![]() ![]() ![]() Ivermectin is an avermectin acaricide that works by interrupting the functioning of a class of ligand-gated chloride ion channels in the scabies mite, causing persistent channel opening. This medicine is an important development in treating crusted scabies, typical scabies failing topical treatments, scabies in community epidemics and in aged-care home settings.Īlthough standard topical treatment of scabies is effective in most patients when used correctly, ivermectin has a role in management of endemic scabies, especially when compliance with head-to-toe application of topical agents is logistically difficult.Įnsure patients know how to take ivermectin (dose frequency and interval) to ensure successful treatment and to minimise the risk of antimicrobial resistance. There are limited data regarding the safety of ivermectin in the very old and very young and also in patients with liver impairment. Overall, trials comparing ivermectin with topical treatments for typical scabies suggest a single dose may not be effective against all stages in the life cycle of the scabies parasite.Īlthough there is a lack of clinical trial evidence for the efficacy of ivermectin specific to the Aboriginal and Torres Strait Islander population, ivermectin has been shown to be successful for treating typical and crusted scabies in mass treatment of communities with endemic scabies. Potential dosing regimens have been evaluated in cohort and case series studies. No controlled clinical trials have been published to evaluate the appropriate dosing regimen of ivermectin to treat typical or crusted scabies. Furthermore there are issues regarding the applicability of the trial population to the proposed PBS population. Ivermectin, when used to treat scabies, is generally well tolerated, with only mild, transient adverse effects.Ĭonducted using ivermectin for typical scabies there has been substantial heterogeneity in study methodology, making the clinical efficacy of ivermectin difficult to evaluate. ![]() ![]() It is difficult to draw a conclusion regarding the comparative efficacy of ivermectin versus benzyl benzoate due to significant heterogeneity across trials. While ivermectin is successful at curing scabies (defined as no new lesions caused by the mite) after two separated doses, it is not ovicidal and has been shown to be slower to eliminate lesions compared with permethrin. Oral ivermectin has been shown to be superior to placebo and has been used successfully in the community management of endemic scabies. Listed for the treatment of onchocerciasis and stronglyloidiasis. While this medicine has been available for some time it was only recently givenĪpproval for treatment of scabies. a class of broad-spectrum antiparasitic agents active against a range of nematodes and ectoparasites. Response to treatment varies and inadequately treated patients may transmit infestation. The optimal dosing schedule for crusted scabies is uncertain.However, no randomised controlled trials have compared ivermectin with other treatments for crusted scabies. Ivermectin in conjunction with topical therapy is the only treatment option indicated or proposed in guidelines for crusted scabies.Ivermectin is not ovicidal - a single dose may be inadequate to eradicate the different stages of the parasite. For typical scabies, minimise the risk of treatment failure and mite-resistance by using two doses of ivermectin.If the cause of treatment failure cannot be identified, oral ivermectin may be indicated. If permethrin or benzyl benzoate does not cure typical scabies, consider and address possible reasons for failure.Mite-resistance through overuse of ivermectin may limit future treatment options. Maintain topical treatments (permethrin 5% cream or benzyl benzoate 25% lotion) as first line for typical scabies. Reserve ivermectin as second line for typical scabies. ![]()
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