Scabies TX
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Transcript of Scabies TX
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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!!