Cost-effective tips:
1. Prescribe antibiotics for Hymenoptera envenomation only when secondary bacterial infection occurs. The immediate local swelling, erythema, warmth, and pain are due to venom effects or allergic reactions and should not be mistaken for infection. Empiric antibiotic prophylaxis is generally not indicated. Secondary bacterial infections typically develop more than 24 hours after envenomation and should be treated if increasing inflammation, lymphangitis, fever, or leukocytosis develops.
2. Not all Hymenoptera envenomation require hospital admission. Patients who may be safely discharged home from the ED include those with limited local reactions as well as patients with mild anaphylactic reactions that respond readily to treatment and remain asymptomatic after 4-6 hours of observation. However, it is important to instruct the patient to return immediately if hoarseness, wheezing, dyspnea, dizziness, or worsening swelling occur.
3. Not all patients with a hypersensitivity reaction to Hymenoptera envenomation require a referral to an allergist. Patients with only mild local reactions are at minimal risk for anaphylaxis with subsequent stings and do not require referral to an allergist. However, patients with severe local reactions or systemic reactions (i.e., anaphylaxis) should be referred for further evaluation, education, and consideration for venom desensitization immunotherapy.
