Help for ineligible patients

As with all of the Pharmacy First services, if patients don’t meet the gateway for the infected insect bites or stings service the pharmacist can advise them of alternative non-antibiotic treatment – such as oral antihistamines – and provide a TARGET self care leaflet and safety netting advice. They will also advise the patient to draw a line around the border of the bite or sting, or take clear photos, and to return to the pharmacy for pharmacist reassessment if their symptoms worsen at any time or do not improve after three days of self care.

In the meantime, pharmacy teams can advise customers that most insect bites and stings only cause a small reaction that can be treated at home with self care and OTC products available from the pharmacy.

For example, oral antihistamine such as acrivastine, chlorphenamine or cetiritzine relieve itching and reduce redness and swelling associated with a bite or sting.

“I usually recommend acrivastine capsules (Benadryl Allergy) for children over 12 and adults,” says clinical pharmacist, Rita Ghelani. “This is a fast-acting antihistamine which can be taken up to three times a day that helps to reduce itching and irritation from a bite. Topical antihistamines such as mepyramine (Anthisan cream) can also help to provide quick relief and are suitable for use in children over two years old.”

Rita also recommends hydrocortisone cream: “Hc45 cream or a generic brand is very effective at reducing itching and redness. This can be applied twice a day for a maximum of seven days. It is suitable for children over 10 years old and can be used in conjunction with an oral antihistamine.

“Other topical preparations to help with bites include local anaesthetics such as benzocaine, which can be soothing and help stop itching. Using Aloe Vera gel can also help to calm redness of the skin and provides a cooling effect.”

Since skin redness and itching are common with bites and stings and may last for up to 10 days, Rita adds: “Remember to advise customers to avoid scratching as much as possible, to reduce inflammation and the risk of infection, and using oral antihistamines regularly will help with this.

“It is unlikely that the skin will become infected after a bite, but if a customer is worried about this then you can offer them antiseptic wipes to keep the area clean, and remind them to seek help if symptoms worsen.”