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Insect bites and stings - Management
How do I manage an infected insect bite or sting?

  • Treat empirically with oral antibiotics for 7 days:
    • Oral flucloxacillin is recommended for empirical treatment of staphylococcal and streptococcal skin infections.
    • Oral erythromycin (or clarithromycin if erythromycin is not tolerated) is an alternative for people with penicillin-allergy.
Basis for recommendation
  • These recommendations are pragmatic advice, based on the most likely causative organism (Staphylococcus aureus or streptococci). We found no randomized controlled trials that studied the effectiveness of antibiotic treatment (or the length of antibiotic course needed) for insect bites or stings.
    • Flucloxacillin has a narrow spectrum of activity, and is active against most susceptible Gram-positive cocci, including beta-lactamase producing staphylococci and streptococci. However, it is not active against MRSA (methicillin-resistant S. aureus), which is increasingly prevalent in the UK. It penetrates well into most tissues, so is suitable for skin and soft tissue infections [Finch et al, 2003].
    • Erythromycin and clarithromycin have a broad spectrum of activity and are active against most sensitive Gram positive cocci (including staphylococci and streptococci) and some Gram negative cocci and anaerobes [Finch et al, 2003].
    • Clarithromycin may be used in people who are known not to tolerate erythromycin, as it has fewer gastrointestinal adverse effects [Finch et al, 2003]. However, it is markedly more expensive than erythromycin.
  • Azithromycin (and other macrolides) are not recommended for empirical treatment as there are concerns about increasing resistance [McNulty, Personal Communication, 2006].

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