Oral Ivermectin Research Articles

The American Heartworm Society and Association of Shelter Veterinarians’ 2019 Shelter Heartworm Management Practices Survey

The primary objective of the 2019 Shelter Heartworm Management Practices Survey was to identify the current practices employed for the prevention, diagnosis, and management of heartworm disease in animal shelters. Survey questions were developed to collect the information of interest for dogs, cats, and ferrets under the care of sheltering organizations along with demographic information about these organizations. An electronic survey was distributed to the American Heartworm Society and Association of Shelter Veterinarians’ mailing lists in February-March 2019. Cross-posting of the survey on relevant lists was encouraged. The survey invitation was directed toward veterinarians delivering care in an animal shelter and excluded practitioners providing services for shelters, shelter animals, or recently adopted animals within a private practice setting. A total of 242 survey responses were received representing private humane societies/societies for the prevention of cruelty to animals (39.7%), municipal animal control facilities (24.9%), traditional (public-private partnership) shelters (21.7%), foster-based organizations (7.9%), sanctuaries (2.6%), and breed/species-specific rescues (2.1%). The largest proportion of respondent shelters were from the southeastern United States (36.9%) and over two-thirds of the shelters had full-time shelter veterinarians (69.0%). Most respondents provided monthly heartworm preventives for dogs (81.1%) and used oral ivermectin products per product labels (67.2%) to do so. Extralabel use of preventives was reported by 21.3% of respondents. Most respondents tested all dogs >6 months of age for heartworm infection (81.9%) and did so during the intake examination (56.6%) with antigen tests (92.2%). At least some heartworm positive dogs were treated by most respondents (93.1%) using a 3-dose (42.5%) or 2-dose (37.9%) melarsomine protocol. Non-arsenical treatment protocols were utilized by 16.8% of respondents. Protocols typically included adjunctive treatment with doxycycline or minocycline (92.3%), prednisone (71.3%), and macrocyclic lactones (58.6%). Nearly two-thirds of respondents housed dogs within foster homes after treatment (65.1%). Heartworm prevention was provided by 29.9% of respondents that admitted cats and 9.9% of those that admitted ferrets. These results can be used to identify challenges to meeting recommended practices regarding prevention, diagnosis, and treatment of heartworm disease in the animal shelter setting and to target operational and educational resources toward the areas of greatest need.

Prospective, randomized, and comparative study of efficacy of ivermectin, benzyl benzoate 25%, permethrin 5% and gamma benzene hexachloride 1% in the treatment of uncomplicated scabies

Background: Scabies is an infectious and contagious human skin disease. The aim of the study was to study the efficacy and safety of four different treatment modalities in clinically diagnosed cases of scabies of single dose of oral ivermectin and commonly used topical scabicidal agent’s benzyl benzoate 25% (BB), permethrin 5% and gamma benzene hexachloride 1% (GBHC).Methods: This study was carried out in the Department of Dermatology, Andhra Medical College, Visakhapatnam. 200 patients diagnosed of scabies were included in the study during the period from August 2013 to July 2014. The percentage of improvement was compared between four groups. Intergroup comparison between two groups was done Chi square test.Results: In the present study a greater number of patients were students (54.5%). Subsidence of lesion and itching with oral ivermectin given as a single dose (200 μg/kg body weight) was 45 (90%) and 44 (88%), with topical permethrin 5% lotion single application 48 (96%), 47 (94%), with topical GBHC 1% lotion 40 (80%) patients, 38 (76%). Topical application of BB lotion 25% was 38 (76%), and 36 (72%) at fourth week.Conclusions: In the present study permethrin 5% cream was found to be more effective among topical agents. Both BB and GBHC 1% lotion are being inexpensive and they can be used as an alternative treatment in developing country like India.

Ophthalmomyiasis with Cochylioma hominivorax - two case reports

Human myiasis is a rare parasitosis caused by infestation of larvae of the order Diptera. It is present in underdeveloped countries related to poor hygiene, alcoholism and mental illness. The infection can affect the skin, subcutaneous tissues and cavities, and the most frequent anatomical site of ophthalmomyiasis is the eyelid. Orbital involvement is rare and corresponds to 5% of cases, with an unfavorable prognosis. Less than 40 cases of orbital myiasis have been described in the literature, 3 of which are Brazilian cases, 3 reports in England, the United States and Canada. The authors describe two cases of orbital and eyelid ophthalmomyiasis, respectively. Both patients from rural areas and poor hygiene conditions. Oral Ivermectin was administered at a dose of 12 mg/day with no response in 24 hours, and then the surgical approach with good evolution in both cases was considered.

CME Dermatology 21: Scabies - Clinical Manifestation, Diagnosis and Therapy

CME Dermatology 21: Scabies - Clinical Manifestation, Diagnosis and Therapy Abstract. Scabies is a common contagious skin infestation found in all parts of the world affecting individuals of all ages. Its worldwide prevalence is estimated at about 200 million people at any one time. Typical manifestations consist of severe itch that is aggravated at night, and disseminated, excoriated, erythematous papules on the trunk and limbs. Diagnosis can be confirmed by microscopic examination of skin scrapings taken from skin lesions. Recommended treatments consist of Permethrin 5 % cream applied once with repetition after 7-14 days or oral ivermectin 200 µg/kg as two doses 1 week apart. Additionally, written instructions on how to behave, decontaminate textiles and apply medications should be provided to suspected cases, and all the patient's close personal contacts should be treated simultaneously. As the disease can be sexually transmitted, screening for sexually transmitted diseases is recommended in sexually active patients.

Scabies therapy in Germany : Results of anationwide survey with aspecial focus on the efficacy of first-line therapy with permethrin

According to the current scabies guideline, topical treatment with permethrin 5% cream is the first-line therapy of common scabies in Germany. However, in the course of growing incidence of scabies in recent years there have been increasing numbers of reports of reduced efficacy in standard therapy. To establish abetter understanding for the efficacy of scabies therapy under practice conditions, asurvey focusing on the first-line therapy with permethrin was conducted in dermatological hospitals, outpatient clinics and dermatology practices. The postal survey addressed all dermatologically active physicians in Germany and queried diagnostic methods, the individual initial treatment, the estimated efficacy of permethrin therapy, the frequency and reasons for therapy failures under permethrin and the therapeutic approach in case of failure of the initial therapy. The efficacy of permethrin was rated with 73% by 187 physicians. About 74% reported to treat initially with 5% permethrin cream. The most common reasons identified for treatment failure were application errors, lack of compliance and inadequate hygiene measures. Suspected diminished efficacy or development of resistance against permethrin and re-infestations were also mentioned. In the case of ineffectiveness of initial therapy, most clinicians opt for oral ivermectin, arepetition of permethrin therapy or acombination of both. Although there are localized reports of decreased effectiveness of permethrin therapy, results of this survey point towards apersisting high efficacy of first-line standard treatment of scabies with permethrin 5% cream in Germany.

Phthiriasis palpebrarum: a diagnosis of keen observation and suspicion

<p class="abstract">Phthiriasis palpebrarum is a rare cause of eyelid infestation and it mimics seborrheic blepharitis. A 60 years old female presented with itching in the eyelids and scalp. On initial examination scaling was present in her eyelashes and eyelid margin. On further examination some movements were noticed in her eyelashes. Immediately, dermatoscopic examination was done and was found to have multiple nits and multiple crab lice over her eyelashes. She was treated with oral ivermectin and trimming of eyelashes as advised by ophthalmologist. She improved in a week. Thus, phthiriasis palpebrarum can mimick seborrheic blepharitis and therefore high index of suspicion and detailed examination is necessary for appropriate diagnosis.</p>

A comparative study to assess the efficacy of permethrin (topical) and ivermectin (oral) in scabies patients seeking care at a tertiary care teaching hospital of northern India

The evidence for the superiority of Ivermectin (Oral) over topical preparations in the treatment of scabies conclusively lacks at present. Randomized controlled trials comparing ivermectin with topical permethrin have provided us the inconclusive results.To comparatively assess the efficacy of permethrin (topical) and ivermectin (oral) in scabies patients.After enrolling 178 study subjects, they were equally distributed to two study groups (I & II) and were given the desired respective therapeutic medication or interventions. Subjects in Group I was given permethrin 5% cream, and subjects in Group B were given a single dose of tablet ivermectin orally (200 mcg/kg). Efficacy of two groups of drugs was compared in terms of improvement in clinical grading of disease (%) & development in clinical grading of pruritus (%) during follow up visits at the end of 1, 2, 4 & 6 weeks.The mean age (± SD) for study subjects in Group I was 18.18 ± 11.33 years, whereas, in the Group II, it was 25.185 ± 10.67 years. The clinically observed cure rate among two groups i.e., Permethrin and Ivermectin at the end of the first and second weeks were 72% and 40%, and 96% and 58%, respectively. Rapid improvement in itching was noted down among subjects receiving topical permethrin as compared to those who received oral ivermectin. Comparatively, during different visits, permethrin provided better and fast improvement in itching grade than ivermectin.The improvement in scabies clinical grade and itching grade for permethrin (topical) was found to be more efficacious in comparison to ivermectin (oral).

Case Report: Nasal Myiasis in an Elderly Patient with Atrophic Rhinitis and Facial Sequelae of Leprosy.

We describe a case of nasal myiasis in an 89-year-old Brazilian patient affected by leprosy with severe nasal sequelae. An initial treatment comprising sinusectomy combined with nasal endoscopy removed more than 300 larvae, supplemented by systemic treatment using oral and topical ivermectin and levofloxacin. Infestation recurred after 2 months, was treated similarly, and resolved completely. The case could be attributed to severe nasal leprosy sequelae, with a lack of sneezing reflex, painless ulceration, atrophic rhinitis (ozena), and inability to clean the nose properly due to hand and nose impairment. This case illustrates the importance of long-term medical follow-up of patients with leprosy sequelae.

Characterization of Phthirus pubis With Ex Vivo Dermoscopy.

Pubic lice are smaller, less pigmented, and less mobile than head lice, and thus more difficult to observe with naked eye.1 In addition, the increasing habit of pubic hair removal has led to a falling incidence of pubic lice owing to the destruction of its natural habitat.2 This may be responsible for the atypical patterns of Phthirus pubis infestation in other parts of the body (eyebrows, axillae, trunk)2 and may be an underestimated cause of resistant pruritus and dermatitis. In vivo dermoscopy is useful for identifying nits and lice on the skin in these cases.1,3 However, a better characterization of the parasite can be made by collecting it from the skin surface with a transparent adhesive tape. This ex vivo dermoscopy is a simple and convenient method that allows for a more hygienic and detailed examination (Fig. 1), with no need of other devices, such as direct,3 confocal,4 or electron microscopy.5P. pubis has a short and broad body with 6 legs. The first pair of legs is slim; the second and third pairs are thicker and carry brown claws for grasping hair. The anterior portion has small mouthparts, used for probing the skin and withdrawing blood from dermal vessels. The ingested blood flows through the digestive tract, identified as brown-reddish structures in both sides and middle of the body (Video, Supplemental Digital Content 1, https://links.lww.com/OLQ/A453). External openings of the respiratory system, called spiracles, are seen as several brown dots at the periphery of the body. Air enters through them and is delivered to the organs by air tubes, depicted as a network of brown longitudinal and transverse lines.4,5Figure 1: Dermoscopic characterization of P. pubis (DermLite DL4W, contact, polarized light). Broad and triangular body with 2 anterior slim legs, and 4 posterior thick legs with dark brown claws (C). D indicates digestive system, brown-reddish colored due to ingested blood; M, mouthparts with antennae; S, spiracles, corresponding to the external openings of the respiratory system, which is conformed by arranged and branching air tubes (T).First-line treatment is topical 1% permethrin. Other pediculicide drugs include 0.2% phenothrin, 0.5% malathion, 1% lindane, and topical or oral ivermectin.6 In conclusion, ex vivo handheld dermoscopy is a useful technique for a quick bedside diagnosis of pediculosis and species identification.Video: Ex vivo dermoscopy showing an alive P. pubis removed from the skin (Supplemental Digital Content 1, https://links.lww.com/OLQ/A453). Note the peristaltic movements pumping the ingested blood through the digestive system (DermLite DL4W, contact, polarized light).

Can we treat scabies adequately using topical medication? Retrospective analysis of 74 patients

Aim: Scabies is a contagious parasitic skin disorder, which is characterized by severe pruritus. Scabies usually presents with papules and excoriations on hands, feet, axillae, umbilicus and genitalia. Recently, both increased prevalence of the disease and resistance to anti-scabies treatment have been reported. Therefore, early diagnosis and appropriate treatment of scabies are crucial. The aim of this study was to evaluate the characteristics of patients with scabies and treatments that the patients received in order to provide successful management of scabies.Material and Methods: Medical records of the patients who were diagnosed with scabies between June 2019 and February 2020 were reviewed retrospectively. Age, gender, disease duration, similar symptoms in household members, dermatological examination, prior treatments and treatments that we recommended were recorded.Results: The study included 74 patients (39 female, 35 male) with scabies. The mean age of the patients was 40.6±16.7 years. The mean disease duration was 53.5±5.5 days. Pruritus was observed in the household members of 37 (50%) patients. 18 (24.3%) patients received only symptomatic treatment since they were diagnosed as other pruritic dermatoses including xerosis or dermatitis, previously. However, we treated 58 (78.4%) patients using topical permethrin 5%. In addition, 4 (5.4%) patients were treated with topical sulfur 12.5% and 3 (4.1%) patients were treated with balsam of Peru. 9 (12.2%) patients who were resistant to topical treatment received oral ivermectin for complete cure of scabies. Conclusion: The results indicated that most of the patients with scabies (78.4%) were treated with topical permethrin successfully, whereas 12.2% patients required oral ivermectin in addition to topical anti-scabies treatment. Nevertheless, delay in diagnosis of 24.3% patients might increase the risk of spread of scabies. Therefore, we recommend topical permethrin, oral ivermectin and immediate further clinical and laboratory evaluation for indeterminate cases.

Oral Ivermectin should be considered as a Magic Therapy for Scabies with 98% Cure

Background: Scabies is one of the commonest endemic pruritic diseases all over the worldwide. Many topical therapeutic options for scabies are available, but none of them could be accepted by many patients as all of them need covering the whole body by ointment overnight. Accordingly patients are looking for safe oral therapy like many other diseases. Objective: To assess the effectiveness of oral ivermectin in the treatment of scabies. Patients and Methods: This single, blinded, therapeutic work was conducted in the Center of Dermatology and Venereology, Baghdad Teaching Hospital, Baghdad, Iraq during the period from April 2018 through October 2019. Fifty of patients with scabies were involved in this study. All socio-demographic data that related to the disease were obtained from each patient. History and clinical examination was done for each case to establish the diagnosis. Fifty patients treated by ivermectin tablet 200 microgram per kg as a single dose on empty stomach and repeated after one week. The patients were seen regularly every 2 weeks for 4 weeks duration after stopping therapy, to re-asses cure and to report any local or systemic side effects. Results: A total of 50 patients were included in this study, 21 (42%) males and 29 (58%) females. The ages of males ranged from 5-47 with a mean 20.90±13.034 years; while the age range of females ranged from 3-67 (30.69±18.766) years. At the end of four weeks after stopping therapy , the response to treatment was as follows: Response in 49 (98%) patients and no response in 1 (2%) patients. No cutaneous or systemic side effects were noticed in any patients, while the recurrence or relapse rate was documented in 2 (4%) patients. Conclusion: Oral ivermectin had achieved cure of scabies in 98% of patients, hence it should be considered as a mass treatment in cases of outbreak and epidemics as it is easy to be used with no significant side effects especially when compared with topical agents.

Single Oral Dose of Ivermectin as a New Therapeutic Trial for Contacts of Patients with Scabies

Background: Scabies is one of the common epidemic and endemic diseases worldwide. Many topical therapeutic modalities for scabies are available. Topical ivermectin has been used effectively in treatment of scabies but there is no oral effective therapy that prevents contacts to get scabies. Objective: To evaluate the effectiveness of oral ivermectin in prevention of scabies contacts to get scabies. Patients and Methods: The study is a single-blinded therapeutic study that was conducted in the Center of Dermatology, Baghdad Teaching Hospital, Baghdad, Iraq during the period from April 2018 through October 2019.Two hundred sixty healthy scabies contacts were included in this study, their ages ranged from 5-60 years with a mean ± SD of 19.3± 1.9 years. All these contacts were screened for active scabies and they were all free. The contacts of scabies were treated by ivermectin tablet 200 microgram per kg as a single dose after 2 hours from dinner. They were seen regularly after 4 weeks to be re-examined and to record any scabies and drug side effects. Results: The response after four weeks of single dose therapy of healthy contacts showed that 245 (94%) from 260 were free of scabies and only 15(6%) contacts showed infection with scabies and this was statistically significant Chi-square (c2= 148, P-value less than 0.00000001. No any side effects were noticed in any treated contacts. Conclusion: Oral single ivermectin dose is an effective therapy to prevent scabies contacts to get infection. It an easy method of prevention which is very useful in condition of scabies outbreaks and epidemics to stop the rapid spread of the disease.

Genital nodular scabies.

Nodular scabies is a less common manifestation of scabies. It is characterized by firm, erythematous, pruritic nodules, often involving the genitalia. Diagnosis can be made clinically, and first-line treatment is topical permethrin or oral ivermectin.

Oral ivermectin for infants and children under 15 kg appears to be a safe and effective treatment for scabies.

Oral ivermectin for infants and children under 15 kg appears to be a safe and effective treatment for scabies.

Safety of oral ivermectin during pregnancy: a systematic review and meta-analysis

BackgroundAbout 3·7 billion doses of ivermectin have been distributed in mass drug administration (MDA) campaigns globally over the past 30 years. At 10−100 times higher than current human doses, ivermectin is a known teratogen in mammals. During these campaigns with recommended doses, pregnant women might be inadvertently exposed. We therefore aimed to evaluate the existing evidence for serious and non-serious adverse events after ivermectin exposure in pregnant women.MethodsFor this systematic review and meta-analysis, we searched relevant databases and trial registry platforms on July 15, 2018, for randomised controlled trials (RCTs) and observational studies that reported adverse events in pregnant women. We did not use language or date restrictions. Outcomes of interest were spontaneous abortions, stillbirths, congenital anomalies, and neonatal death (serious adverse events), as well as maternal morbidity, preterm births, and low birthweight (adverse events). The risk of bias was assessed using the Newcastle-Ottawa Scale for observational studies and the Cochrane Risk of Bias Tool for RCTs. We did the meta-analysis of observational studies and RCTs separately. The quality of evidence was assessed using the GRADE approach. The study protocol is registered with PROSPERO, protocol CRD42016046914.FindingsWe identified 147 records, of which only five observational studies and one RCT were included for quantitative analysis; these studies were published between 1990 and 2008, and were done in six African countries. 893 women with 899 pregancy outcomes were included, of whom 496 pregnant women (500 pregnancy outcomes) received ivermectin inadvertently during MDA campaigns in the observational studies and 397 pregnant women (399 pregnancy outcomes) purposely received ivermectin as part of the open-label RCT. No study reported neonatal deaths, maternal morbidity, preterm births, or low birthweight. It is unclear whether exposure to ivermectin during pregnancy increases the risk of spontaneous abortions and stillbirths (odds ratio [OR] 1·15 [95% CI 0·75−1·78] with very low certainty of evidence for the four observational studies and 0·62 [0·18−2·14] with very low certainty of evidence for the RCT) or congenital anomalies (OR 1·69 [95% CI 0·83−3·41] with very low certainty of evidence for the five observational studies and 1·10 [0·07−17·65] with very low certainty of evidence for the RCT).InterpretationThere is insufficient evidence to conclude on the safety profile of ivermectin during pregnancy. Treatment campaigns should focus additional efforts on preventing inadvertent treatment of pregnant women.FundingUnitaid.

The effect of food on the pharmacokinetics of oral ivermectin.

Ivermectin is an older anthelminthic agent that is being studied more intensely given its potential for mass drug administration against scabies, malaria and other neglected tropical diseases. Its pharmacokinetics (PK) remain poorly characterized. Furthermore, the majority of PK trials are performed under fasted-state dosing conditions, and the effect of food is therefore not well known. To better plan and design field trials with ivermectin, a model that can account for both conditions would be valuable. To develop a PK model and characterize the food effect with single oral doses of ivermectin. We performed a population-based PK analysis of data pooled from two previous trials of a single dose of 12 mg ivermectin, one with dosing after a high-fat breakfast (n=12) and one with fasted-state dosing (n=3). The final model described concentration-time profiles after fed and fasted dosing accurately, and estimated the food effect associated with relative bioavailability to 1.18 (95% CI 1.10-1.67). In this analysis, the effect of a high-fat breakfast compared with a fasted-state administration of a single oral dose of 12 mg ivermectin was minimal.

Skin infections in Australian Aboriginal children: a narrative review.

Summary Impetigo, scabies, cellulitis and abscesses are common in Australian Aboriginal children. These conditions adversely affect wellbeing and are associated with serious long term sequelae, including invasive infection and post‐infectious complications, such as acute post‐streptococcal glomerulonephritis and acute rheumatic fever, which occurs at the highest documented rates in the world in remote Aboriginal communities.Observational research in remote communities in northern Australia has demonstrated a high concurrent burden of scabies and impetigo and their post‐infectious complications.Few data are available for other Australian states, especially for urban Aboriginal children; however, nationwide hospital data indicate that the disparity between Aboriginal and non‐Aboriginal children in skin infection prevalence also exists in urban settings.The Australian National Healthy Skin Guideline summarises evidence‐based treatment of impetigo, scabies and fungal infections in high burden settings such as remote Aboriginal communities. It recommends systemic antibiotics for children with impetigo, and either topical permethrin or oral ivermectin (second line) for the individual and their contacts as equally efficacious treatments for scabies. β‐Lactams are the treatment of choice and trimethoprim–sulfamethoxazole and clindamycin are effective alternatives for treatment of paediatric cellulitis. Abscesses require incision and drainage and a 5‐day course of trimethoprim–sulfamethoxazole or clindamycin.Addressing normalisation of skin infections and the social determinants of skin health are key challenges for the clinician. Research is underway on community‐wide skin health programs and the role for mass drug administration which will guide future management of these common, treatable diseases.

Prevalence and Alternative Treatment of Head-Lice Infestation in Rural Thailand: A Community-Based Study.

Head-lice infestation, pediculosis capitis, remains a public-health burden in many countries. The widely used first-line pediculicides and alternative treatments are often too costly for use in poor socio-economic settings. Ivermectin has been considered an alternate treatment for field practice. This study was composed of 2 parts, a cross-sectional survey and an intervention study. The main objectives were to determine the prevalence and potential factors associated with head-lice infestation, and to evaluate the effectiveness and safety of oral ivermectin administration. A community-based cross-sectional survey was conducted among 890 villagers in rural areas along Thai-Myanmar border. Females with infestations were eligible for the intervention study, and 181 participated in the intervention study. A post-treatment survey was conducted to assess acceptance of ivermectin as a treatment choice. Data analysis used descriptive statistics and a generalized-estimation-equation model adjusted for cluster effect. The study revealed the prevalence of head-lice infestation was 50% among females and only 3% among males. Age stratification showed a high prevalence among females aged <20 years, and among 50% of female school-children. The prevalence was persistent among those with a history of infestation. The major risk factors were residing in a setting with other infected cases, and sharing a hair comb. The study also confirmed that ivermectin was safe and effective for field-based practice. It was considered a preferable treatment option. In conclusion, behavior-change communication should be implemented to reduce the observed high prevalence of head-lice infestation. Ivermectin may be an alternative choice for head-lice treatment, especially in remote areas.

Ivermectin safety in infants and children under 15 kg treated for scabies: a multicentric observational study.

Scabies is a frequent condition seen in infants and children. Only topical treatments have been approved in infants, but some of them are poorly tolerated. Oral ivermectin is approved for the treatment of scabies in several countries, but its use in infants and children weighing < 15 kg is off label. To assess the safety of ivermectin in infants and young children, and to collect data on ivermectin efficacy in these age groups. This study was performed in the dermatology and paediatric dermatology departments of 28 French centres between July 2012 and November 2015. Physicians treating an infant or child weighing < 15 kg for scabies with oral ivermectin were asked to send back a completed standardized and anonymous questionnaire, and the data were analysed. Data were collected on 170 infants and children aged 1-64 months, with a body weight of 4-14·5 kg, who were treated with oral ivermectin. The mean dose received was 223 μg kg-1 and 89% of the patients received a systematic second dose. Concomitant topical treatment was administered to 73% of patients. Adverse events were reported in seven patients (4%) and were not severe. At the follow-up visit, 139 (85%) patients had achieved healing. Factors significantly associated with healing were an ivermectin dose > 200 μg kg-1 (P < 0·001), and a delay between those two doses of < 10 days (P = 0·025). Our findings suggest the safety and efficacy of ivermectin for the treatment of scabies in infants and young children. What's already known about this topic? Scabies is a frequent condition in small children and infants, but the therapeutic options are limited. Ivermectin has been approved for the treatment of scabies in adults and children > 15 kg, but its use is off-label in infants and children weighing < 15 kg. Safety data on the use of ivermectin in children weighing < 15 kg are limited. What does this study add? Of 170 infants and children weighing < 15 kg who were treated for scabies with oral ivermectin, there were only seven reported mild adverse events and no serious ones. Our results show that ivermectin is effective in treating scabies in 85% of patients. Efficacy is higher when the received dose exceeds 200 μg kg-1 and when the delay between the two doses is < 10 days. Respond to this article.

Management of scabies.

Scabies is a common infestation worldwide, affecting persons of any age and socioeconomic status. In Singapore, it is more common in institutions rather than in homes. The two variants are classic scabies and crusted scabies, with the latter having a significantly higher mite burden. Early identification, isolation of index patients and prophylactic treatment of contacts are essential in dealing with the outbreak. Locally, most primary care practitioners make the diagnosis based on visual inspection and clinical examination. A skin scrape is done to confirm the diagnosis, especially in atypical presentations. Scabietic mites, eggs or faeces can be seen on microscopy. The usual treatment for adult scabies in Singapore is the use of topical malathion or permethrin. A combination of topical permethrin and oral ivermectin is used for crusted scabies.