Permethrin and ivermectin for scabies pdf

Northern Territory Government. Contact Us. Skip directly to site content Skip directly to page options Skip directly to A-Z link. Parasites - Scabies. Section Navigation. Facebook Twitter LinkedIn Syndicate. Minus Related Pages. The following medications for the treatment of scabies are available only by prescription. Permethrin is a synthetic pyrethroid similar to naturally occurring pyrethrins which are extracts from the chrysanthemum flower.

Permethrin is safe and effective when used as directed. Permethrin kills the scabies mite and eggs. Permethrin is the drug of choice for the treatment of scabies. Two or more applications, each about a week apart, may be necessary to eliminate all mites. Children aged 2 months or older can be treated with permethrin. Crotamiton is not FDA-approved for use in children. Frequent treatment failure has been reported with crotamiton. Although FDA-approved for the treatment of scabies, lindane is not recommended as a first-line therapy.

We searched for all relevant studies to answer this question and found 15 studies, which we collected and analysed. We found that for the most part, there was no difference detected in the efficacy of permethrin compared to systemic or topical ivermectin.

Overall, few and mild adverse events were reported. Our confidence in the effect estimates was mostly low to moderate.

Poor reporting of studies was a major limitation. Additional high-certainty studies are needed to strengthen the confidence in the results and improve the evidence base. Scabies is an intensely itchy parasitic infection of the skin. It occurs throughout the world, but is particularly problematic in areas of poor sanitation, overcrowding, and social disruption.

In recent years, permethrin and ivermectin have become the most relevant treatment options for scabies. We examined topical permethrin, topical ivermectin, and systemic ivermectin as a treatment for scabies in women and men of all ages.

We assessed efficacy as complete clearance of skin lesions at different time points after the start of the treatment. Other outcomes were the number of participants re-treated, the number of participants with at least one adverse event, and the number of participants who stopped participating in the study because they experienced an adverse event.

We found 15 relevant studies. Nearly all studies were set in South Asia or North Africa. These studies compared systemic ivermectin with topical permethrin, topical ivermectin with topical permethrin, or systemic ivermectin with topical ivermectin to treat people with scabies. All studies were conducted at a single centre with mostly small numbers of participants per study group. Oral ivermectin may lead to slightly lower rates of complete clearance after one week compared to permethrin cream low-certainty evidence , but little or no difference in rates of complete clearance by week two low-certainty evidence.

Treatments with one to three doses of ivermectin or one to three applications of permethrin may lead to little or no difference in rates of complete clearance after four weeks low-certainty evidence. There is probably little or no difference in complete clearance rates after one week of treatment with oral ivermectin or one application of permethrin lotion moderate-certainty evidence. There is probably little or no difference in rates of complete clearance between systemic ivermectin at standard dose and topical ivermectin lotion four weeks after initiation of treatment moderate-certainty evidence.

Likewise, after four weeks, ivermectin lotion probably leads to little or no difference in rates of complete clearance when compared to permethrin cream moderate-certainty evidence , and there is little or no difference among treatments with systemic ivermectin in different doses high-certainty evidence.

Participants were instructed to apply the medication all over the body below the neck at night. Usha All participants received standard instructions about the mode of application, general measures, importance of treating the family contacts, prevention of fomite transmission.

Wankhade For those whose microscopic examination was negative, inclusion in study was based on clinical criteria. People with any other associated skin disease that could alter the picture of scabies, or complications of scabies like pyoderma. History of topical steroid use in the previous 4 weeks or use of topical or systemic antibiotic therapy in the week before entry into the study. People having scabies with atypical presentation like crusted scabies or scabies incognito.

People with associated comorbid condition like hypertension, diabetes, liver, kidney disorder. If there were no signs of cure, the same intervention was repeated at the end of week 1 only once. Cure no new clinical lesions and improvement in pruritus, no new lesions like papules, vesicles, and classical burrows suggestive of live parasite should be seen; week 1 and 4.

CD also contributed substantially to writing the Cochrane Review. SR and CD have no conflicts of interest. National Center for Biotechnology Information , U. Cochrane Database Syst Rev. Published online Apr 2. Author information Copyright and License information Disclaimer. Stefanie Rosumeck, Email: ed. Corresponding author. This article has been cited by other articles in PMC. Abstract Background Scabies is an intensely itchy parasitic infection of the skin. Objectives To assess the efficacy and safety of topical permethrin and topical or systemic ivermectin for scabies in people of all ages.

Selection criteria We included randomized controlled trials that compared permethrin or ivermectin against each other for people with scabies of all ages and either sex. Data collection and analysis Two review authors independently screened the identified records, extracted data, and assessed the risk of bias for the included trials.

Main results Fifteen studies participants comparing topical permethrin, systemic ivermectin, or topical ivermectin met the inclusion criteria. Safety Reporting of adverse events in the included studies was suboptimal. Authors' conclusions We found that for the most part, there was no difference detected in the efficacy of permethrin compared to systemic or topical ivermectin.

Ivermectin and permethrin for treating scabies What is the aim of this review? Key messages We found that for the most part, there was no difference detected in the efficacy of permethrin compared to systemic or topical ivermectin. What was studied in the review? What are the main results of the review?

We searched for studies published up to 25 April GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect.

Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.

Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. Open in a separate window. Abbreviations: CI: confidence interval; RR: risk ratio. Moderate certainty: we are moderately confident in the effect estimate.

The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited.

The true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate. The true effect is likely to be substantially different from the estimate of effect. Background This section is based on Strong Description of the condition Scabies is an intensely itchy parasitic infection of the skin that is caused by the Sarcoptes scabiei mite.

Diagnosis Diagnosis on clinical grounds is usually made based on a history of itching particularly if contacts are also affected and the finding of lesions at the classical sites. Description of the intervention Various treatments are available for scabies. Prevention Prevention is based on principles common to most infectious diseases, that is limitation of contact with the mite.

Is oral ivermectin superior to topical permethrin? Is oral ivermectin superior to topical ivermectin? Is topical ivermectin superior to topical permethrin? Is a single dose of oral ivermectin superior to multiple doses of oral ivermectin?

Methods Criteria for considering studies for this review Types of studies We only included randomized controlled trials RCTs. Types of participants Children or adults of both sexes with a diagnosis of classical scabies, as defined by the study authors.

Types of interventions Intervention Topical permethrin. Topical ivermectin. Systemic ivermectin. Control One of the above mentioned interventions. Search methods for identification of studies We attempted to identify all RCTs regardless of language or publication status published, unpublished, in press, or in progress.

Grey literature We searched the following sources for published and unpublished trials up to 26 July British Library Index of Conference Proceedings explorecatalogue. Searching other resources Reference lists We scanned the reference lists of all included RCTs for further studies. Data collection and analysis Several of the following sections may be identical to parts of the Cochrane Handbook for Systematic Reviews of Interventions Higgins Selection of studies Two review authors independently screened the titles and abstracts of all studies identified by the search to determine those that were potentially relevant.

Data extraction and management Two review authors SR and CD independently extracted data from the included trial reports using a standardized data extraction form Microsoft Word.

Random sequence generation. Allocation concealment. Blinding of participants and personnel. Blinding of outcome assessment. Completeness of outcome data. Selective reporting. Other sources of bias. Unit of analysis issues To avoid unit of analysis errors, we included every study only once in each comparison for each outcome at each time point.

Assessment of reporting biases Had we included 10 or more studies comparing the same intervention, we would have evaluated a funnel plot. Data synthesis We have summarized and presented qualitative information for example, study design, description of participants, study groups, outcome measurements in the Characteristics of included studies tables.

Risk of bias If most of the information was from studies with an overall assessment of moderate or high risk of bias, we downgraded one serious limitations or two levels very serious limitations Guyatt a.

Inconsistency We judged large and unexplained inconsistency based on similarity of point estimates and the extent of overlap of CIs. Publication bias Due to the small number of studies pooled, it was inappropriate to evaluate a funnel plot. Sensitivity analysis For two comparisons and outcomes, we conducted sensitivity analyses due to statistical heterogeneity.

Results Description of studies Results of the search The electronic searches see Electronic searches retrieved references. A total of 15 trials met the inclusion criteria of the review. Figure 1. Included studies We included 15 RCTs that investigated participants treated with ivermectin or permethrin. Sample sizes The sample size varied from 62, in Ahmad , to , in Chhaiya Sex All studies recruited both women and men. Diagnosis of scabies A detailed description of how scabies was diagnosed in each study is provided as part of the Characteristics of included studies tables.

Treatment of family members and close contacts In nine studies, members of the family or close contacts, or both, were treated alongside the study participants. Figure 2. Blinding We assessed performance and detection bias for efficacy and safety outcomes separately. Incomplete outcome data We assessed attrition bias for efficacy and safety outcomes separately, which led to different assessments in four studies Das ; Sharma ; Chhaiya ; Ahmad Selective reporting We rated two studies as at high risk of reporting bias.

Other potential sources of bias We judged three studies as at high risk of other sources of bias. The included studies investigated the following four comparisons. Oral ivermectin versus topical permethrin.

Oral ivermectin versus topical ivermectin. Topical ivermectin versus topical permethrin. Oral ivermectin versus oral ivermectin in different doses. Data on the following six comparisons are reported here. Ivermectin systemic 1 dose versus ivermectin systemic 2 to 3 doses. Figure 3. Analysis 1. Figure 4. Figure 5. Number of participants with at least one adverse event The reporting of adverse events was poor. Figure 6. Analysis 2.

Analysis 3. Analysis 4. Analysis 5. Discussion Summary of main results Fifteen trials, comprising participants treated with ivermectin or permethrin, met our inclusion criteria. Efficacy We analysed 13 studies comprising participants evaluating systemic ivermectin versus permethrin. Safety Generally, systemic and topical drugs can lead to different types of events, endangering blinding. Potential biases in the review process While we considered publication bias to be undetected, we cannot rule it out.

Agreements and disagreements with other studies or reviews Our results comparing permethrin and systemic ivermectin are similar to our recently published comprehensive systematic review considering several scabies treatments Dressler a. Authors' conclusions Topical permethrin, topical ivermectin, and systemic ivermectin all lead to high clearance rates in the treatment of scabies. Appendices Appendix 1.

Appendix 2. Appendix 3. Appendix 4. Notes Unchanged. Outcome or subgroup title No. Treatment of contacts and proper hygienic measures were emphasized. Number of participants analysed in week 2 and 3 is unclear.

Risk of bias Bias Authors' judgement Support for judgement Random sequence generation selection bias Unclear risk Quote: "randomly distributed" Allocation concealment selection bias Unclear risk Insufficient information Blinding of participants and personnel performance bias Efficacy High risk No information Blinding of participants and personnel performance bias Safety High risk No information Blinding of outcome assessment detection bias Efficacy High risk No information Blinding of outcome assessment detection bias Safety High risk No information Incomplete outcome data attrition bias Efficacy High risk Percentage of "improved clinically" reported, no definition.

Results for groups C and D not reported. Incomplete outcome data attrition bias Safety Unclear risk Quote: "We however did not experience any adverse effect in all four groups.

Incomplete outcome data attrition bias Safety High risk Quote page 1 : "The main objective of the study is to know the efficacy and safety of Oral Ivermectin in comparison to commonly used topical antiscabies drugs […]" Quote page 3 : "Oral Ivermectin is well tolerated, non irritant to skin, does not show central nervous system side effects because it does not cross blood brain barrier. Baseline characteristics Age mean : group A: Assessment of safety was planned, but not reported numerically.

Probably baseline differences in severity: "more patients in the ivermectin group had moderate and severe lesions as compared to permethrin group" Inconsistent data for safety page and : 8 versus 7 participants with adverse events. If there was no sign of cure, same treatment was repeated. Risk of bias Bias Authors' judgement Support for judgement Random sequence generation selection bias Unclear risk Quote: "randomely allocated" Insufficient information Allocation concealment selection bias Unclear risk Quote: "randomely allocated" Insufficient information Blinding of participants and personnel performance bias Efficacy High risk No information Blinding of participants and personnel performance bias Safety High risk No information Blinding of outcome assessment detection bias Efficacy High risk No information Blinding of outcome assessment detection bias Safety High risk No information Incomplete outcome data attrition bias Efficacy High risk No numerical data given.

Incomplete outcome data attrition bias Safety High risk No numerical data given. Grant: Declarations of interest SR and CD have no conflicts of interest.

CD is a member of the Cochrane Scientific Committee. Efficacy, acceptability and cost effectiveness of four therapeutic agents for treatment of scabies. Clinical efficacy and safety of topical versus oral ivermectin in treatment of uncomplicated scabies. Comparison of safety, efficacy, and cost effectiveness of benzyl benzoate, permethrin, and ivermectin in patients of scabies. Comparative efficacy and safety of topical permethrin, topical ivermectin, and oral ivermectin in patients of uncomplicated scabies.

Evaluation of the commonest site, demographic profile and most effective therapy in scabies. Treatment of scabies with oral ivermectin in an enclosed rural community [Tratamiento de escabiasis con Ivermectina por via oral en una comunidad rural cerrada. Implicaciones epidemiologicas]. Comparative study of efficacy of oral ivermectin versus some topical antiscabies drugs in the treatment of scabies.

An open label, randomized, comparative study of antiscabietic drugs permethrin, gamma benzene hexachloride and ivermectin in patients of uncomplicated scabies. Comparison of efficacy and safety of oral ivermectin with topical permethrin in treatment of scabies.

Indian Journal of Pharmacology ; 45 :S Doctoral thesis as supplied 31 January Data on file. A comparison of efficacy of single topical permethrin and single oral ivermectin in the treatment of scabies. Topical permethrin and oral ivermectin in the management of scabies: a prospective, randomized, double blind, controlled study. A comparative study of oral ivermectin and topical permethrin cream in the treatment of scabies.

Comparison of safety, efficacy, cost effectiveness of permethrin and ivermectin in patients of scabies. A comparative study of topical permethrin, oral ivermectin and combination of permethrin with ivermectin in patients of scabies. To study cost effectiveness of topical permethrin versus oral ivermectin in patients of uncomplicated scabies.

Treatment of scabies: the topical ivermectin vs. References to ongoing studies NCT A report of clinical trial conducted on Toto ointment and soap products. Arthropods and Human Skin. Biology, host relations, and epidemiology of Sarcoptes scabiei. Australian Public Assessment Report for Ivermectin. Clinical trial on the effectiveness of Gliricidia sepium Kakawati in treating patients with scabies in the antipolo CBHP.

Deaths associated with ivermectin treatment of scabies. Increasing prevalence of infectious diseases in asylum seekers at a tertiary care hospital in Switzerland. Deaths associated with ivermectin for scabies. Lancet ; Current treatments for scabies. Centers for Disease Control and Prevention. Central Drugs Standard Control Organization. List of new drugs approved in India from to Chosidow O. Scabies and pediculosis. Permethrin and ivermectin for scabies. Deaths after ivermectin treatment.

The epidemiology of head lice and scabies in the UK. The treatment of scabies. Reporting in the clinical trials evaluating scabies treatments. Engauge Digitizer. Version 9. Mitchell M, Epidemiological problems of scabies. Ivermectin use in scabies. US Food, Drug Administration. Evidence Prime, Inc. Green M. Epidemiology of scabies. GRADE guidelines: 4. GRADE guidelines: 5. GRADE guidelines 6. GRADE guidelines: 7. GRADE guidelines: 8. Scabies: a suitable case for a global control initiative. The Cochrane Collaboration, Available from handbook.

Chapter 6: Searching for studies. Meinking TL, Taplin D. Pediatric Dermatology. Package leaflet: Information for the user, Stromectol 3 mg, tablets September [Bijsluiter: informatie voor de gebruiker, Stromectol 3 mg, tabletten]. Pediculocidal and scabicidal properties of Lippia multiflora essential oil.

A comparative study of the scabicidal activities of formulations of essential oil of Lippia multiflora Moldenke and benzyl benzoate emulsion BP. Lancet ; ; author reply Review Manager 5 RevMan 5. Version 5. Prevalence of scabies and impetigo worldwide: a systematic review. Mass drug administration for scabies control in a population with endemic disease. European guideline for the management of scabies.

Scheinfeld N. Controlling scabies in institutional settings: a review of medications, treatment models and implementation. Genetic epidemiology of Sarcoptes scabiei Acari: Sarcoptidae in northern Australia. Acaricidal activity of Melaleuca alternifolia tea tree oil. Ivermectin and permethrin for treating scabies. Strong M, Johnstone P. Interventions for treating scabies.