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NICE publishes antimicrobial prescribing guideline on insect bites and stings

NICE has published a new guideline, developed jointly with Public Health England, covering the management of insect bite and stings, including those that have occurred outside of the UK.

The guideline says that antibiotics should not be given for an insect bite or sting in people who do not have symptoms or signs of an infection.

As bacterial infection is rare, most insect bites and stings can be treated at home with simple first aid, with advice from a community pharmacist, the guideline says.

It also notes that redness, itchiness or pain and swelling after an insect bite or sting is much more likely to be an inflammatory or allergic reaction rather than an infection, especially with rapid onset.

Insect bites and stings are the second most common cause of serious allergic reactions, so the guideline recommends that people with symptoms of a serious allergic reaction should be referred for urgent care.

It also highlights the importance of considering a referral or seeking specialist advice for people at higher risk. This includes people who are severely immunocompromised and have symptoms or signs of an infection, people who have had a previous systemic allergic reaction to the same type of bite/sting, people with a bite/sting in the mouth or throat or around the eyes and people with fever or persistent lesions following an insect bite/sting from outside the UK because this may indicate a more serious illness such as malaria.

Where there are symptoms and signs of infection, these most likely indicate cellulitis and so should be treated with antibiotics in line with the NICE guideline on cellulitis and erysipelas.

The guideline committee says it is also important to prompt people to think about whether the bite may be a tick bite, so that appropriate treatment can be given in line with the NICE guideline on Lyme disease.


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