Bee

Treatment — Treatment of LLRs is based upon symptoms. We know of no published studies comparing different treatments; our approach is described below:
Cold compresses are soothing acutely. The limb should be elevated if the sting is on an extremity.
Oral prednisone, 40 to 60 mg given as a single dose or rapidly tapered over 2 to 5 days, may help reduce significant swelling.
Nonsteroidal antiinflammatory drugs (NSAIDs) can reduce pain.
Pruritus can be treated with oral antihistamines (eg, cetirizine, 10 mg once daily) and high potency topical corticoid steroids (eg, fluocinonide 0.05 percent or clobetasol 0.05 percent ointment, applied every four hours) until the itching subsides.
Some individuals develop predictable large local reactions with every Hymenoptera sting and seek advice on how to prevent this. Our clinical experience is that immediate application of high potency topical corticosteroids and administration of a single dose of 20 mg of prednisone often attenuates the response.
Excluding a secondary bacterial infection — Most Hymenoptera stings do not become superinfected, although this can occur. An infected sting must be differentiated from a large local reaction (discussed in the next section). The stings of yellowjackets and imported fire ants are more likely to become infected than those of other species [11]. Yellowjackets tend to scavenge around rotting food and presumably carry bacteria on their exterior. Fire ant stings cause sterile pustule-like lesions that can become infected if opened, as mentioned previously.
Infection is suspected when redness, swelling, and pain become dramatically worse 3 to 5 days
after the sting, when the typical large local reaction is beginning to regress. The presence of fever suggests infection, but lymphangitis streaks may be seen with either infection or an uncomplicated LLR. If the clinician is unsure, a course of oral antibiotics may be prudent. (See "Cellulitis and erysipelas", section on 'Treatment'.)

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