Bed Bugs: Current Treatment Guidelines

Charleen McNeill, PhD, Anna Jarrett, PhD, FNP-BC, and Marilou D. Shreve, DNP, PNP-BC


Journal for Nurse Practitioners. 2017;13(6):381-388. 

In This Article

Abstract and Introduction


Bed bugs have been around for at least 4 millennia. Although the incidence of bed bugs was dramatically reduced after World War II, the United States is now experiencing a significant resurgence. Despite the increased prevalence of bed bugs, many report knowing little or nothing about them. Health care providers need contemporary guidelines regarding the prevention and treatment of bed bugs to combat this persistent pest. Herein we provide education on the epidemiology, life cycle, clinical presentation, diagnosis, and comprehensive treatment of bed bugs to include eradication and potential mental health complications.


Bed bugs have been around for at least 4 millennia, as identified in 3,500-year-old fossils from an Egyptian village and referred to by the likes of Aristotle and Aristophanes.[1] Although they were prevalent in the United States until World War II, the wide use of pesticides, like dichlorodiphenyltrichloroethane (more commonly known as DDT), dramatically reduced their prevalence.[2] The US is now one of many countries experiencing a resurgence of bed bugs,[3] likely due to increased global travel, a growing number of regulatory restrictions placed on insecticides like DDT, and enhanced tolerance to the newer organic compounds used in the treatment of bed bugs.[4] Recently, bed bugs were found to be present in all 50 states, and 95% of pest management professionals surveyed reported encountering an infestation in the past year.[5] Bed bug infestations occur wherever humans live and congregate, including homes, apartments, college dorms, hospitals, day-care centers, movie theaters, and places of worship. One in 5 Americans either had a home infestation or knew someone who encountered bed bugs in their home or while traveling.[6] In 2016, the cities reporting the most infestations included: Baltimore; Washington, DC; Chicago; New York; and Columbus, OH.[7] In spite of their increased prevalence, many people have little or no knowledge about bed bugs.[8] The nexus of this lack of knowledge, combined with the dramatic resurgence of a public health concern, has placed health care practitioners in a unique position to address this problem. Thus, health care professionals need to be educated on the epidemiology, life cycle, clinical presentation, diagnosis, and treatment of bed bugs. Office visits should include guidance and client education, not only for those clients who experienced an infestation, but also for clients who could likely encounter bed bugs.