Insect bites and stings – when to refer…


Insect bites and stings – when to refer…

July 25, 2019

The hot weather has meant many more of our patients and customers are spending time outdoors, and with insect activity also increased many more people are visiting our pharmacies complaining about bites and stings. We have been hearing concerns from GPs and via our colleagues in the Local Medical Committee (LMC) that they are seeing a large number of referrals to GPs, many of which are not appropriate.

Most bites and stings will resolve on their own, although some may cause discomfort for a number of days, and give rise to a number of symptoms depending on the type of insect.

Whilst we are all in a position to provide advice on self care, and signpost patients to support such as that on the website, it is important that we only refer patients to other services (including GPs, out of hours centres or A&E) when there is a genuine concern of secondary infection (however – see below!), anaphylaxis, or risk of spreading a serious illness such as Lyme Disease or malaria.

Supporting material
For pharmacy professionals, check out the NICE Clinical Knowledge Summary on Insect Bites and Stings at:!scenario:2
For pharmacy support staff, reviewing the information on the website would be appropriate:

Suggested approach
Upon presentation at the pharmacy, please follow the following guideline:

  • Priovide advice on self-care, offer appropriate OTC products (eg oral antihistamines, topical hydrocortisone if appropriate, simple analgesia) and under what circumstance the patient should see a GP or other healthcare professional.
  • If the above has been tried without any improvement over a number of days, or if symptoms are worstening without concern of systemic complications – refer to a pharmacy providing the Pharmacy First Extended Care service for insect bites. You can access a list HERE – they are trained to identify when insect bites are infected and need treating with antibiotics – remind the patient to call first to check the relevant pharmacist is available – or call for them. Only refer to a GP if the patient is unable to access an Extended Care pharmacy without undue delay.
  • If you have a genuine concern that the bite may have complications of Lyme Disease or malaria, refer to the GP; if you have concerns over anaphylaxis you must call 999 and request an ambulance.

Thank you in anticipation.

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