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Treatment of Scabies:Permethrin vs. Ivermectin

A04

, ,

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Transmission of scabies

Mite Sarcoptes scabiei, skin to skin contactTypical vs atypical/crusted/keratotic

2-6 weeks before symptoms are apparentDuring the incubation period the newly infestedhealthcare worker could be a source oftransmission

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Prevention and Control

Recognize patient with symptoms and signsSkin scrapings

Contact isolation precautionsPersonal protective equipment

Pharmaceutical agents :Lindane: standard tx, but resistancePermethrin vs Ivermectin

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Thinking Process

Inadequate treatment of scabies increase transmission of scabiesthroughout hospitals

Find a more effective treatment among choices of medication

Permethrin vs Ivermectin

Search form evidence-based medicine database for answer

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Permethrin vs Ivermectin

Which is better for scabiestreatment?

Ask an answerable question

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PICO

P atient Scabies infected patient

InterventionMedical treatment with Permethrin

ComparisonMedical treatment with Ivermectin

Outcome Prevention of scabies outbreak

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Tracking Down the BestEvidence

Cochrane Database of Systemic ReviewsPubMed Library

Clin-eguide

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Tracking down the best evidence

Database: Cochrane Database of Systemic ReviewsKey Word: scabiesResult:

[Review]Interventions for treating scabies M Strong, PW JohnstoneCochrane Database of Systematic Reviews 2008 Issue 2

(Status: Edited )

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Database: Clin-eguideKey Word: scabiesResult:

A comparative study of oral ivermectin and topicalpermethrin cream in the treatment of scabies

Journal of the American Academy of

Dermatology - Volume 42, Issue 2 (February2000) - Copyright 2000 American Academy ofDermatology, Inc.

Tracking down the best evidence

http://www.mdconsult.com/das/journallist/view/96070669-4/home/0190-9622/0?issn=0190-9622http://www.mdconsult.com/das/journallist/view/96070669-4/home/0190-9622/0?issn=0190-9622http://www.mdconsult.com/das/journallist/view/96070669-4/issue/10005?ANCHOR=169059&issn=0190-9622http://www.mdconsult.com/das/journallist/view/96070669-4/issue/10005?ANCHOR=169059&issn=0190-9622http://www.mdconsult.com/das/journallist/view/96070669-4/home/0190-9622/0?issn=0190-9622http://www.mdconsult.com/das/journallist/view/96070669-4/home/0190-9622/0?issn=0190-9622http://www.mdconsult.com/das/journallist/view/96070669-4/home/0190-9622/0?issn=0190-9622

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Permethrin acts by disrupting the sodium

channel currentTopical application ensures maximumconcentration of the drug in the skin

Infrequently used because of its high cost

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Ivermectin bind selectively to GABA gatedchloride ion channels, which occur in nerve

and muscle cellsnot be effective against the younger stagesinside the egg because the nervous systemhas not yet developedAdditional doses needed

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Single application of permethrin was superior toa single oral dose of ivermectin by 2 weeks

(P < .001).

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Database: PubMedKey Word: scabiesResult:

2001 National Guideline on the Management of ScabiesEvidence BaseMedline search strategyYears covered 1966-1997

Key terms - scabies/th, scabies/dt, lindane/tu,permethrin/tu, malathion/tu.

Tracking down the best evidence

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Permethrin 5% cream (level of evidence 1b, grade ofrecommendation A)Malathion 0.5% aqueous lotion (level of evidence 4, grade ofrecommendation C)These should be applied to the whole body from the neckdownwards, 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 athigh temperature (>50

C) if possible.Mites separated from the human host die after 72 hours.

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

Pregnancy and BreastfeedingPermethrin is safe during pregnancy or breastfeeding

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Thank you for listening!!