Background
Discussion
Diagnosis
Treatments
Study | Indicative cure rate | Drugs and treatment regimen | Comments |
---|---|---|---|
Topical
| |||
Benzyl benzoate
| |||
[45] Moberg et al., 1984 | (43 %; 6/14) | benzyl benzoate (22.5 %) | case report |
[46] Yonkosky et al., 1990 | (12 %; 23/195) | benzyl benzoate (50 %) | case study |
[47] Nnoruka et al., 2001 | (48 %; 14/29) | benzyl benzoate (22.5 %) | clinical exploratory study |
[38] Glaziou et al., 1993 | (48 %; 10/21) | benzyl benzoate (10 %) | RCT |
Permethrin
| |||
[38] Leibowitz, 1993 | (0 %; 0/11) | permethrin 5 % cream | un-controlled case study |
[40] Fraser, 1994 | permethrin | (in vitro study) | |
[48] Walton et al., 2000 | " | (in vitro study) | |
[37] Pasay et al., 2006 | " | (in vitro study) | |
[39] Pasay et al., 2008 | " | (in vitro study) | |
[33] Mounsey et al., 2008 | " | (in vitro study) | |
[34] Mounsey et al., 2009 | " | (in vitro study) | |
[49] Saqib et al., 2012 | quasi clinical study, re-infestation after successful treatment (7 %; 4/60) | ||
[50] Huffam et al., 1997 | (0 %; 0/20) | permethrin 5 % cream | crusted scabies |
Sulphur
| |||
[51] Coskey RJ, 1979 | (0 %; 0/1) | sulphur 5 % in an ointment | case report |
Oral
| |||
Ivermectin
| |||
[52] Glaziou et al., 1993 | (70 %; 16/23) | single dose, 100 μg/kg | RCT, poor efficacy partly attributed to the lower dose used in the study |
[30] Currie et al., 1994 | (0 %; 0/1) | two doses, 200 μg/kg | case report, crusted scabies |
[33] Currie B.J 1999 | five dose regimen, 200 μg/kg | crusted scabies, monthly administration failed to prevent reinfestation | |
[36] Currie et al., 2004 | (0 %; 0/2) | seven doses, 270 μg/kg | reinfestation following seven doses, unpublished observations |
[53] Brooks, et al., 2002 | (56 %; 24/43) | single dose, 200 μg/kg | results evaluated at 3 weeks post treatment |
[33] Mounsey et al., 2008 | In vitro study | ||
[41] van den Hoek et al., 2008 | (0 %; 0/7) | case report | |
[34] Mounsey et al., 2009 | In vitro study | ||
[42] Ly et al., 2009 | (30 %;16/53) single dose, 150–200 μg/kg | first RCT to report resistance of ivermectin | |
[43] Rizvi et al., 2011 | (78 %; 38/50) single dose, 200 μg/kg | quasi clinical study | |
[54] Fujimoto et al., 2014 | (0 %; 0/1) | 6000 μg/week* 3 + 12000 μg/week *3 | case report |
[49] Saqib et al., 2012 | quasi clinical study, re-infestation after successful treatment (7 %; 4/60) | ||
[50] Huffam et al., 1997 | (60 %; 12/20) | one-three doses, 200 μg/kg combined with topical scabicide and keratolytic therapy | crusted scabies |
Study | Drugs | Dosage | Treatment regimen | Contraindication | Disadvantages | Comments |
---|---|---|---|---|---|---|
Topical
| ||||||
Benzyl benzoate | 25 % solution | one or several consecutive 24-h applications | pregnant women and infants | burning or stinging, pruritus, dermatitis, convulsions (rare) | In use since 1930s; possible neurological complications with misuse; withdrawn in the European Union due to neurotoxicity concerns | |
Permethrin | 5 % cream (8–14 h) then wash off | apply overnight | infants aged <2 months | mild burning, itching stinging, pruritus, erythema, tingling, persistent excoriation, dystonia (rare), convulsions (rare) | in use since the 1980s; relatively expensive; growing resistance among scabies mites poor compliance reported in mass community intervention programs | |
Sulphur | 2–10 % precipitate in petroleum base | apply for 24 h, and then wash and reapply repeat applications for 3 days | noxious, malodorous messy; not given as first-line agents; multiple applications required; can cause skin irritation; | has been used for centuries; indicated in infants, pregnant and lactating women; inexpensive | ||
Oral
| ||||||
Ivermectin | 200 μg/kg orally repeated after 1–2 weeks | children aged <5 years.; children <15 kg; pregnant or lactating women | transient side effects: gastrointestinal disorders; pustular rash, cellulitis; abdominal pain, diarrhoea, headache, vomiting, hypotension, toxic epidermal necrosis, mucosal drug eruption, fever, anorexia, lymph node swelling, eosinophilia, pain of joint and muscles, mazzotti reaction | in use since 1980’s (for the mass treatment of onchocerciasis, and filariasis); not approved for the treatment of typical scabies (except in Japan, Brazil, France); only indicated if symptoms persists 3 weeks after application of benzyl benzoate or permethrin; no ovicidal activity, thus repeat treatment is required; one report of increased deaths among elderly patients during scabies outbreak in an institutional setting (1997); there has been considerable criticism on the validity of this report, no other studies have replicated these findings |
Conclusions
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Availability of a ‘fool-proof’ diagnostic tool will enable the selective treatment of affected individuals, decrease the potential for escalating mite resistance, and reduce the need for mass treatment and the associated costs.
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Long-term adherence difficulties, safety and efficacy uncertainties in the young and elderly, and growing concerns over the development of resistance to classical scabicides, all signal the need to identify new treatment options for scabies (with greater levels of treatment compliance in MDA programs) to reduce the burden of infection in endemic settings and the morbidity and mortality associated with it.