Insect Bite

1. See also
   1. Allergic Reaction
   2. Stinging Insect Allergy
   3. Bee sting
   4. Mosquito Bite
   5. Scorpion
   6. Brown Recluse Spider
   7. Black Widow Spider
2. Complications
   1. Anaphylaxis or other serious Allergic Reaction
   2. Papular Urticaria
   3. Vector Borne Disease
   4. Cellulitis
      1. Inflammation out of proportion to Insect Bite
      2. Regional Lymphadenopathy
      3. Ascending lymphangitis
3. Management: General
   1. Remove Stinger with forceps (avoid pinching the Stinger gland)
   2. Apply ice pack for 10 minutes per hour for 3 hours
      1. Contraindicated in Tarantula Bite
   3. Treat itch symptomatically (e.g. Benadryl, Zyrtec)
4. Management: Acute Allergic Reaction
   1. See Anaphylaxis
   2. Prescribe Epi-Pen for emergency use for those with Anaphylaxis history
5. Management: Suspected Cellulitis
   1. Antibiotic
      1. Erythromycin
      2. Doxycycline
      3. Penicillin
      4. Cephalosporin (1st generation)
   2. Tetanus prophylaxis
      1. Update Tetanus Vaccine (Td)
      2. Tetanus Immune Globulin (BayTet)
6. Prevention
   1. See Prevention of Vector-borne Infection
   2. Check clothes for insects before donning
   3. Avoid habitats
      1. Woodpiles
      2. Crawl spaces
      3. Corners of buildings
   4. Dress for working outdoors
      1. Keep skin covered by clothing
         1. Wear gloves
         2. Shirt tucked into pants
         3. Pants tucked into socks
         4. Wear a hat and high collar
         5. Avoid loose clothing
      2. Avoid insect attractants
         1. Bright colors
         2. Perfumes
   5. Insect Repellants
      1. DEET
         1. Mosquitoes
         2. Fleas
         3. Gnats
         4. Chiggers
      2. Permethrin (Elimite, Nix) on clothes
         1. Ticks
7. References
   1. Kemp (1998) Postgrad Med 103(6):88-106
   2. Norris (1998) Physician and Sports Med 26(7):47-58