Module overview & key information

The vast majority of insect bites and stings heal spontaneously without problems. They may be intensely itchy and inflamed for a few days and require some symptomatic treatment. 

Inflamed, often excoriated skin presents an opportunity for infection and a small number of insect bites or stings will become infected a few days after the initial injury. These require treatment to prevent the development of more serious infections (e.g. cellulitis or sepsis). 

There is no need for prophylactic antibiotic treatment of insect bites. Rapid-onset reactions to bites or stings are more likely to be allergic or inflammatory rather than infectious in origin.

Diagnosis

The diagnosis of infected insect bites and stings is based on the history and examination.

Taking a history

Ask about the onset, site, appearance and duration of symptoms including:

• Local symptoms such as pain, swelling and erythema
• Symptoms that could indicate a systemic reaction such as urticaria, rhinitis, wheezing, abdominal pain, vomiting and dizziness
• Risk factors for insect bites or stings such as outdoor activities, contact with domestic pets, overseas travel or contact with infested individuals (scabies)
• Was the bite or sting from a specific insect (e.g. bee, wasp, hornet) witnessed?
• History of serious reactions to insect bites or stings in the past
• Use of OTC and prescribed preparations for this episode – in some people, topical preparations can cause allergic or sensitivity reactions.