Scabies is usually treated with a topically applied acaricide. However, a single oral dose of ivermectin has been reported to be effective.1,2 In a study of 11 patients with uncomplicated scabies, a single oral dose of ivermectin 200 micrograms/kg was effective in curing infection after 4 weeks. In a group of 11 patients, also infected with HIV, scabies was cured in 8 after 2 weeks.
Two of the remaining 3 patients received a second dose of ivermectin which cured the scabies infection by the fourth week. A single oral dose of ivermectin 150 micrograms/kg was partially effective in an outbreak of scabies in 1153 Tanzanian patients.
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Ivermectin is a semisynthetic derivative of one of the avermectins, a group of macrocyclic lactones produced by Streptomyces avermitilis. It has a microfilaricidal action in onchocerciasis and reduces the microfilarial load without the toxicity seen with diethylcarbamazine. Ivermectin also has a microfilaricidal action in lymphatic filariasis and is used in its management. Ivermectin is active in some other worm infections. It is used in the treatment of strongyloidiasis and has been tried in some Mansonella infections.
In the treatment of onchocerciasis, a single oral dose of 3 to 12 mg of ivermectin, based roughly on 150 micrograms/kg for patients weighing more than 15 kg and over 5 years of age, is given annually or every 6 months. This schedule has been adopted for mass treatment in infected areas. No food should be taken for 2 hours before or after the dose.
Ivermectin 200 micrograms/kg as a single dose, or daily on two consecutive days, is used for the treatment of strongyloidiasis.
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The adverse effects reported with ivermectin in patients with filariasis are generally consistent with a mild Mazzotti reaction arising from its effect on microfilariae. They include fever, pruritus, skin rashes, arthralgia, myalgia, asthenia, orthostatic hypotension, tachycardia, oedema, lymphadenopathy, gastrointestinal symptoms, sore throat, cough, and headache. The effects tend to be transient and if treatment is required they respond to analgesics and antihistamines.
Ivermectin may cause mild ocular irritation. Somnolence, transient eosinophilia, and raised liver enzyme values have also been reported. Ivermectin is not recommended during pregnancy. Mass treatment is generally withheld from pregnant women (see Pregnancy, below), children under 15 kg, and the seriously ill.
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Adverse effects directly attributable to diethylcarbamazine include nausea and vomiting. Headache, dizziness, and drowsiness may occur.
Hypersensitivity reactions arise from the death of the microfilariae. These can be serious, especially in onchocerciasis where there may also be sight-threatening ocular toxicity; fatalities have been reported. Encephalitis may be exacerbated in patients with loiasis and fatalities have occurred.
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