What treatment options are available for a patient with a bed bug infestation?

Bed Bug Treatment Options for Patients

For a patient with bed bug infestation, recommend an integrated pest management approach combining professional extermination services with non-chemical interventions including mattress encasements, hot water laundering (≥60°C), and hot air drying of bedding and clothing. 1

Identification and Clinical Presentation

• Bed bug bites typically present as:
  • Pruritic, erythematous maculopapules in clusters or linear/curvilinear distribution
  • Often found on exposed areas of the body
  • May have small red punctum at center of bite
  • Three bites in a row ("breakfast, lunch, dinner" pattern) is highly suggestive 1
• Reactions are usually self-limited but may cause significant psychological distress

Treatment Recommendations for the Patient

Symptomatic Treatment for Bites

• Topical treatments:
  • Pramoxine for pruritus
  • Topical corticosteroids for significant inflammation
• Oral antihistamines to alleviate itching 1

Home Intervention Strategy

1. Professional Extermination

   • Refer patient to licensed pest control professionals with bed bug expertise
   • Caution against self-application of insecticides due to risk of toxicity and resistance 2

2. Non-Chemical Interventions

   • Mattress and box spring encasements (zippered, allergen-proof)
   • Declutter living spaces to eliminate hiding places
   • Vacuum thoroughly and frequently (use HEPA filter vacuum if available) 1
   • Place bed bug interceptors/traps at the base of beds and furniture

3. Laundry Management

   • Wash all bedding, clothing, and fabric items in hot water (≥60°C)
   • Tumble dry on hot cycle (>40°C) for at least 30 minutes
   • For delicate items that cannot be washed hot:
     • Dry cleaning with perchloroethylene is effective
     • Freezing at -17°C for at least 2 hours (note: home freezers may take up to 8 hours to reach this temperature) 3

Important Precautions

• Avoid excessive use of insecticides, especially in sleeping areas
• Warn patients about potential health risks from improper insecticide use, including:
  • Respiratory issues
  • Skin irritation
  • Neurological symptoms in severe cases 2
• Items that cannot be washed should be removed from body contact for at least 72 hours

Follow-up Recommendations

• Schedule follow-up in 2-4 weeks to assess treatment efficacy
• Advise patient that complete eradication may require multiple professional treatments
• Recommend continued vigilance and preventive measures even after apparent resolution

Prevention of Reinfestation

• Inspect secondhand furniture before bringing into home
• When traveling, inspect hotel rooms and keep luggage elevated
• Avoid bringing discarded furniture into the home
• Continue using mattress encasements long-term 1

Remember that bed bugs are not known disease vectors, but their presence can significantly impact quality of life through anxiety, discomfort, and sleep disturbance 4. A comprehensive approach focusing on professional extermination combined with thorough home cleaning and laundry management offers the best chance for successful eradication.