Important points
For common scabies, save ivermectin for second line treatment.
For common scabies, keep topical treatments (permethrin 5% cream or benzyl benzoate 25% lotion) as the initial course of treatment. Future treatment choices may be limited if ivermectin misuse results in mite resistance.
If benzyl benzoate or permethrin are unable to treat typical scabies, take into account and deal with potential causes.
Oral ivermectin may be recommended if the reason for treatment failure cannot be determined.
Use two doses of ivermectin to reduce the likelihood of treatment failure and mite resistance in cases of typical scabies.
Ivermectin is not ovicidal; it may not be sufficient to kill all stages of the parasite with a single dosage.
The only recommended or suggested course of treatment for crusted scabies is ivermectin in combination with topical therapy.
Ivermectin hasn’t been compared to other therapies for crusted scabies in any randomized controlled trials,
though.
It’s unclear what dosage regimen is best for treating crusted scabies.
Treatment outcomes vary, and individuals who receive insufficient care run the risk of spreading infestation.
What is understood about this medication
A class of broad-spectrum antiparasitic drugs active against a variety of nematodes and ectoparasites is represented by the avermectin acaricide.
Although this medication has been on the market for a while, the TGA has only recently approved it for the treatment of scabies for
Ivermectin Purchase. Additionally, it is PBS listed and TGA authorized for the treatment of stronglyloidiasis and onchocerciasis.
It has been demonstrated that oral ivermectin works better than a placebo and has been effectively used to treat endemic scabies in communities.
Ivermectin is not ovicidal and has been demonstrated to be slower to remove lesions when compared to permethrin, even if it is effective at curing scabies (defined as no new lesions generated by the mite) after two separate doses.
It is difficult to draw a conclusion regarding the comparative efficacy of ivermectin versus benzyl benzoate due to significant heterogeneity across trials.
Ivermectin, when used to treat scabies, is generally well tolerated, with only mild, transient adverse effects.
Uncertainty zones
It has been challenging to assess the clinical efficacy of ivermectin due to significant methodological variation in the RCTs that used it to treat typical scabies. Moreover, there exist concerns concerning the trial population’s suitability for the intended PBS population.
There are currently no published controlled clinical trials assessing the ideal ivermectin dosage for treating crusted or normal scabies. Cohort and case series studies have been used to assess possible dosage schedules.
Overall, studies contrasting topical treatments for common scabies with ivermectin reveal that a single dose may not be sufficient to combat the scabies parasite at every step of its life cycle.
While there is a dearth of clinical trial data supporting ivermectin’s effectiveness specifically for the Aboriginal and Torres Strait Islander community, the drug has been demonstrated to be effective when treating normal and crusted scabies in communities where scabies is endemic.
Ivermectin’s safety in the very young, very old, and in individuals with hepatic disease is not well-documented.
What is stated by NPS MedicineWise?
This medication is a significant advancement in the management of crusted scabies, scabies that is not responding to topical treatments, scabies outbreaks in the community, and scabies in elderly care facilities.
Ivermectin plays a function in the management of endemic scabies, even if normal topical treatment of scabies is beneficial in the majority of patients when administered appropriately. This is especially true when logistically challenging to apply topical medicines head-to-toe.
Ivermectin’s safety in the very young, very old, and in individuals with hepatic disease is not well-documented.
To ensure a successful course of therapy and to reduce the possibility of antimicrobial resistance, make sure patients understand how to take ivermectin, including the dosage and interval.
What is the comparison?
Guidelines for normal scabies do not imply or suggest any additional treatment alternatives.
in patients for whom topical therapy is contraindicated following the failure of topical therapies combined with permethrin and benzyl benzoate for crusted scabies.
In a number of RCTs, review articles, including a Cochrane review, and in observational studies, small uncontrolled trials, and case series, the safety and effectiveness of ivermectin have been evaluated in relation to topical scabies treatments in patients with typical scabies as well as in patients with crusted scabies.
