Bug Bite Treatment
For most common bug bites, treatment includes washing the area with mild soap and water, applying cold compresses, and using topical preparations containing menthol 0.5% or corticosteroids like mometasone furoate 0.1% or betamethasone valerate 0.1% ointment for symptomatic relief. 1
Initial Assessment and Management
For simple bug bites:
For insect stings (bees, wasps):
- Remove the stinger by scraping or flicking it away with a fingernail within 10-20 seconds (avoid grasping the venom sac) 1
- Clean the area with mild soap and water
- Apply cold compresses
Symptom Management
For Itching (Pruritus)
First-line options:
- Topical preparations containing menthol 0.5% 1
- Topical corticosteroids: mometasone furoate 0.1% or betamethasone valerate 0.1% ointment 1
- Non-sedating antihistamines for daytime use: loratadine 10 mg daily or fexofenadine 180 mg daily 1
- First-generation antihistamines for nighttime use: diphenhydramine 25-50 mg or hydroxyzine 25-50 mg 1
Avoid:
For Pain
- Oral analgesics as needed 1
- For mosquito bites specifically, concentrated heat application has shown significant reduction in both itch (57% within first minute, 81% after 5-10 minutes) and pain 2
Severe Reactions Management
For Anaphylaxis
If signs of anaphylaxis develop (flushing, syncope, tachycardia, hypotension, respiratory distress, widespread urticaria):
Administer epinephrine immediately 1, 3
- Adult dose: 0.3-0.5 mg IM
- Pediatric dose: 0.01 mg/kg up to 0.3 mg IM
- May repeat every 5 minutes if needed
Additional measures:
- Assess airway, breathing, and circulation 1
- Provide oxygen for prolonged reactions 1
- Establish IV access for fluid resuscitation with normal saline for hypotension 1
- Administer corticosteroids (methylprednisolone 1-2 mg/kg IV) to prevent protracted or biphasic anaphylaxis 1
- Place patient in supine position with legs elevated if experiencing cardiovascular symptoms 1
Special Considerations for Specific Bug Bites
Bed Bug Bites
- Typically present as pruritic, erythematous maculopapules in clusters or linear/curvilinear distribution 4
- Treatment is symptomatic as reactions are self-limited 4
- For significant eruptions, topical corticosteroids can control inflammation and hasten resolution 4
- Consider professional extermination for home infestation 4
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
- For those with history of severe reactions to insect stings, consider venom immunotherapy (VIT) 1
Infection Prevention and Treatment
- Consider oral antibiotics (3-5 days) for high-risk patients (immunocompromised, asplenic, advanced liver disease) 1
- First-line antibiotic choice: amoxicillin-clavulanate (875/125 mg twice daily) 1
- For penicillin-allergic patients: doxycycline (100 mg twice daily) or clindamycin (300 mg three times daily) plus TMP-SMX (160/800 mg twice daily) 1
- Ensure tetanus prophylaxis is current (within 10 years for clean minor wounds or 5 years for contaminated wounds) 1
Clinical Pearls and Pitfalls
- Systemic IgE-mediated hypersensitivity reactions to arthropod bites/stings beyond bees and wasps are rare but can occur with mosquitoes, flies, and other insects 5
- Multiple mechanisms of insecticide resistance exist; chemical treatment for infestations should only be undertaken by trained professionals 4
- Anaphylactic reactions to mosquito bites are extremely rare, though they are common with bee and wasp stings 6
- Delayed reactions to mosquito bites may involve both Arthus-type mechanisms and cell-mediated immunity 6