A patient returning from Honduras with multiple sandfly bites—what over‑the‑counter symptomatic treatments and monitoring advice should I provide?

Immediate Pharmacy Recommendations for Sandfly Bites After Honduras Travel

For symptomatic relief of sandfly bites, recommend topical antihistamine cream or oral antihistamines (e.g., diphenhydramine, cetirizine) to reduce itching, along with topical hydrocortisone 1% cream to decrease inflammation. 1

Symptomatic Management

• Topical antihistamines or oral antihistamines (diphenhydramine 25-50 mg every 6 hours or cetirizine 10 mg daily) help control pruritus from the bites 1
• Hydrocortisone 1% cream applied twice daily reduces local inflammatory response 1
• Avoid scratching to prevent secondary bacterial infection, which can complicate sandfly bites 1
• Keep bite areas clean with soap and water to minimize infection risk 1

Critical Monitoring Instructions

Educate the patient to seek immediate medical evaluation if any skin lesions develop at bite sites within the next 3-6 months, as cutaneous leishmaniasis can present weeks to months after sandfly exposure. 1

Warning Signs Requiring Medical Evaluation:

• Chronic skin lesions that develop at bite sites—typically painless, indurated papules that may ulcerate 1
• Lesions appearing 2-8 weeks (or longer) after exposure, as the incubation period for cutaneous leishmaniasis is usually several weeks 1
• Persistent nasal congestion or mucosal symptoms developing months later, which could indicate mucosal leishmaniasis from New World Leishmania species endemic to Honduras 1
• Fever with hepatosplenomegaly (though visceral leishmaniasis is less common from Honduras exposure) 1

Geographic Risk Context

Honduras is endemic for New World cutaneous leishmaniasis, particularly Leishmania (Viannia) panamensis and L. (V.) braziliensis, which carry risk of mucosal complications 1. The patient should understand that:

• Most sandfly bites do not transmit leishmaniasis, but the risk exists 1
• Lesions may not appear for weeks to months after the bites 1, 2
• Local trauma to bite sites can precipitate lesion development in infected individuals 2

Additional Considerations

• Sandfly fever virus (phlebovirus) could cause acute febrile illness within 3-5 days of bites, presenting with fever, myalgia, and headache lasting approximately 3 days 3
• If fever develops within 1-2 weeks of return, the patient should seek medical evaluation to exclude other travel-related infections, though malaria is not endemic to Honduras 1
• Secondary bacterial infection of bite sites may present with purulence, increased warmth, or expanding erythema and requires antibiotic evaluation 1

Prevention for Future Travel

For any future travel to leishmaniasis-endemic areas, recommend:

• DEET-containing insect repellents (applied sparingly to exposed skin) 1
• Permethrin-treated clothing for additional protection 1
• Avoiding outdoor activities at dusk and dawn when sandflies are most active 1
• Sleeping under permethrin-treated bed nets in endemic areas 4