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Three Part Question

Three part question. In [adults with insect bites] do [steroids] reduce [inflammation]?

Clinical Scenario

A 24 year old male presented the emergency department with a painful, red, inflammed area on his arm. He noticed this 4 hours after playing a game of football on the pitch. You wonder whether steroids will reduce his inflammation and symptoms.

Search Strategy

MEDLINE 1966 - 06/05 & EMBASE 1988-06/05, using the OVID interface
insect bite$.mp. or exp "Insect Bites and Stings"/ OR exp "Bites and Stings"/ ] AND [exp STEROIDS/ OR steroids.mp.OR corticosteroid$.mp.] AND [inflammation.mp. or exp INFLAMMATION/ OR swelling.mp. or exp Edema/] LIMIT to human and English language.

Search Outcome

Altogether 185 papers were found using EMBASE and 16 papers using MEDLINE. 1 paper was relevant to the question and is summarised in the table below.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Tow A 1966 West Virginia	50 patients bitten by insects	Case series	Efficacy of Oral dexamethasone relieves inflammation	An initial dose of 6mg oral dexamethasone is effective in most cases	Age of patient and number of bites was not taken into account. The results are not clearly stated. Stings and bites were not separately studied. The study does not indicate the frequency at which the drugs were given

Comment(s)

There is no solid evidence to answer the question. The study that was done is very old and the results are not clearly stated. There is selection bias and no comparisons were made. However it does show oral dexamethasone alone to be a reliable drug for treatment of insect bites. Repeated doses can be given if required.

Clinical Bottom Line

New trials are required to answer the question. Steroids should be given for insect bites and stings until further evidence is available.

References

1. Tow A, Oral dexamethasone in Insect Bites: The West Virginia medical journal, (1966) 62 (6): 161-62.