Using the Pharmacy First service

Pharmacy teams seeing patients asking about insect bites can explain about the Pharmacy First service for infected insect bites, which may mean the pharmacist can offer them treatment and advice that can help.

The NHS Pharmacy First clinical pathway for infected insect bites and stings is for children aged one year and over, and adults, who are showing clear evidence of infection that is present or worsening at least 48 hours after the initial bite or sting, with three or more of the following symptoms:

• Redness of the skin
• Pain or tenderness to the area
• Swelling of the skin
• Skin surrounding the bite(s) or sting(s) feels hot to touch
• Redness or swelling of the skin surrounding the bite(s) or sting(s) is spreading
• Evidence of pustular discharge at site of bite(s) or sting(s).

AND any of the following:

• Redness or swelling of the skin surrounding the bite(s) or sting(s) is spreading
• Evidence of pustular discharge at site of bite(s) or sting(s).

Patients would be excluded from the service if consent is refused and documented in their medical notes; if they are under one year of age; if they are under 16 years or age and pregnant or pregnancy is suspected; for severely immunosuppressed individuals as defined in Chapter 28a of the Green Book; or if they have a history of severe immediate hypersensitivity reaction (e.g. anaphylaxis) to another beta-lactam antibiotic (e.g. cephalosporin, carbapenem or monobactam).

Other criteria for exclusion include (but are not limited to) no clear evidence of infection; failed previous antibiotic for this episode of infected insect bite or sting; severe pain out of proportion to the wound (which may indicate the presence of toxin-producing bacteria; if the bite came from a human or animal; the bite or sting occurred while travelling outside the UK; or bites caused by ticks due to the risk of Lyme disease.

If the person is excluded from the service the pharmacist will record the reason for exclusion in the appropriate clinical record and give them self care advice. The pharmacist can still refer their patient to their GP or other appropriate healthcare setting for further assessment if needed, and they will also advise the person to attend A&E urgently if they are showing signs of having a systemic reaction to an insect bite or sting such as anaphylaxis, or if sepsis is suspected.

However, if these criteria do apply, the pharmacist can supply flucloxacillin capsules/oral solution/oral suspension (subject to inclusion/exclusion criteria in the patient group direction (PGD)) and will share the TARGET self care leaflet as well as NHS information on insect bites and stings. Where relevant, the person can also be given information from UKHSA on tick awareness, and from The Anaphylaxis Campaign on insect sting allergy.