Treat and prevent bug or insect bites with effective OTC at-home remedies and prevention strategies. Soothe itching and swelling with options like hydrocortisone 1% cream, diphenhydramine with zinc acetate, or calamine lotion. Clean bites with antiseptic solutions to prevent infection, and avoid future bites using DEET-based repellents or permethrin-treated clothing. For severe allergic reactions or secondary infections, explore prescription options like oral antihistamines, antibiotics, or epinephrine.
January 8, 2025

Bug and Insect Bites: Treat and Prevent

Evidence-Based Over-The-Counter Guide

William Shen

William Shen

Co-founder & CPO

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Bug bites commonly cause localized reactions such as itching, redness, and swelling. Some bites may lead to allergic reactions or infections. If you believe that you have been bitten by a venomous spider or insect, please seek urgent medical evaluation. 

Local effects can be treated symptomatically with topical or oral antihistamines, calamine lotion, topical corticosteroids, cold compresses, or, in severe cases, systemic glucocorticoids. According to a 2022 review in the American Journal of Family Medicine, there are limited data to support one treatment over another.

At-home medicinal options:

  • Antiseptic cleanser: Wash the bite with soap and antiseptic solution or wipe to reduce the risk of infection. Analgesic & Antiseptic Wipes (FDA M003/M017). 

  • Diphenhydramine and zinc acetate: Applied to the affected area to relieve pain and itching. Dose: Diphenhydramine HCl 2% and zinc acetate 0.1% applied up to 3-4 times daily for adults and children over 2 years old. Diphenhydramine 2% zinc 0.1% gel (FDA M017/M016).

  • Hydrocortisone 1% cream: Apply 2-3 times daily to reduce inflammation and itching. Hydrocortisone 1% cream.

  • Calamine lotion: Soothes irritation and provides a protective barrier. Calamine Lotion (FDA M016).

Prevention:

  • N,N-diethyl-m-toluamide (DEET): 20% to 50% is the most studied and widely recommended insect repellant. DEET 40% Aerosol Spray (EPA 56575-11).

  • Permethrin-impregnated clothing: Can help prevent arthropod bites and stings. Premium Permethrin 0.5%.

Prescription medications:

  • Oral antihistamines: Prescription-strength antihistamines, such as hydroxyzine, may be used for severe pruritus.

  • Antibiotics: Prescribed if secondary bacterial infection develops, such as cellulitis.

  • Epinephrine: For systemic allergic reactions (anaphylaxis), an epinephrine injection (e.g., EpiPen) may be required.

Citation:

Herness, J., Snyder, M. J., & Newman, R. S. (2022). Arthropod bites and stings. American family physician, 106(2), 137-147.

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.  

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