What is the treatment for an individual bitten by bed bugs?

Treatment of Bed Bug Bites

Bed bug bites are self-limited and require only symptomatic treatment with topical antihistamines or pramoxine for itching, oral antihistamines for more widespread symptoms, and topical corticosteroids for significant eruptions—antibiotics are not indicated unless clear signs of secondary bacterial infection develop. 1, 2

Initial Symptomatic Management

First-Line Treatments

• Apply topical pramoxine to alleviate pruritus at the bite sites. 1
• Use oral antihistamines to control itching, particularly when multiple bites are present or symptoms are widespread. 1, 2, 3
• Apply cold compresses to reduce local pain and swelling. 4
• Consider oral analgesics for pain management if needed. 4

For Significant Eruptions

• Apply topical corticosteroids to control inflammation and pruritus, and to hasten resolution of lesions when reactions are prominent. 1, 2, 3
• Consider oral corticosteroids for severe cases with extensive swelling, though definitive controlled trial evidence is lacking. 4

Critical Clinical Pitfalls to Avoid

Do NOT Prescribe Antibiotics Routinely

• The swelling and inflammation from bed bug bites are caused by allergic mediator release, not infection—antibiotics should only be prescribed if there are clear signs of secondary bacterial infection (progressive redness, increasing pain, purulent discharge, fever, or warmth and tenderness). 4, 1

Recognize Self-Limited Nature

• Reactions to bed bug bites are self-limited and will resolve without treatment in most cases. 1
• Treatment is primarily symptomatic to improve comfort during the natural resolution process. 1, 2

Monitoring for Complications

Watch for Systemic Reactions (Rare)

• Monitor for systemic symptoms including urticaria, angioedema, respiratory symptoms, or cardiovascular symptoms. 4
• Administer epinephrine immediately if systemic reactions occur, though anaphylaxis from bed bug bites is extremely rare. 4, 3

Secondary Infection Signs

• Only prescribe antibiotics if progressive redness, increasing pain, purulent discharge, fever, or warmth and tenderness develop. 4

Expected Clinical Course

Typical Presentation

• Bed bug bites typically appear as pruritic, erythematous maculopapules in clusters or linear/curvilinear distribution on exposed body areas. 1
• A small red punctum may be visible at the center of the bite mark. 1
• Three bites in a row or papules on the upper eyelid with erythema and edema are highly suggestive of bed bug bites. 1

Exaggerated Reactions in Sensitized Individuals

• Previously sensitized individuals may develop vesicles, urticarial wheals, urticarial perilesional plaques, diffuse urticaria, bullae, or nodules. 1
• These exaggerated reactions still require only symptomatic treatment with antihistamines and corticosteroids. 1, 2

Essential Patient Education

Address Psychological Impact

• Bed bug infestations cause significant psychological distress, anxiety, poor self-esteem, and adverse effects on quality of life. 1
• Reassure patients that bed bugs are not known to transmit human pathogens. 2, 3

Eradication is Key

• Ensure the infestation responsible for the bites is effectively eliminated to prevent ongoing symptoms. 2
• Consultation with a professional exterminator is recommended to fully eradicate an infestation. 1
• Integrated pest management combining nonchemical interventions (vacuuming, hot water washing of linens, caulking cracks, bed bug interceptors) and professional chemical treatment is most effective. 1