Treatment of Scabies: Permethrin vs.

Ivermectin
A04 義大醫院 王柏欣, 陳奕峰, 詹子慶

skin to skin contact  Typical vs atypical/crusted/keratotic  2-6 weeks before symptoms are apparent  During the incubation period the newly infested healthcare worker could be a source of transmission  .Transmission of scabies Mite Sarcoptes scabiei.

but resistance  Permethrin vs Ivermectin .Prevention and Control Recognize patient with symptoms and signs  Skin scrapings  Contact isolation precautions  Personal protective equipment  Pharmaceutical agents :  Lindane: standard tx.

Thinking Process Inadequate treatment of scabies increase transmission of scabies throughout hospitals Find a more effective treatment among choices of medication Permethrin vs Ivermectin Search form evidence-based medicine database for answer .

Ask an answerable question Permethrin vs Ivermectin Which is better for scabies treatment? .

PICO Patient Intervention Comparison Scabies infected patient Medical treatment with Permethrin Medical treatment with Ivermectin Prevention of scabies outbreak Outcome .

Tracking Down the Best Evidence Cochrane Database of Systemic Reviews  PubMed Library  Clin-eguide  .

Tracking down the best evidence Database: Cochrane Database of Systemic Reviews Key Word: scabies Result: [Review] Interventions for treating scabies M Strong. PW Johnstone Cochrane Database of Systematic Reviews 2008 Issue 2 (Status: Edited) .

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Inc. Issue 2 (February 2000) . .Copyright © 2000 American Academy of Dermatology.Volume 42.Tracking down the best evidence Database: Clin-eguide Key Word: scabies Result: A comparative study of oral ivermectin and topical permethrin cream in the treatment of scabies Journal of the American Academy of Dermatology .

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Permethrin acts by disrupting the sodium channel current  Topical application ensures maximum concentration of the drug in the skin  Infrequently used because of its high cost  .

which occur in nerve and muscle cells  not be effective against the younger stages inside the egg because the nervous system has not yet developed  Additional doses needed  .Ivermectin bind selectively to GABA gated chloride ion channels.

001).Single application of permethrin was superior to a single oral dose of ivermectin by 2 weeks (P < . .

scabies/dt. . permethrin/tu. lindane/tu. malathion/tu.Tracking down the best evidence Database: PubMed Key Word: scabies Result: 2001 National Guideline on the Management of Scabies  Evidence Base  Medline search strategy  Years covered 1966-1997  Key terms .scabies/th.

usually overnight. Mites separated from the human host die after 72 hours.        Permethrin 5% cream (level of evidence 1b. grade of recommendation A) Malathion 0. Potentially contaminated clothes and bedding should be washed at high temperature (>50°C) if possible. Itch may persist for several weeks. . Antihistamines may also be helpful in relieving itch.5% aqueous lotion (level of evidence 4. Application of crotamiton cream may give symptomatic relief. and washed off after 12 hours. grade of recommendation C) These should be applied to the whole body from the neck downwards.

   Oral ivermectin in a dose of 200 mcg/kg in the treatment of Norwegian scabies. Ivermectin is not licensed for this purpose in the UK There have been concerns about toxicity   Pregnancy and Breastfeeding Permethrin is safe during pregnancy or breastfeeding .

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