pharmacy first infected insect bite

Question 1

for what age group does this pathway cover

Answer 1

1 year+
excluding pregnant individuals under 16

Question 2

what red flags are important to rule out

Answer 2

anaphylaxsis
immunosurpressed patient
airway obstruction
orbital cellulitis
sting around eyes
NEWS2 if signs of deteriorating illness

Question 3

what is the inclusion criteria for this pathway

Answer 3

at least 48 hours since the initial sting/bite
3 or more of the following:
☐ Redness of skin
☐ Pain or tenderness to the area
☐ Swelling of skin
☐ Skin surrounding the bite feels hot to touch
THEN
any of the following
☐ Redness and swelling of skin surrounding
the bite is spreading
☐ There is evidence of pustular discharge at
site of bite/sting?

Question 4

what is the exclusion criteria for this pathway

Answer 4

Does the patient meet ANY of the following criteria:
☐ Bite or scratch caused by animal(s)
☐ Bite caused by human(s)
☐ Bite caused by tick in the UK and signs of Lyme disease such as erythema migrans
(bullseye) rash
☐ Bite or sting that occurred while travelling outside of UK with concern of insect
borne diseases e.g. malaria, tick borne encephalitis
☐ Bite or sting caused by an unusual or exotic insect

Question 5

if the patinet has been bitten or stung outside of the UK, can they be treated via pharmacy first

Answer 5

No, reffer to GP

Question 6

what drugs are associated with the treatment of infected insect bite

Answer 6

flucloxacillin
clarithromycin (penicillin allergic)
erythromycin (pregnant)

Question 7

what self care advice should we offer the patinet

Answer 7

avoid scratching - can use oral antihistamine
otc pain relief such as paracetamol

Question 8

symptoms required for antibiotic treatment

Answer 8

redness and swelling of skin surrounding bite is spreading
pus/discharge

Question 9

what advice should be given to patients with symptoms of infected insect bite but dont qualify for antibiotics

Answer 9

Clearly demarcate the area and ask patient to monitor
Ask patient to return to pharmacy if symptoms worsen at any time OR do not improve after 3 days of over the counter treatment for pharmacist reassessment

Question 10

how should clarithromycin be taken with food

Answer 10

with or without food

Question 11

how should flucloxacillin be taken

Answer 11

1 hour before or 2 hours after food
swallow capsules whole