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Insect bites are common during the summer months and most clear up on their own with self-care advice and over-the-counter products, as Victoria Goldman explains…

Sometimes the bites can cause severe inflammation or an infection, which prompts patients to seek medical advice. According to an article in BMJ Open in 2023¹, two-thirds of patients presenting to out-of-hours primary care with insect bites are prescribed antibiotics.

Community pharmacists can prescribe antibiotics for infected insect bites through Pharmacy First, when appropriate, for customers aged one year and over.

However, with concerns about antimicrobial resistance, it’s important that pharmacists (and the rest of the pharmacy team) have a clear understanding of insect bites and their management.

Initial assessment

The first step in assessing a customer is to confirm that they have an insect bite that can be treated as part of Pharmacy First. They may have been bitten by a horse fly or spider instead, for example, or they may have a tick bite.

A distinctive bull’s eye rash at the site of a tick bite is a common sign of Lyme’s disease. What a customer assumes is an insect bite could even be caused by a non-bite-related skin infection or even skin cancer. Any unusual bites or skin lesions should be referred onto a GP.

“Infected insect bites take up around five percent of Pharmacy First queries in our pharmacy,” says Alexander Briggs, a pharmacist at Westcliffe Pharmacy in Shipley.

“We get around three or four a week, especially in the summer. Following the pathway is straightforward, and infected insect bites can usually be managed within the pharmacy.

“But difficulty can arise when people have just come back from holiday – making sure we’re treating an insect bite rather than anything resulting from a tropical disease.”

Kenny Chan, lead information services pharmacist at Numark, says that there could be several reasons why a patient with insect bites may need to be referred to their GP or another healthcare professional immediately.

“If the patient experiences systemic symptoms such as fever, chills, widespread rash, or swelling in areas away from the bite (such as the face or throat), this could suggest a more serious reaction or infection that needs medical evaluation,” he says.

“Patients with underlying health conditions, such as diabetes or compromised immune systems, may be at higher risk for complications from insect bites. These patients may require additional monitoring.”

Bite management

If an insect bite becomes infected, this doesn’t happen immediately. According to the 2020 National Institute for Health and Care Excellence (NICE) NICE Guideline NG182 on “Insect bites and stings: antimicrobial prescribing”², patients are advised to wait for 48 hours after the bite before seeking medical advice.

In the meantime, they can ease their symptoms with oral antihistamines or topical corticosteroids. Customers should return to the pharmacy if their symptoms worsen significantly or rapidly, or if they feel generally unwell.

“A challenge is knowing whether to give antibiotics or not,” says Mark Burdon, superintendent pharmacist at Burdon Pharmacies in Newcastle upon Tyne.

“Delayed prescriptions are very useful as a safety net – asking people to come back in a day or two if it’s not getting any better or the reaction is starting to spread.

“In the meantime, I prefer to suggest non-drug approaches, such as ice, which can take the itch away. But otherwise a mild steroid cream can be helpful.”

Skin redness and itching from an insect bite can last for up to ten days.

“Time is the most important thing,” says Alexander. “If a bite’s infected, it usually becomes less itchy and feels hot. If patients are worried, they could mark around the area with biro to see if it’s growing.”

Sports injuries

According to a five-year study led by researchers at the University of Bath,³ published in 2023, the risk of serious injury from most sports and exercise is very small.

The study, funded by the British Medical Association, found that the benefits of taking part in fitness activities far outweigh the dangers. However, injury risks for popular sports and other physical activities are increasing.

“Community pharmacists are in a great position to provide advice for the prevention and management of sports-related injuries,” says Ambrin Sethi, lecturer in clinical pharmacy practice at the University of Hertfordshire’s School of Health Medicine and Sciences. “However, currently they are under-utilised. This could be improved by providing training for pharmacists and pharmacy staff in this area and raising awareness within the local community.”

Simon Harris, the superintendent pharmacist at Cadbury Heath Pharmacy in Bristol, works closely with his local community. “In the past, we have sponsored local youth football clubs and had healthy living leaflets within the local gym,” he says.

“Both of these have resulted in increased awareness of how the local pharmacy team can help in the treatment and prevention of sport-related injuries.”

Sports injuries advice

If someone experiences a sprain or strain, they should follow the PRICE approach – Protect, Rest, Ice, Compression and Elevation. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are commonly recommended for short-term muscular pain due to their combined anti-inflammatory and analgesic properties.

However, these may not be suitable for everyone and aren’t advised for long-term use due to potential side-effects. Pharmacists should weigh the benefits against any potential risks.

“For bigger joints or muscular, oral ibuprofen tablets are usually more helpful,” says Mark Burdon.

“Topical NSAIDs, especially gels, are more appropriate when small joints are affected such as toes or fingers. Customer preference may depend on how a product feels or works – some products contain levomenthol, for example, and some pain patches contain NSAIDs whereas others don’t.

“Customers don’t always need to use a drug-based approach, and I often recommend products that don’t involve medication such as hot and cold products.”

Customers with more serious injuries or injuries that don’t improve with self-care should be referred to a GP, physiotherapist or orthopedic specialist.

“Pharmacists have a triage role,” says Alexander. “We can advise on whether a customer can use self-treatment, needs to see a physiotherapist or their GP or should go to A&E.”

References 

1. https://bmjopen.bmj.com/content/13/9/e070636#ref-8

2. https://www.nice.org.uk/guidance/ng182

3. https://injuryprevention.bmj.com/content/30/1/60