Bed Bug Treatment
Bed bug infestations require an integrated pest management approach combining environmental decontamination with professional chemical treatment, as bed bugs themselves do not require medical treatment—only their bite reactions need symptomatic management.
Understanding Bed Bugs vs. Medical Treatment
Bed bugs are obligate blood parasites that do not transmit disease and do not require pharmacological treatment of the patient 1. The focus is on eradication of the infestation and symptomatic management of bite reactions 2, 3.
Bite Reaction Management (Symptomatic Only)
- Topical pramoxine and oral antihistamines for pruritus relief 2
- Topical corticosteroids for significant eruptions to control inflammation and hasten resolution 2
- Reactions are self-limited and typically resolve within 1-2 weeks without treatment 3
- Systemic reactions (asthma, angioedema, generalized urticaria, anaphylaxis) are rare but may require standard emergency management 3
Environmental Eradication Strategy
Non-Chemical Interventions (First-Line)
Laundry decontamination is critical and highly effective 4:
- Washing at ≥60°C kills all life stages (adults, nymphs, eggs) 4
- Tumble drying on hot cycle (>40°C) for ≥30 minutes is effective 4
- Dry cleaning with perchloroethylene eliminates all stages 4
- Freezing at -17°C for ≥2 hours kills all stages, though 2.5 kg of dry laundry requires approximately 8 hours to reach this temperature 4
- Items can be removed from body contact for ≥72 hours as an alternative 5
- Keep affected areas clean and clutter-free
- Vacuum thoroughly (especially cracks and crevices)
- Mattress encasements to trap bed bugs and prevent access 6
- Caulk wall holes and cracks where bugs hide
- Proper disposal of heavily infested items
- Bed bug traps/interceptors at base of beds and furniture
Heat treatment for furniture and room contents 7:
- Exposure to 49°C provides rapid mortality; lower temperatures (41-45°C) require longer exposure times 7
- Professional heat treatment of 2-7 hours with proper containment (polystyrene sheathing) achieves complete mortality 7
- Temperatures needed to kill bed bugs are relatively low compared to other insects 7
Chemical Interventions (Professional Application Required)
Chemical treatments should only be undertaken by trained pest control professionals due to resistance patterns and toxicity risks 6. Available insecticide classes include 6, 2:
- Neonicotinoids
- Insect growth regulators
- Chlorfenapyr
- Synthetic pyrethroids (though resistance is common)
- Silicates, carbamates, organophosphates
Critical Pitfalls to Avoid
- Do not attempt chemical treatment yourself—multiple mechanisms of insecticide resistance exist and improper use risks toxicity, especially cardiovascular and neurologic effects in children 2
- Insecticides should be used with extreme caution to prevent over-exposure 2
- Fumigation of living areas is unnecessary 5
- Both non-chemical and chemical technologies must be combined for optimal results 2
Integrated Pest Management Algorithm
- Confirm infestation through inspection of sleeping quarters and identification of bed bugs 3
- Immediate laundry decontamination: Wash all bedding, clothing, and linens at ≥60°C or tumble dry on hot cycle for ≥30 minutes 4
- Physical interventions: Vacuum, declutter, install mattress encasements, place interceptors 6, 2
- Consult professional exterminator for chemical treatment with appropriate insecticides 6, 2
- Monitor with trapping devices (active monitors with heat/CO2 attractants or passive sticky pads) 2
- Treat bite reactions symptomatically only as needed 2
Important Considerations
- Consultation with a professional exterminator is recommended to fully eradicate an infestation 2
- Bed bug infestations cause significant psychological distress, stigmatization, anxiety, and adverse effects on quality of life 2, 3
- Rapid detection and eradication are paramount due to the substantial socioeconomic burden 2
- There is no evidence that bed bugs transmit communicable disease despite historical attribution of >40 diseases 1