Treatment of Scabies: Permethrin vs.

Ivermectin
A04 , ,

Transmission of scabies
Mite Sarcoptes scabiei, skin to skin contact Typical vs atypical/crusted/keratotic 2-6 weeks before symptoms are apparent During the incubation period the newly infested healthcare worker could be a source of transmission

Prevention and Control

Recognize patient with symptoms and signs Skin scrapings Contact isolation precautions Personal protective equipment

Pharmaceutical agents : Lindane: standard tx, but resistance Permethrin vs Ivermectin

Thinking Process
Inadequate treatment of scabies increase transmission of scabies throughout hospitals

Find a more effective treatment among choices of medication

Permethrin vs Ivermectin

Search form evidence-based medicine database for answer

Ask an answerable question

Permethrin vs Ivermectin Which is better for scabies treatment?

PICO

Patient
Intervention Comparison

Scabies infected patient

Medical treatment with Permethrin Medical treatment with Ivermectin Prevention of scabies outbreak

Outcome

Tracking Down the Best Evidence

Cochrane Database of Systemic Reviews PubMed Library Clin-eguide

Tracking down the best evidence

Database: Cochrane Database of Systemic Reviews Key Word: scabies Result: [Review] Interventions for treating scabies M Strong, PW Johnstone Cochrane Database of Systematic Reviews 2008 Issue 2 (Status: Edited)

Tracking down the best evidence

Database: Clin-eguide Key Word: scabies Result: A comparative study of oral ivermectin and topical permethrin cream in the treatment of scabies Journal of the American Academy of Dermatology - Volume 42, Issue 2 (February 2000) - Copyright 2000 American Academy of Dermatology, Inc.

Permethrin acts by disrupting the sodium channel current Topical application ensures maximum concentration of the drug in the skin Infrequently used because of its high cost

Ivermectin bind selectively to GABA gated chloride ion channels, which occur in nerve and muscle cells not be effective against the younger stages inside the egg because the nervous system has not yet developed Additional doses needed

Single application of permethrin was superior to a single oral dose of ivermectin by 2 weeks (P < .001).

Tracking down the best evidence

Database: PubMed Key Word: scabies Result: 2001 National Guideline on the Management of Scabies Evidence Base Medline search strategy Years covered 1966-1997 Key terms - scabies/th, scabies/dt, lindane/tu, permethrin/tu, malathion/tu.

Permethrin 5% cream (level of evidence 1b, grade of recommendation A) Malathion 0.5% aqueous lotion (level of evidence 4, grade of recommendation C) These should be applied to the whole body from the neck downwards, and washed off after 12 hours, usually overnight. Itch may persist for several weeks. Application of crotamiton cream may give symptomatic relief. Antihistamines may also be helpful in relieving itch. Potentially contaminated clothes and bedding should be washed at high temperature (>50C) if possible. Mites separated from the human host die after 72 hours.

Oral ivermectin in a dose of 200 mcg/kg in the treatment of Norwegian scabies. Ivermectin is not licensed for this purpose in the UK There have been concerns about toxicity

Pregnancy and Breastfeeding Permethrin is safe during pregnancy or breastfeeding

Thank you for listening!!