Insect Bites Medication

  • Author: Bo Burns, DO, FACEP, FAAEM; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Feb 14, 2011
 

Medication Summary

Goals of therapy are to treat anaphylaxis and prevent complications.

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Cardiovascular agents

Class Summary

Act to decrease the muscle tone in the small and large pulmonary airways and increase vascular tone.

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Epinephrine (Adrenalin, Bronitin, EpiPen)

 

Drug of choice for shock, angioedema, airway obstruction, bronchospasm, and urticaria in severe anaphylactic reactions. Administer IM; administer IV to patients in extremis; may be administered SL or ET when no IV access available. Continuous infusion may be given in cases of refractory shock.

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Bronchodilators

Class Summary

Through activation of cyclic AMP, beta agonists stimulate the ATPase pump, thereby shifting potassium into the intracellular compartment and stimulating an adrenergic response.

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Albuterol (Ventolin)

 

Beta agonist useful in treating bronchospasms refractory to epinephrine. Relaxes bronchial smooth muscle by action on beta2 receptors and has little effect on cardiac muscle contractility. Numerous inhaled beta agonists are used for treatment of bronchospasm; albuterol is used most commonly.

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Antihistamines

Class Summary

Prevent histamine response in sensory nerve endings and blood vessels; more effective in preventing histamine response than in reversing it. H2 antihistamines are useful in treatment of anaphylactic reactions when used concomitantly with H1 antagonists. Many H2 blockers are available. Cimetidine is the prototype drug.

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Diphenhydramine (Benadryl)

 

Used for symptomatic relief of allergic symptoms caused by histamines released in response to allergens; many effective H1 blockers; diphenhydramine is effective and widely available.

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Cimetidine (Tagamet)

 

An H2 antagonist that, when combined with H1 type, may be useful to treat itching and flushing in anaphylaxis, pruritus, urticaria, and contact dermatitis that do not respond to H1 antagonists alone. Use in addition to H1 antihistamines.

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Corticosteroid, Systemic

Class Summary

Have anti-inflammatory properties and cause profound and varied metabolic effects. In addition, these agents modify the body's immune response to diverse stimuli. Prednisone and methylprednisolone are typical drugs of this class. Oral bioavailability is generally similar to parenteral; administer oral prednisone when indicated if a patient is not in extremis and can comfortably take PO; administer parenteral steroid when indicated for a patient in more severe circumstances.

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Prednisone

 

Believed to ameliorate delayed effects of anaphylactic reactions and may limit biphasic anaphylaxis. Doses below are general guidelines for usage; dosing is highly individualized.

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Methylprednisolone (Solu-Medrol, Depo-Medrol)

 

Useful to treat inflammatory and allergic reactions. By reversing increased capillary permeability and suppressing PMN activity, may decrease inflammation.

A multitude of corticosteroid preparations is available. Methylprednisolone is widely available in the ED due to other uses (ie, acute asthma, spinal cord injury) and is supplied in both parenteral and oral formulations.

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Toxoids

Class Summary

For active immunity against tetanus.

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Tetanus toxoid adsorbed or fluid

 

Used to induce active immunity against tetanus in selected patients. The immunizing agents of choice for most adults and children > 7 y are tetanus and diphtheria toxoids. Necessary to administer booster doses to maintain tetanus immunity throughout life.

Pregnant patients should receive only tetanus toxoid, not a diphtheria antigen-containing product.

In children and adults, may administer into deltoid or midlateral thigh muscles. In infants, preferred site of administration is mid thigh laterally.

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Immunoglobulins

Class Summary

Consists of administration of immunoglobulins pooled from serum of immunized patients.

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Tetanus immune globulin (TIG)

 

Used for passive immunization of any person with a wound that may be contaminated with tetanus spores.

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Contributor Information and Disclosures
Author

Bo Burns, DO, FACEP, FAAEM  Assistant Professor, Associate Residency Director, Medical Clerkship Director, Department of Emergency Medicine, University of Oklahoma School of Community Medicine; Attending Physician, Department of Emergency Medicine

Bo Burns, DO, FACEP, FAAEM, is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Kavon Charles Azadi, MD  Resident Physician, Oklahoma Institute for Disaster and Emergency Medicine, University of Oklahoma College of Community Medicine, Department of Emergency Medicine

Kavon Charles Azadi, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, American Medical Student Association/Foundation, and Oklahoma State Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Robert M McNamara, MD, FAAEM  Chair and Professor, Department of Emergency Medicine, Temple University School of Medicine

Robert M McNamara, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Association, Pennsylvania Medical Society, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD  Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Gino A Farina, MD, FACEP, FAAEM  Associate Professor of Clinical Emergency Medicine, Albert Einstein College of Medicine; Program Director, Department of Emergency Medicine, Long Island Jewish Medical Center

Gino A Farina, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Miguel C Fernandez, MD, and Nicolas F Arredondo, MD, to the development and writing of this article.

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Insect Bites. Yellowjacket wasp. Image courtesy of CDC.
Insect Bites. Anopheles albimanus mosquito feeding on human host. Image courtesy of CDC.
Insect Bites. A bedbug, Cimex lectularius, feeding on human blood. The bedbug's name comes from its preferred habitat, including mattresses, sofas, and other furniture. Image courtesy of CDC.
Insect Bites. Louse, Pediculus humanus, dorsal view after feeding on blood. Most lice are scavengers, feeding on skin and other debris found on the host's body, but some species feed on sebaceous secretions and blood. Image courtesy of CDC.
 
 
 
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