Who to refer & red flags

The PGDs for infected insect bites list specific criteria for referral. Most of the people who attend pharmacies with suspected infected insect bites or stings will not be systemically unwell but may be concerned because of local pain and inflammation. 

A few patients may have symptoms suggesting more severe illness (e.g. signs of a systemic hypersensitivity reaction) or who are at risk of severe illness (e.g. immunosuppressed individuals). 

It is important to recognise this and ensure they get urgent care. Pharmacists are not expected to diagnose unusual conditions but to recognise those that do not fit the picture for infected insect bites or stings and refer appropriately.  

Some patients who do not meet the criteria for the PGDs may seek assessment by a pharmacist (e.g. those with tick bites and signs of Lyme disease). These patients will need referral. Potentially serious infected skin conditions that are outside the scope of the PGD are listed in the clinical pathway and relevant PGDs. 

Refer to A&E or call 999 if: 

• There are signs of a systemic hypersensitivity reaction or anaphylaxis
• There is airways obstruction (e.g. sting in the mouth or throat) or concerns for orbital (around the eye) cellulitis due to a bite or sting close to the eyes
• The individual is severely immunosuppressed and has signs or symptoms of infection.