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Scenario: Small local reactions
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.
Scenario: Large local reactions
Definition
- Large local reactions present with severe pain, and oedema that extends beyond the site of the sting or bite. Most can be managed symptomatically.
- Late-onset reactions can occur (after several hours), which present as urticarial reactions or serum sickness-like reactions with urticaria, joint swelling, and arthralgia.
How do I manage large local reactions to an insect bite or sting?
- Treat pain with an oral analgesic (e.g. paracetamol or ibuprofen).
- Treat large local allergic reactions with a short course of an oral antihistamine.
- Offer a non-sedating antihistamine to control daytime symptoms.
- Consider giving an additional sedating antihistamine at night if the itch is interfering with sleep.
- Consider using a short course of an oral steroid (e.g. prednisolone for 3–5 days) if local swelling is severe.
- If the airway is affected, treat urgently as anaphylaxis — see the CKS topic on Angio-oedema and anaphylaxis for more information.
In depth
When is referral indicated?
- 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.
- The Anaphylaxis Campaign recommends referral to an allergy clinic if there is a large local skin reaction, with redness and swelling over 10 cm in diameter. However clinicians should check the referral policy of their local allergy clinic as this may vary.
- Seek specialist advice from an allergy clinic or immunologist regarding local recommendations for interim management of anyone waiting to be seen by the allergy clinic.
What follow up is recommended?
- If a person has a local reaction to an insect bite or sting:
- Follow-up is not usually required unless symptoms are worsening.
- If the person presents with a severe local reaction, consider reviewing within 2–3 days.
- Advise urgent medical review if symptoms of systemic toxicity develop.
- Remember to consider indications for referral to an allergy clinic.
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.
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.
Non-sedating oral antihistamines
Age from 2 years to 5 years 11 months
Cetirizine s/f solution: 5mg once a day
Cetirizine 1mg/ml oral solution sugar free
Take one 5ml spoonful once a day.
Supply 100 ml.
Loratadine syrup: 5mg once a day
Loratadine 5mg/5ml oral solution
Take one 5ml spoonful once a day.
Supply 100 ml.
Age from 6 years to 11 years 11 months
Cetirizine s/f solution: 10mg once a day
Cetirizine 1mg/ml oral solution sugar free
Take two 5ml spoonfuls once a day.
Supply 100 ml.
Loratadine syrup: 10mg once a day
Loratadine 5mg/5ml oral solution
Take two 5ml spoonfuls once a day.
Supply 100 ml.
Age from 12 years onwards
Cetirizine tablets: 10mg once a day
Cetirizine 10mg tablets
Take one tablet once a day.
Supply 14 tablets.
Fexofenadine tablets: 180mg once a day
Fexofenadine 180mg tablets
Take one tablet once a day.
Supply 14 tablets.
Loratadine tablets: 10mg once a day
Loratadine 10mg tablets
Take one tablet once a day.
Supply 14 tablets.
Short course of oral prednisolone (adults)
Age from 12 years onwards
Prednisolone tablets: 40mg each morning for 3 days
Prednisolone 5mg tablets
Take eight tablets each morning (as a single dose) for 3 days.
Supply 24 tablets.
Prednisolone tablets: 50mg each morning for 3 days
Prednisolone 5mg tablets
Take ten tablets each morning (as a single dose) for 3 days.
Supply 30 tablets.
Prednisolone tablets: 40mg each morning for 5 days
Prednisolone 5mg tablets
Take eight tablets each morning (as a single dose) for 5 days.
Supply 40 tablets.
Prednisolone tablets: 50mg each morning for 5 days
Prednisolone 5mg tablets
Take ten tablets each morning (as a single dose) for 5 days.
Supply 50 tablets.
Prednisolone e/c tablets: 40mg each morning for 3 days
Prednisolone 5mg gastro-resistant tablets
Take eight tablets each morning (as a single dose) for 3 days.
Supply 24 tablets.
Prednisolone e/c tablets: 50mg each morning for 3 days
Prednisolone 5mg gastro-resistant tablets
Take ten tablets each morning (as a single dose) for 3 days.
Supply 30 tablets.
Prednisolone e/c tablets: 40mg each morning for 5 days
Prednisolone 5mg gastro-resistant tablets
Take eight tablets each morning (as a single dose) for 5 days.
Supply 40 tablets.
Prednisolone e/c tablets: 50mg each morning for 5 days
Prednisolone 5mg gastro-resistant tablets
Take ten tablets each morning (as a single dose) for 5 days.
Supply 50 tablets.
Short course of oral prednisolone (children)
Age from 1 month to 1 year 11 months
Prednisolone soluble tablets: 10mg each morning for 3 days
Prednisolone 5mg soluble tablets
Take two tablets each morning (as a single dose) for 3 days.
Supply 6 tablets.
Age from 2 years to 5 years 11 months
Prednisolone soluble tablets: 20mg each morning for 3 days
Prednisolone 5mg soluble tablets
Take four tablets each morning (as a single dose) for 3 days.
Supply 12 tablets.
Age from 6 years to 11 years 11 months
Prednisolone soluble tablets: 30mg each morning for 3 days
Prednisolone 5mg soluble tablets
Take six tablets each morning (as a single dose) for 3 days.
Supply 18 tablets.
Prednisolone soluble tablets: 40mg each morning for 3 days
Prednisolone 5mg soluble tablets
Take eight tablets each morning (as a single dose) for 3 days.
Supply 24 tablets.
Scenario: Systemic reactions
Definition
- Anaphylaxis can occur after an insect sting (usually within minutes), particularly from a bee or wasp, and requires urgent action.
- Anaphylaxis after an insect bite is rare.
- Multiple bee or wasp stings may cause systemic toxicity which requires urgent action as this can be fatal, particularly in children.
- Late-onset reactions to stings can occur (after several hours), which present as urticarial reactions, or serum sickness-like reactions with urticaria, joint swelling and arthralgia.
How do I manage systemic reactions to an insect bite or sting?
- If a severe systemic reaction occurs, such as wheezing or other signs of respiratory distress, or hypotension:
- Treat urgently as for anaphylaxis and admit to hospital.
- If there are symptoms of systemic toxicity that suggest impending anaphylaxis (e.g. abdominal pain, vomiting, rhinitis and conjunctivitis, or a sense of impending doom):
- Treat as for anaphylaxis and admit to hospital.
- If generalized urticaria occurs, but the person is otherwise well:
- Give an oral antihistamine and an oral corticosteroid.
- Offer a non-sedating antihistamine to control daytime symptoms.
- Consider giving an additional sedating antihistamine at night if the itch is interfering with sleep.
- In adults, give prednisolone 40 mg once a day, and in children give 1–2 mg/kg body weight once a day.
- Continue prednisolone for 3–5 days, depending on the severity of the reaction.
- Advise the person to seek urgent medical help if the rash worsens, swelling develops which involves the mouth or throat, or wheeze or breathing difficulty occurs.
In depth
When should I refer or seek specialist advice?
- Admit all patients with anaphylaxis, after immediate emergency management.
- If mild symptoms appear to be worsening then admission may be required for observation (uncommon).
- The decision to admit will depend upon on the type of reaction, social circumstances, and access to local medical facilities. Exercise clinical judgement in these circumstances.
- Consider referral to an allergy clinic if an insect sting or bite has caused generalized symptoms.
- The Anaphylaxis Campaign recommends referral to an allergy clinic if there is a large local skin reaction, with redness and swelling over 10 cm in diameter. However clinicians should check the referral policy of their local allergy clinic as this may vary.
- Seek specialist advice from an allergy clinic or immunologist regarding local recommendations for interim management of anyone waiting to be seen by the allergy clinic.
In depth
What follow up is recommended?
- If symptoms of generalized urticaria are mild follow-up is generally not necessary.
- Advise review if they have worsening urticaria.
- Advise urgent medical review if symptoms of systemic toxicity develop.
- Anyone who has had anaphylaxis; check that an appointment has been made for referral to an allergy clinic.
Prescriptions
Non-sedating oral antihistamines
Age from 2 years to 5 years 11 months
Cetirizine s/f solution: 5mg once a day
Cetirizine 1mg/ml oral solution sugar free
Take one 5ml spoonful once a day.
Supply 100 ml.
Loratadine syrup: 5mg once a day
Loratadine 5mg/5ml oral solution
Take one 5ml spoonful once a day.
Supply 100 ml.
Age from 6 years to 11 years 11 months
Cetirizine s/f solution: 10mg once a day
Cetirizine 1mg/ml oral solution sugar free
Take two 5ml spoonfuls once a day.
Supply 100 ml.
Loratadine syrup: 10mg once a day
Loratadine 5mg/5ml oral solution
Take two 5ml spoonfuls once a day.
Supply 100 ml.
Age from 12 years onwards
Cetirizine tablets: 10mg once a day
Cetirizine 10mg tablets
Take one tablet once a day.
Supply 14 tablets.
Fexofenadine tablets: 180mg once a day
Fexofenadine 180mg tablets
Take one tablet once a day.
Supply 14 tablets.
Loratadine tablets: 10mg once a day
Loratadine 10mg tablets
Take one tablet once a day.
Supply 14 tablets.
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.
Short course of oral prednisolone (adults)
Age from 12 years onwards
Prednisolone tablets: 40mg each morning for 3 days
Prednisolone 5mg tablets
Take eight tablets each morning (as a single dose) for 3 days.
Supply 24 tablets.
Prednisolone tablets: 50mg each morning for 3 days
Prednisolone 5mg tablets
Take ten tablets each morning (as a single dose) for 3 days.
Supply 30 tablets.
Prednisolone tablets: 40mg each morning for 5 days
Prednisolone 5mg tablets
Take eight tablets each morning (as a single dose) for 5 days.
Supply 40 tablets.
Prednisolone tablets: 50mg each morning for 5 days
Prednisolone 5mg tablets
Take ten tablets each morning (as a single dose) for 5 days.
Supply 50 tablets.
Prednisolone e/c tablets: 40mg each morning for 3 days
Prednisolone 5mg gastro-resistant tablets
Take eight tablets each morning (as a single dose) for 3 days.
Supply 24 tablets.
Prednisolone e/c tablets: 50mg each morning for 3 days
Prednisolone 5mg gastro-resistant tablets
Take ten tablets each morning (as a single dose) for 3 days.
Supply 30 tablets.
Prednisolone e/c tablets: 40mg each morning for 5 days
Prednisolone 5mg gastro-resistant tablets
Take eight tablets each morning (as a single dose) for 5 days.
Supply 40 tablets.
Prednisolone e/c tablets: 50mg each morning for 5 days
Prednisolone 5mg gastro-resistant tablets
Take ten tablets each morning (as a single dose) for 5 days.
Supply 50 tablets.
Short course of oral prednisolone (children)
Age from 1 month to 1 year 11 months
Prednisolone soluble tablets: 10mg each morning for 3 days
Prednisolone 5mg soluble tablets
Take two tablets each morning (as a single dose) for 3 days.
Supply 6 tablets.
Age from 2 years to 5 years 11 months
Prednisolone soluble tablets: 20mg each morning for 3 days
Prednisolone 5mg soluble tablets
Take four tablets each morning (as a single dose) for 3 days.
Supply 12 tablets.
Age from 6 years to 11 years 11 months
Prednisolone soluble tablets: 30mg each morning for 3 days
Prednisolone 5mg soluble tablets
Take six tablets each morning (as a single dose) for 3 days.
Supply 18 tablets.
Prednisolone soluble tablets: 40mg each morning for 3 days
Prednisolone 5mg soluble tablets
Take eight tablets each morning (as a single dose) for 3 days.
Supply 24 tablets.
Scenario: Infected sting or bite
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.