NHS treatment for infected insect bites

Most insect bites get better on their own. A small number become infected — spreading redness, warmth, swelling. Our pharmacist can assess yours and supply antibiotics if needed.

Tick bites and any bite with a bullseye (target) rash — please do NOT use this service. The NHS Pharmacy First insect-bite pathway specifically excludes tick bites due to the risk of Lyme disease. Contact your GP, call NHS 111, or visit an Urgent Treatment Centre directly so you can be assessed for Lyme disease without delay.

When does an insect bite need treatment?

The vast majority of insect bites — mosquitoes, midges, gnats, fleas, bedbugs — cause an immediate itchy reaction but heal without medical treatment. Antihistamines, topical hydrocortisone, and time are all most people need.

Some bites become infected when bacteria that normally live on the skin (usually staph or strep) get into the scratched-open area. Most bites cause itch and a small red lump in the first 24–48 hours — this is normal and not infection. After 48 hours, infection is suggested by 3 or more of:

Redness around the bite
Pain or tenderness
Swelling around the bite
Warmth around the bite

PLUS at least one of:

Spreading redness extending outwards from the bite
Pus or discharge from the bite site

Fever, swollen glands, feeling generally unwell, or red streaks tracking away from the bite are red flags — see below.

Bites become infected most often when scratched a lot — usually in children. If you're noticing the bite area looks worse rather than better after 48 hours, come in.

Who can use this service?

Adults and children aged 1 and over
Signs of secondary bacterial infection in an insect bite
No widespread spreading cellulitis
Not systemically unwell

Tick bites are absolute exclusions from this service — see the red callout above. If the infection is spreading rapidly or you're feeling unwell, contact your GP or NHS 111 directly. For severe symptoms (high fever, rapidly spreading redness, signs of sepsis), call 999 or attend A&E.

What treatment can be supplied?

The NHS Pharmacy First infected insect bite pathway follows NICE NG182 (Insect bites and stings: antimicrobial prescribing) and NICE CKS guidance, as implemented in the NHS England Pharmacy First v1.1 patient group directions (valid from 1 October 2025):

Oral flucloxacillin — first-line for most patients aged 1+ (5-day course)
Oral clarithromycin — alternative for non-pregnant penicillin-allergic patients (5-day course)
Oral erythromycin — alternative for pregnant penicillin-allergic patients (5-day course)
Self-care alone — for mild, localised reactions that don't meet infection criteria. Cleaning the area, oral antihistamines, hydrocortisone 1% cream for itch.

The pharmacist will explain what to watch for, how long to take any antibiotics, and what to do if symptoms get worse despite treatment.

How it works — fully online from your phone

Start the online assessment via the Digital Gateway link above — when you were bitten, where on the body, how it's progressed, your history and medicines. You'll upload a photo of the bite so the pharmacist can assess for cellulitis. If your bite is from a tick, or shows a bullseye / target-shaped rash, do not start this assessment — contact your GP or NHS 111 directly for Lyme assessment.
Pharmacist reviews your record — usually within 1-2 hours during opening hours.
Pharmacist phones or video-calls you to discuss and confirm the plan. If we need a closer look at the bite (especially to assess spreading redness or a possible bullseye rash), we may send a secure accuRx video link.
Clinical decision — oral antibiotic (flucloxacillin first-line, or clarithromycin/erythromycin for penicillin allergy), self-care advice for mild reactions, or urgent referral if signs of spreading cellulitis or Lyme disease.
If antibiotics are supplied: free delivery via Royal Mail Tracked anywhere in England, same-day in Leeds LS postcodes, or collect from us.
Safety-netting — clear advice on what to watch for and when to escalate.
GP notified automatically via NHS GP Connect.

Refer urgently to GP or A&E (or call 999) if: red streaks tracking up the limb from the bite (lymphangitis); rapidly spreading redness; fever and feeling very unwell (possible sepsis); a tick bite with a bullseye-shaped rash (possible Lyme disease — needs early treatment); difficulty breathing or facial swelling (allergic reaction — call 999); a bite or sting in the mouth or throat with swelling; a bite or sting near or around the eyes; severe pain that feels out of proportion to how the bite looks (call 999 or go to A&E — risk of serious tissue infection).

Start your bite assessment online

If your bite is spreading or getting worse, don't wait. Open our NHS-assured Digital Gateway, upload a photo, and the pharmacist will assess for infection and decide on treatment.

Start online assessment → Or call 0113 244 1551

Frequently asked questions

How can I tell the difference between an allergic reaction and infection?: Allergic reactions appear quickly — within hours — and are usually itchy with localised swelling, sometimes hives elsewhere. Bacterial infection takes 24-48 hours to develop and gets worse rather than better. The pharmacist can usually distinguish them quickly.
Should I be worried about Lyme disease?: Lyme disease comes from tick bites and the classic sign is a bullseye-pattern rash that expands over days to weeks. Tick bites and bullseye rashes are absolute exclusions from this service — please don't use the online assessment for these. Contact your GP, call NHS 111, or attend an Urgent Treatment Centre so you can be assessed for Lyme disease without delay. Early antibiotic treatment matters for Lyme, and we want you on the right pathway from the start.
Can children be seen?: Yes — for any child aged 1 or over. Bites in young children are common, especially in summer.
What about wasp and bee stings?: Stings cause an immediate painful reaction but rarely get bacterially infected unless scratched. If you have widespread swelling, breathing difficulty, or signs of anaphylaxis, call 999 immediately. Mild localised reactions don't need a Pharmacy First consultation — over-the-counter antihistamines and cold packs are usually enough.
Is it free?: Yes — both the consultation and any medicine supplied through Pharmacy First.

About this service at Hyde Park Pharmacy

Hyde Park Pharmacy is a community pharmacy in central Leeds (premises 9011727, regulated by the General Pharmaceutical Council). Our superintendent pharmacist is Shoyab Umarji (GPhC #2065619, Independent Prescriber). The infected insect bite pathway follows v1.1 NHS England Pharmacy First service spec (October 2025).

For the full list of Pharmacy First conditions, see our main Pharmacy First page. For a step-by-step explanation of the post-submission flow, see what happens next.