Treatment for Bed Bug Infestations and Bites
For bed bug bites, treatment is symptomatic with topical pramoxine and oral antihistamines for pruritus, plus topical corticosteroids for significant eruptions; eradication requires integrated pest management combining nonchemical methods (vacuuming, hot water washing of linens >130°F, mattress encasements) with professional application of insecticides, as reactions are self-limited but infestations cause substantial psychological distress and quality of life impairment. 1, 2
Treatment of Bed Bug Bites
Symptomatic Management
- Topical pramoxine and oral antihistamines are first-line for alleviating pruritus from bed bug bites 1
- Topical corticosteroids should be used for significant eruptions to control inflammation, reduce pruritus, and hasten resolution of lesions 1
- Oral corticosteroids and epinephrine have been used empirically for severe systemic reactions, though evidence for their efficacy is limited 2
Clinical Course
- Bed bug bite reactions are self-limited and typically resolve within 1-2 weeks without treatment 2, 3
- Typical reactions include pruritic, erythematous maculopapules in clusters or linear/curvilinear distribution on exposed body areas 1
- Exaggerated reactions (vesicles, urticarial wheals, bullae, nodules) may occur in previously sensitized individuals 1
Important Caveats
- No evidence-based interventions for bed bug bite treatment have been evaluated in clinical trials 2
- Antibiotics are not indicated unless secondary infection develops 2
- Systemic reactions are rare but can include asthma exacerbations, angioedema, generalized urticaria, iron deficiency anemia, and rarely anaphylaxis 3
Eradication of Bed Bug Infestations
Integrated Pest Management Approach
Nonchemical Interventions (Primary Strategy):
- Keep affected areas clean and free of clutter to eliminate hiding places 1
- Vacuum thoroughly using HEPA filtration or central vacuum systems that remove air to distant locations 1
- Wash all linens and bedding in hot water (>130°F) at least every 2 weeks 1
- Encase mattresses, box springs, and pillows in zippered, allergen-proof encasings (vinyl or cloth with semipermeable plastic backing) 1
- Caulk wall holes and cracks where bugs can hide 1
- Properly dispose of highly infested items that cannot be salvaged 1
- Place bed bug traps/interceptors at the base of beds and furniture 1
- Heat or cold treatment can be effective for killing bed bugs 3
Chemical Interventions (Professional Application Only):
- Insecticides include synthetic pyrethroids, silicates, insect growth disruptors, carbamates, organophosphates, neonicotinoids, diethyl-meta-toluamide, chlorfenapyr, fipronil, and plant essential oils 1
- Chemical treatment should only be undertaken by trained professionals who understand current resistance patterns 1
- Multiple mechanisms of insecticide resistance exist, making eradication challenging 2
- Use insecticides with extreme caution to prevent cardiovascular and neurologic toxicity, especially with young children present 1
Critical Implementation Points
- Both nonchemical and chemical technologies must be combined for optimal results 1
- Only 2 clinical trials have tested pest control interventions for bed bugs, reflecting the limited evidence base 2
- Consultation with a professional exterminator is recommended to fully eradicate an infestation 1
- Health concerns about spraying mattresses with pesticides and insecticide resistance make eradication particularly challenging 2
Psychological and Quality of Life Considerations
- Bed bug infestations cause significant psychological distress, anxiety, stigmatization, poor self-esteem, and substantial adverse effects on quality of life 1, 3
- The fear and perceived violation of an infestation can be debilitating, even beyond the physical symptoms 4
- Rapid detection and eradication are of paramount importance given the socioeconomic burden to society 1