CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.
Insect bites and stings - Management
View full scenario
Definition
- Small local reactions to insect bites or stings present with localized pain, swelling, and erythema at the site of the bite or sting. Most can be managed symptomatically.
What self care advice should I give for someone with an insect bite or sting?
- If a person has been stung and the stinger is still in place:
- Remove it as soon as possible by flicking or scraping with a fingernail, piece of card, or knife blade.
- Never squeeze the stinger or use tweezers, as this will cause more venom to go into the skin.
- Remove ticks as soon as possible.
- Wash the area of the bite or sting with soap and water.
- Apply ice to reduce swelling, if present.
- Do not scratch, as this will cause the site to swell and itch more, and increase the chance of infection.
- If there are signs of a severe allergic reaction (generalized symptoms, breathing difficulties, and/or hypotension) seek urgent medical help.
- Bites from fleas, mites, and bedbugs may be due to an infestation. The source of the infestation should be confirmed and then eliminated.
In depth
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.
In depth
What follow up or referral is recommended?
- Follow-up or referral is usually not necessary for anyone with a small local reaction to an insect bite or sting.
- Admission may be required for observation when mild symptoms progress to a severe reaction (uncommon).
- The decision to admit will depend upon the type of reaction, social circumstances, and access to local medical facilities. Exercise clinical judgement in these circumstances.
Prescriptions
Analgesia: use when required
Age from 1 month to 2 months
Paracetamol s/f susp: 30mg to 60mg up to three times a day
Paracetamol 120mg/5ml oral suspension paediatric sugar free
Take 1.25ml to 2.5ml every 8 hours when required for pain relief. Maximum of 3 doses in 24 hours.
Supply 100 ml.
Ibuprofen s/f susp: 5mg/kg three to four times a day (> 5kg)
Ibuprofen 100mg/5ml oral suspension sugar free
*WEIGHT REQUIRED* Take 5mg per kg bodyweight three to four times a day when required for relief of pain. Do not exceed the stated dose.
Supply 50 ml.
Age from 3 to 5 months
Ibuprofen s/f susp: 50mg three times a day
Ibuprofen 100mg/5ml oral suspension sugar free
Take 2.5ml three times a day when required for pain relief. Do not exceed the stated dose.
Supply 50 ml.
Age from 3 to 11 months
Paracetamol s/f susp: 60mg to 120mg up to four times a day
Paracetamol 120mg/5ml oral suspension paediatric sugar free
Take 2.5ml to 5ml every 4 to 6 hours when required for pain relief. Maximum of 4 doses in 24 hours.
Supply 150 ml.
Age from 6 to 11 months
Ibuprofen s/f susp: 50mg three to four times a day
Ibuprofen 100mg/5ml oral suspension sugar free
Take 2.5ml three to four times a day when required for pain relief. Do not exceed the stated dose.
Supply 100 ml.
Age from 1 year to 3 years 11 months
Ibuprofen s/f susp: 100mg three times a day
Ibuprofen 100mg/5ml oral suspension sugar free
Take one 5ml spoonful three times a day when required for pain relief. Do not exceed the stated dose.
Supply 100 ml.
Age from 1 year to 5 years 11 months
Paracetamol s/f susp: 120mg to 240mg up to four times a day
Paracetamol 120mg/5ml oral suspension paediatric sugar free
Take one to two 5ml spoonfuls every 4 to 6 hours when required for pain relief. Maximum of 4 doses in 24 hours.
Supply 300 ml.
Age from 4 years to 6 years 11 months
Ibuprofen s/f susp: 150mg three times a day
Ibuprofen 100mg/5ml oral suspension sugar free
Take 7.5ml three times a day when required for pain relief. Do not exceed the stated dose.
Supply 150 ml.
Age from 6 years to 11 years 11 months
Paracetamol s/f susp: 250mg to 500mg up to four times a day
Paracetamol 250mg/5ml oral suspension sugar free
Take one to two 5ml spoonfuls every 4 to 6 hours when required for pain relief. Maximum of 4 doses in 24 hours.
Supply 300 ml.
Age from 7 years to 9 years 11 months
Ibuprofen s/f susp: 200mg up to three times a day
Ibuprofen 100mg/5ml oral suspension sugar free
Take two 5ml spoonfuls three times a day when required for pain relief. Do not exceed the stated dose.
Supply 200 ml.
Age from 10 years to 11 years 11 months
Ibuprofen s/f susp: 300mg up to three times a day
Ibuprofen 100mg/5ml oral suspension sugar free
Take three 5ml spoonfuls three times a day when required for pain relief. Do not exceed the stated dose.
Supply 300 ml.
Age from 12 years to 17 years 11 months
Paracetamol tablets: 500mg to 1g up to four times a day
Paracetamol 500mg tablets
Take one or two tablets every 4 to 6 hours when required for pain relief. Maximum of 8 tablets in 24 hours.
Supply 50 tablets.
Ibuprofen tablets: 200mg to 400mg three to four times a day
Ibuprofen 200mg tablets
Take one or two tablets 3 to 4 times a day when required for pain relief. Do not exceed the stated dose.
Supply 56 tablets.
Age from 18 years onwards
Paracetamol tablets: 1g up to four times a day
Paracetamol 500mg tablets
Take two tablets every 4 to 6 hours when required for pain relief. Maximum of 8 tablets in 24 hours.
Supply 50 tablets.
Ibuprofen tablets: 400mg three times a day
Ibuprofen 400mg tablets
Take one tablet three times a day when required for pain relief. Do not exceed the stated dose.
Supply 21 tablets.
Topical corticosteroid
Age from 1 month onwards
Hydrocortisone 1% cream: apply once or twice a day
Hydrocortisone 1% cream
Apply thinly to the affected area 1 to 2 times a day. Use for a maximum of 7 days unless otherwise directed.
Supply 15 gram.
Hydrocortisone 1% ointment: apply once or twice a day
Hydrocortisone 1% ointment
Apply thinly to the affected area 1 to 2 times a day. Use for a maximum of 7 days unless otherwise directed.
Supply 15 grams.
Topical antipuritic
Age from 2 months to 2 years 11 months
Crotamiton 10% cream: apply once a day when required
Crotamiton 10% cream
Apply to the affected area once a day when required for relief of itching.
Supply 30 grams.
Crotamiton 10% lotion: apply once a day when required
Crotamiton 10% lotion
Apply to the affected area once a day when required for relief of itching.
Supply 100 m.
Age from 3 years onwards
Crotamiton 10% cream: apply 2-3 times a day when required
Crotamiton 10% cream
Apply to the affected area 2 to 3 times a day when required for relief of itching.
Supply 30 grams.
Crotamiton 10% lotion: apply 2-3 times a day when required
Crotamiton 10% lotion
Apply to the affected area 2 to 3 times a day when required for relief of itching.
Supply 100 ml.
Sedating oral antihistamines (for itch at night)
Age from 1 year to 5 years 11 months
Hydroxyzine syrup: 5 to 15 mg at night when required
Hydroxyzine 10mg/5ml oral solution
Take 2.5ml to 7.5ml at night when required for relief of itching.
Supply 100 ml.
Age from 1 year 1 month to 1 year 11 months
Chlorphenamine oral solution: 1 mg at night when required
Chlorphenamine 2mg/5ml oral solution
Take 2.5ml at night when required for relief of itching.
Supply 50 ml.
Age from 2 years to 5 years 11 months
Chlorphenamine oral solution: 1-2mg at night when required
Chlorphenamine 2mg/5ml oral solution
Take 2.5ml to 5ml at night when required for relief of itching.
Supply 100 ml.
Age from 6 years to 11 years 11 months
Chlorphenamine oral solution: 2-4 mg at night when required
Chlorphenamine 2mg/5ml oral solution
Take one to two 5ml spoonfuls at night when required for relief of itching.
Supply 100 ml.
Hydroxyzine syrup: 15mg to 25mg at night when required
Hydroxyzine 10mg/5ml oral solution
Take 7.5ml to 12.5ml at night when required for relief of itching.
Supply 200 ml.
Age from 12 years onwards
Chlorphenamine tablets: 4 mg at night when required
Chlorphenamine 4mg tablets
Take one tablet at night when required for relief of itching.
Supply 14 tablets.
Hydroxyzine tablets: 25mg at night when required
Hydroxyzine 25mg tablets
Take one tablet at night when required for relief of itching.
Supply 14 tablets.
© NHS Institute for Innovation and Improvement