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Infected Insect Bites

(For adults and children aged 1 year and over)
Exclude: pregnant individuals under 16 years.

Consider the risk of deterioration, red flags or serious illness:
  • Signs of systemic hypersensitivity reaction or anaphylaxis
  • Severely immunosuppressed with signs/symptoms of an infection
  • Stings with risk of airway obstruction or concerns of orbital cellulitis
Gateway Point
Administer adrenaline (if anaphylaxis)

Consider calculating NEWS2 Score ahead of signposting patient to A&E or calling 999.
Does the patient meet ANY of the following criteria?
  • Bite or scratch caused by animal(s) or human(s)
  • Bite by tick in the UK and signs of Lyme disease (erythema migrans)
  • Bite/sting while travelling outside UK (concern of malaria, tick borne encephalitis)
  • Bite or sting caused by an unusual or exotic insect
Onward referral
• General practice
• Other provider
Has it been at least 48 hours after the initial insect bite or sting?
Is itch the principal symptom?
(In the absence of other signs of infection)
Skin redness and itching are common (lasts up to 10 days). Avoiding scratching reduces infection risk.

Recommend self care, oral antihistamine and/or topical steroids over the counter.
Infected insect bite less likely.

Recommend self care, oral antihistamine and/or topical steroids over the counter.
Gateway Point
Does the patient have acute onset of ≥3 of the following symptoms of an infected insect bite?
  • Redness of skin
  • Pain or tenderness to the area
  • Swelling of skin
  • Skin surrounding the bite feels hot to touch
Redness and swelling of skin surrounding the bite is spreading.

Clearly demarcate the area and ask patient to monitor.

Recommend self care, oral antihistamine and/or topical steroids. Return if worsens or no improvement in 3 days.
Does the patient meet ANY of the following criteria:
  • Patient systemically unwell
  • Known comorbidity which may complicate (e.g. peripheral arterial disease, chronic venous insufficiency, lymphoedema or morbid obesity)
  • Severe pain out of proportion to the wound
  • Patient has significant collection of fluid or pus
Onward referral
• General practice
• Other provider
Offer flucloxacillin (if no allergy) for 5 days (subject to PGD criteria) plus self care.
Reported penicillin allergy?
Offer clarithromycin for 5 days plus self care.
If pregnant
Offer erythromycin for 5 days plus self care.
SAFETY NETTING (FOR ALL PATIENTS):

If symptoms worsen rapidly or significantly at any time, OR do not improve after completion of 5 days treatment course -> Onward referral.