Infected insect bites
INFECTED INSECT BITES
ELIGIBILITY:1 Adults and children aged 1 year and over
EXCLUDE: Pregnant individuals under 16 years
INSECT BITES AND STINGS are common and usually only cause minor irritation. The main symptoms are pain at the site, along with a small, swollen lump on the skin which may itch.6
Bites and stings usually resolve quickly, lasting from a few hours to a few days. However, some can be painful or trigger a serious allergic reaction. Bites and stings can become infected if they are exposed to bacteria when they are not well looked after.6,7 You can advise those with bites and stings on how to prevent an infection, while eligible customers with infected bites and stings may be supported through the Pharmacy First service.
A worried looking mum approaches the counter with her 4-year-old son Alfie, who is visibly distressed and keeps scratching a small, swollen lump on his arm. She tells you that he has just been bitten by an insect in the park, and she noticed the Pharmacy First poster mentioning insect bites. She wants to know if the service can help him.
Firstly, it is important to ensure that Alfie is not experiencing any signs of a serious allergic reaction (anaphylaxis).
Call 999 if Alfie has any of these symptoms:6
Swelling of the lips, mouth, throat, or tongue
Breathing very fast or struggling to breathe
(includes wheezing, choking or gasping for air)Throat feels tight or struggling to swallow
Skin, tongue or lips turning blue, grey or pale
Confusion, dizziness, or drowsiness
Fainting and cannot be woken up
Is limp, floppy, or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus)
These can all be signs of a serious allergic reaction and may need immediate treatment in hospital.
Thankfully, Alfie isn’t showing any signs of anaphylaxis; however, you tell mum that if he starts to experience any of these symptoms, she should seek emergency assistance.
Click the button to find out whether this customer is eligible for referral.
REFERRAL OUTCOME
NOT referred to the Pharmacy First service
You recognise that the service is not suitable for Alfie as the bite is recent and is unlikely to be infected at this stage. However, you can still support Alfie and his mum in other ways.
"Although most bites improve quickly they can sometimes get infected, at which point the Pharmacy First service may be suitable. You should keep an eye on the bite and watch out for any signs of an infection, which may develop after 48 hours."1
SIGNS OF INFECTION
Signs mum should look out for over the next few days include:1,6
Redness of the skin
Pain or tenderness to the area
Swelling of skin
Skin surrounding the bite feels hot to touch
Pus at the site of the bite
Fever and swollen glands
SELF-CARE ADVICE
Mum can help manage Alfie’s symptoms and reduce the risk of infection:6
Carefully remove anything that might be left on or in Alfie’s arm
Wash the skin with soap and water to help lower the chance of infection
Put an ice pack wrapped in cloth or a clean cloth soaked in cold water on the bite for at least 20 minutes, as it is slightly swollen
Keep the affected area raised if possible
Alfie should avoid scratching the area, as this makes the bite more likely to get infected
OTC PRODUCTS
Alfie may benefit from using the following medicines for symptom relief:6,7
Oral antihistamines can help to relieve itching and reduce the allergic response
Paracetamol and ibuprofen can help to manage the pain. Ibuprofen specifically can help to reduce any inflammation caused by the bite. Remember to offer oral suspensions that are suitable for Alfie’s age
Topical steroids creams, such as hydrocortisone, are not suitable for Alfie’s age, but may be considered for adults and children over 10 years
It’s important to check about any existing medical conditions or medicines that Alfie may be taking with the pharmacist, to ensure suitability.
Complete the care
Mum tells you that she has some chlorphenamine solution at home that she will give him and see how he gets on. She recognises that the Pharmacy First service is only suitable for those with an infection and will come back if she is still concerned, however she is reassured knowing that the insect bite will likely resolve on its own.
KEY LEARNING POINT
Some customers may not be eligible for the service which can be disappointing, especially if they are distressed and in pain. However, you can still support them with personalised recommendations and reassurance. Recognising that antibiotics are not always the answer, particularly in self-limiting conditions, is key.