Title
Questionnaire/history:
Redness (usually inflammatory or allergic and not infected, usually starts to improve 2-3 days after exposure, can last 10 days)?
Painful?
Itchy?
Foreign travel?
- Occurred whilst outside the UK?
- Caused by unusual or exotic insect?
Exposure to poison ivy or giant hogweed?
Systematically unwell?
Past medical history:
- Diabetes?
- Severely immunocompromised?
- Previous systemic allergic reaction?
Current medication:
- Oral steroids?
Known drug allergies:
Examination:
Single prominent blister or mark (?horsefly, mosquito or a sting)?
Multiple small red papules (?fleas, midges, mitres, bed bugs or mosquitoes or bed bugs)?
Location?
- Below knees (?flea bites)?
- High risk reaction site (eg mouth or throat, peri-orbital, areas of lymphoedema, area of leg ischaemia)?
Erythema migrans?
Management:
Advised:
Most people with insect bites and stings can be directed to a community pharmacist
Itching and redness are common and can last 10 days, antibiotics usually not needed
To try to avoid scratching to reduce inflammation and to reduce the risk of secondary infection
Antihistamines (orally)
Cold compress and topical steroids to help reduce itching.
To draw around the area of erythema to track spreading and review if erythema continues to spread
To take serial pictures to monitor
If infected:
Flucloxacillin 500 mg - 1g QDS for 5-7 days (or clarithromycin 500mg BD 5-7 days if penicillin-allergic; erythromycin if pregnant)
If near eyes or nose: Co-amoxiclav 625 mg TDS 7 days (or clarithromycin 500mg BD with metronidazole 400mg TDS for 7 days if penicillin-allergic)
Review if any systemic symptoms develop
Resource(s):