not be used on infected areas or open wounds

Prevention

• Wear protective clothing (long pants, long sleeves, closed shoes) 2
• Use insect repellents containing DEET (safe for children >2 months when used as directed) 2
• Apply permethrin spray on clothing 2

When to Seek Medical Attention

• Signs of infection (increasing redness, warmth, swelling, or pus)
• Systemic symptoms (fever, widespread rash, difficulty breathing)
• Symptoms that worsen despite 48 hours of treatment 2

While concentrated heat application has shown promising results in recent studies (81% reduction in mosquito bite-induced itch within 5-10 minutes) 6, topical hydrocortisone remains the standard first-line treatment due to its established efficacy and safety profile.