Every summer, GP surgeries across England see a predictable surge in appointments for one complaint: insect bites that have become red, swollen, and painful. Most are straightforward infections that respond quickly to antibiotics — but getting those antibiotics has traditionally meant waiting for a GP slot.
Under the NHS Pharmacy First service, community pharmacists can now assess and treat infected insect bites directly, including supplying prescription-only antibiotics where clinically appropriate. For anyone dealing with a bite that is getting worse rather than better, this offers a faster route to treatment.
When Does an Insect Bite Become Infected?
Most insect bites in England — from mosquitoes, midges, horseflies, and fleas — cause minor irritation that resolves on its own. An infection develops when bacteria (usually Staphylococcus aureus) enter through broken skin, often because the bite has been scratched.
Signs of infection include:
- Increasing redness that spreads beyond the original bite
- Warmth and swelling around the bite area
- Pus or weeping fluid from the bite
- Increasing pain rather than improvement over 48 hours
- Red streaks spreading from the bite (seek urgent care for this sign)
An uninfected bite — even if itchy and swollen — does not typically need antibiotics. Pharmacists can help distinguish between a normal inflammatory reaction and a genuine infection.
What the Pharmacist Can Do
Under Pharmacy First, a pharmacist can:
- Assess the bite — examining the area, measuring the extent of redness, and asking about the timeline
- Prescribe antibiotics — typically flucloxacillin for seven days, or clarithromycin if you are allergic to penicillin
- Recommend self-care — antihistamines for itching, cold compresses, and advice on when to return
The consultation is free on the NHS. No appointment is needed at most pharmacies — walk in and describe your symptoms.
When to See a Pharmacist vs When to Call 111
| Symptom | Where to go |
|---|---|
| Bite is red, warm, and slightly swollen with possible pus | Pharmacy — Pharmacy First consultation |
| Bite area is spreading but you are otherwise well | Pharmacy first; they will refer to GP if needed |
| Red streaks spreading from the bite towards the body | Call 111 or visit A&E — possible cellulitis |
| Fever, chills, or feeling generally unwell alongside the bite | Call 111 or see GP urgently |
| Bite near the eye or on the face with significant swelling | See GP or call 111 |
Treatment Options
| Treatment | Typical use | Duration |
|---|---|---|
| Flucloxacillin 500mg (oral) | First-line for infected bites | Four times daily for 5–7 days |
| Clarithromycin 500mg (oral) | Penicillin allergy alternative | Twice daily for 5–7 days |
| Hydrocortisone cream 1% (OTC) | Reducing inflammation around uninfected bites | Apply thinly twice daily, short-term |
| Oral antihistamines (OTC) | Reducing itch to prevent scratching | As directed on pack |
According to NICE guidance, most localised skin infections from insect bites resolve within seven days of starting oral antibiotics.
Preventing Insect Bite Infections
The best treatment is prevention — both of bites themselves and of secondary infection:
- Use insect repellent containing DEET or icaridin when outdoors during peak midge and mosquito season (May–September)
- Cover up in the evenings when biting insects are most active
- Resist scratching — keep nails short, especially for children, and consider covering bites with a plaster
- Clean bites promptly with soap and water if the skin is broken
- Apply antiseptic to any bite that has been scratched open
Finding Your Nearest Pharmacy
With over 13,000 community pharmacies in England, most people live within a short walk of a Pharmacy First provider. Search for pharmacies near you on PharmSee, or use the location analysis tool to see how many pharmacies serve your postcode.
If you are unsure whether your local pharmacy offers Pharmacy First, simply call ahead — the vast majority of community pharmacies in England participate in the service.
Sources: NHS England Pharmacy First service specification; NICE Clinical Knowledge Summary — Insect bites and stings; NHS.uk — Insect bites and stings.