Bedbug Bites Treatment & Management

Updated: Mar 05, 2018
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Treatment

Approach Considerations

Medical care of bedbug bites depends on the patient's clinical picture. Treatment of these bites is not usually required. However, if secondary infection occurs, apply local antiseptic lotion or antibiotic cream or ointment. Creams with corticosteroids and oral antihistamines may be advised in the presence of an allergic reaction. Infestation often leads to nervousness, anxiety, and insomnia. [3]

Papular Urticaria and Acute Urticaria for complete information on these topics.

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Prevention of Bedbug Bites

To reduce bedbug infestations, use insecticides and eliminate bedbug hiding sites. [26] However, due to the development of insecticide resistance, new tools and techniques are needed for bed bug control. Behavior and physiology modifying chemicals may be exploitable for this purpose. [27]

Because bites occur on exposed skin surfaces, advise affected individuals to wear nightclothes that cover as much skin as possible.

Permethrin, diethyltoluamide, and pyrethrums

A number of insecticides are effective, including permethrin, and diethyltoluamide is an excellent insect repellent. Bedbugs feeding after insecticide exposure may alter the effects of the pesticide on bedbug mortality. [28] Permethrin spray can be applied to clothing. Combined use of permethrin-treated clothing and cutaneous diethyltoluamide may be considered. In an African survey of rural homes, bed nets impregnated with permethrin were responsible for the disappearance of bedbugs. [29]

Note that encephalopathy may occur in children exposed to high concentrations of diethyltoluamide. Infant bedding can be treated separately with pyrethrums.

To prevent bedbugs from gaining access to the bed, try inserting bedposts of bedbug-free beds into containers of paraffin oil. However, bedbugs can be resourceful; they have been known to climb walls and across ceilings to drop onto their victims during the night. See the image below.

Treatment for bedbug bites is typically supportive Treatment for bedbug bites is typically supportive. Local antiseptic lotions or antibiotic creams can be applied for secondary infections, whereas corticosteroid creams and oral antihistamines can be used for allergic reactions. Bedbugs can be eliminated through the use of permethrin insecticides, baited traps, special bedbug-free beds, and bed nets. Homemade methods, such as wrapping duct tape around bed legs as shown, may be effective, but bedbugs have been known to climb other objects and then fall down onto a bed. Image courtesy of Wikimedia Commons.

Control and elimination measures

Structural insect proofing can be performed to prevent the bugs from entering homes and beds, in addition to using control measures such as spraying infested buildings with insecticides such as malathion. Eradication of a bedbug infestation may require a professional exterminator.

Bedbug control can be challenging. One approach is room heat treatment, vacuuming, and nonchemical pesticides, and possibly chemical ones.

A heat treatment method to eliminate bedbug infestations in room contents has been evaluated. [30] High temperatures caused temporary immobilization even with exposures that did not have lethal effects. One method for limited heat treatment of furniture and other room contents required equipment costing less than US$400 and provided an opportunity for residual pesticide application with minimal disruption in use of the treated room.

Baited traps may be effective tools for evaluating bedbug control programs and detecting early bedbug infestations. Carbon dioxide was significantly more attractive to bed bugs than heat. [31]

Widespread resistance to pyrethroid and neonicotinoid insecticides favors consideration of the newly developed fungal biopesticide Aprehend, containing Beauveria bassiana, against insecticide-resistant bedbugs. [35] Aprehend may be equally effective against insecticide-susceptible and insecticide-resistant bedbugs and represents a possible new tool for bedbug control.

Bedbug management in homes and apartments may benefit from early detection, a key to slowing spread and reducing management cost. [34] A variety of passive monitors that detect low-level bedbug infestations are on the market.

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Special Concerns

At this time, no evidence suggests bedbugs actually transmit pathogens to humans. [32] Theoretically, failure to diagnose bedbug bites puts a patient at increased risk of hepatitis B or some other infection. Because bedbugs may at least theoretically transmit disease, the physician may be at medicolegal risk if the patient develops any such infection. Reinhardt et al suggest the delayed reaction time of skin to bites has implications in litigation, such as when people seek compensation from hotels. [20]

DEET is a highly effective bedbug repellent, but it has a substantial order and can dissolve certain plastics. [33]

Bedbugs can spread through ventilation ducts, water pipes, and gutters and can travel in clothing and luggage. [4] Travelers should examine hotel rooms, looking behind the headboard and in mattress seams, for evidence of bedbugs.

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