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Insect bites and stings - Management
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Definition
- Secondary bacterial infection may occur as a result of scratching or may be introduced at the time of the bite or sting.
How do I know if an insect bite or sting is infected?
- A secondary infection may appear as impetigo, cellulitis, or lymphangitis.
- Signs that suggest a secondary infection include:
- The presence of pus.
- Increasing erythema, oedema, or tenderness beyond the anticipated pattern of response.
- Regional lymphadenopathy — this can also occur in the absence of infection, as a response to the inflammatory reaction produced by a bite.
- Lymphangitis, which is the most reliable sign and suggests streptococcal involvement.
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.
In depth
What if treatment is not effective?
- Seek specialist advice regarding further management.
Prescriptions
1st-line antibiotic: flucloxacillin for 7 days
Age from 1 month to 1 year 11 months
Flucloxacillin oral solution: 62.5mg four times a day
Flucloxacillin 125mg/5ml oral solution
Take 2.5ml four times a day for 7 days.
Supply 100 ml.
Flucloxacillin oral solution: 125mg four times a day
Flucloxacillin 125mg/5ml oral solution
Take one 5ml spoonful four times a day for 7 days.
Supply 200 ml.
Age from 2 years to 9 years 11 months
Flucloxacillin oral solution: 125mg four times a day
Flucloxacillin 125mg/5ml oral solution
Take one 5ml spoonful four times a day for 7 days.
Supply 200 ml.
Flucloxacillin oral solution: 250mg four times a day
Flucloxacillin 250mg/5ml oral solution
Take one 5ml spoonful four times a day for 7 days.
Supply 200 ml.
Age from 10 years to 11 years 11 months
Flucloxacillin oral solution: 250mg four times a day
Flucloxacillin 250mg/5ml oral solution
Take one 5ml spoonful four times a day for 7 days.
Supply 200 ml.
Flucloxacillin oral solution: 500mg four times a day
Flucloxacillin 250mg/5ml oral solution
Take two 5ml spoonfuls four times a day for 7 days.
Supply 300 ml.
Age from 12 years onwards
Flucloxacillin capsules: 250mg four times a day
Flucloxacillin 250mg capsules
Take one capsule four times a day for 7 days.
Supply 28 capsules.
Flucloxacillin capsules: 500mg four times a day
Flucloxacillin 500mg capsules
Take one capsule four times a day for 7 days.
Supply 28 capsules.
1st-line in penicillin allergy: clarithromycin for 7 days
Age from 1 month to 3 years
Clarithromycin suspension: child weighs 7.9kg or less
Clarithromycin 125mg/5ml oral suspension
*WEIGHT REQUIRED* Take 7.5mg per kg bodyweight TWICE a day for 7 days.
Supply 70 ml.
Age from 3 months to 5 years
Clarithromycin suspension: child weighs 8kg to 11.9 kg
Clarithromycin 125mg/5ml oral suspension
Take 2.5ml twice a day for 7 days.
Supply 70 ml.
Age from 6 months to 7 years
Clarithromycin suspension: child weighs 12kg to 19.9kg
Clarithromycin 125mg/5ml oral suspension
Take one 5ml spoonful twice a day for 7 days.
Supply 70 ml.
Age from 3 to 10 years
Clarithromycin suspension: child weighs 20kg to 29.9kg
Clarithromycin 125mg/5ml oral suspension
Take 7.5ml twice a day for 7 days.
Supply 140 ml.
Age from 7 years to 11 years 11 months
Clarithromycin suspension: child weighs 30kg or more
Clarithromycin 250mg/5ml oral suspension
Take one 5ml spoonful twice a day for 7 days.
Supply 70 ml.
Age from 12 years onwards
Clarithromycin tablets: 250mg twice a day
Clarithromycin 250mg tablets
Take one tablet twice a day for 7 days.
Supply 14 tablets.
Clarithromycin tablets: 500mg twice a day
Clarithromycin 500mg tablets
Take one tablet twice a day for 7 days.
Supply 14 tablets.
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