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Insect bites and stings - Management
What drug treatments can I recommend for small local reactions to insect bites or stings?
- Treat local pain and oedema with cold compresses and oral analgesics (e.g. paracetamol or ibuprofen).
- Treat local itching with topical crotamiton. Alternatively, consider using a mild potency topical corticosteroid (e.g. hydrocortisone 1%).
- Consider an oral sedating antihistamine at night if the itch is interfering with sleep.
Clarification / Additional information
- Apply crotamiton 2–3 times a day. For children under 3 years old, apply crotamiton once a day only.
- Apply topical hydrocortisone sparingly to the affected area once or twice a day for no longer than 7 days [BNF 52, 2006].
Basis for recommendation
- These recommendations are based on expert opinion from the medical literature [Kemp, 1998; Burns, 2004; Moffitt et al, 2004; Steen et al, 2005; Micromedex, 2007].
- Topical treatments:
- Crotamiton cream or lotion has soothing qualities and may help to relieve itch, although no controlled studies have been published that assess its efficacy. It is licensed for the relief of itching and skin irritation caused by insect bites and stings.
- CKS could find no trial evidence for topical hydrocortisone. However, it is licensed for the treatment of insect bite reactions, and is widely recommended to reduce inflammation and itching after an insect bite or sting [BNF 52, 2006].
- Oral antihistamines:
- CKS found limited evidence that oral antihistamines are effective in treating pruritus.
- Results from a review of 16 randomized controlled trials and other studies (n = 803) suggest that neither first nor second generation antihistamines offer relief from itch in conditions such as atopic dermatitis [Klein and Clark, 1999].
- Several small, poorly designed trials have found that loratadine and cetirizine reduce cutaneous reactions and pruritus when given for mosquito bites. However, larger studies are needed to confirm this [Karppinen et al, 2000; Karppinen et al, 2002].
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