Effective strategies for identifying and eradicating bedbug infestations and managing symptoms of bites. Detect infestations with manual inspections or attractant-based traps, and treat bites with topical hydrocortisone or antihistamines for itch relief. Explore proven methods like washing bedding in hot water, vacuuming, steam cleaning, and using diatomaceous earth for infestation control, and consider professional pest control for persistent cases.
January 9, 2025

Bedbugs: How to Treat and Eradicate

Evidence-Based Over-The-Counter Guide

William Shen

William Shen

Co-founder & CPO

See all guides. Have more questions?

Bedbugs (Cimex lectularius) are small, reddish-brown parasitic insects that feed on the blood of humans and animals. They are primarily nocturnal and can infest beds, furniture, and other household items. Treatment focuses on eradicating infestations and managing symptoms of bites.

Bedbug bites themselves may be hard to distinguish from other arthropod bites. Infestation can be confirmed by inspection of rest areas, such as beds, sofas, and their surroundings. 

First-line recommendations:

  • Confirmation of infestation: Manual inspection and use of attractant-based bedbug traps (“monitors” or “interceptors”) are commercially available and may be useful for detecting low-level infestations. Bedbug interceptor device.

  • Cleaning bites: Wash with soap or antiseptic solutions.

  • Symptomatic treatment: Topical glucocorticoids such as hydrocortisone 1% can be used once or twice a day for up to 7 days. 1% Hydrocortisone Cream (FDA M017)

Second-line recommendations:

  • Antihistamines: Topical antihistamines can be used instead of hydrocortisone. 2% Diphenhydramine HCl (M017). Antihistamines taken orally may also be helpful if bites are particularly widespread or itchy. Don’t take for more than 1-2 days at a time. Fexofenadine HCI 180mg (NDA 21909/S-003).

  • Diatomaceous earth (food-grade): Use on cracks and crevices. Food Grade Diatomaceous Earth.

Infestation eradication:

  • Wash: Clothing and bedding in hot water (≥60°C/140°F) and dry on high heat for at least 30 minutes.

  • Vacuum: Clean affected areas thoroughly, especially mattress seams, furniture crevices, and baseboards. Dispose of vacuum bags or waste basket outdoors immediately. Vacuum with accessory tools.

  • Protect: Cover mattresses and pillows in bedbug-proof covers after steaming or washing.

  • Steam cleaning: For infested areas and items. Steam clean floors, wall seams, and furniture around the bedroom and house. 10-in-1 Handheld Steam Cleaner.

Professional pest control services:

  • Thermal remediation (heat treatment) or professional pesticide application may be required for large or persistent infestations.

Citation

Parola, P., & Izri, A. (2020). Bedbugs. New England Journal of Medicine, 382(23), 2230-2237.

What OTC evidence is reviewed?

  • For each condition, we performed a literature review to find a recent widely cited expert group guideline published in the leading specialty-specific peer-reviewed journal or top general medical journal.

  • Based on the recommendations in the publication, we identify recommended active ingredients and devices that are available over-the-counter per FDA regulations.

What evidence is prioritized?

Levels of evidence considered:

  • Tier 1 (Safe and Definitely Effective): Professional field consensus or multiple randomized controlled clinical trials showing the same conclusion. Wherever possible, we use Tier 1 evidence for "first-line" recommendations.

  • Tier 2 (Safe and Probably Effective): Individual clinical trials which may be discordant or large-scale observational experience. Tier 2 evidence may inform "first-line", "second-line", or "supplement" recommendations.

  • Tier 3 (Safe and Maybe Effective): Mechanistic plausibility without high-quality clinical evidence of efficacy but high-quality evidence of safety. Tier 3 evidence may inform "second-line" or "supplement" recommendations.

How does MDandMe select recommended products?

  • Based on the top clinical recommendation, we evaluate products containing the recommended active agent with FDA-approved dosage based on price, average customer reviews, how often it is purchased, and how quickly it will ship to home. 

  • We provide public documentation of the active ingredients in our recommendations, using all 32 FDA monographs, Prescription-to-Nonprescription (Rx-to-OTC) Switches, as well as New Drug Application (NDA) approvals.

How does MDandMe select recommended devices?

  • Based on the top clinical recommendation, we evaluate devices that are FDA-cleared or comply with other medical guidelines (if not a FDA-regulated category) by reputability, price, and average customer reviews.

  • We provide public documentation of supporting evidence for each device.  

Where do I view other OTC guides?

Browse topic list here:

You can view all of our published OTC guides here.