Efficacy, acceptability and cost effectiveness of four therapeutic agents for treatment of scabies

Abstract

The aim of this study is to evaluate four drug regimens for treatment of scabies as regard their efficacy, acceptability and cost effectiveness. Two hundred cases with ordinary scabies were randomized into four groups. First group received ivermectin 200 μg/kg body weight single oral dose, repeated after one week. The second received benzyl benzoate 20% cream. The third received permethrin 2.5%-5% lotion, whereas the fourth group received 5-10% sulfur ointment. Topical treatments were applied for five consecutive nights. Patients were followed up for two weeks for cure rate and adverse effects. At the end of the study, permethrin provided a significant efficacy of 88% and acceptability in 100% of cases, but had higher cost to treat one case (20.25 LE). Ivermectin provided efficacy and acceptability rates of 84% and 96%, respectively, and had a cheaper cost (9.5 LE). Benzyl benzoate provided 80% for both rates and was the cheapest drug. Sulfur ointment provided the least rates, and it was the most expensive. Treatment choice will depend on the age, the general condition of cases, patient compliance to topical treatment and his ability to stick to its roles, and the economic condition of the patient.

Ivermectin and permethrin for treating scabies

“…Three studies compared four treatment groups. Abdel‐Raheem 2016 investigated topical permethrin and systemic ivermectin (plus two groups treated with sulfur ointment or benzyl benzoate cream not included in this review). Das 2006 also examined the effect of gamma benzene hexachloride 1% and included a placebo group.…”

“…The oldest included study was conducted from 1993 to 1995 and was published in 1996 ( Macotela‐Ruiz 1996 ), while the three most recent ones were published in 2016 ( Abdel‐Raheem 2016 ; Ahmad 2016 ; Wankhade 2016 ).…”

“…Only three studies reported the mean age at baseline of all included participants. In the study by Abdel‐Raheem 2016 , the mean age of the 200 participants who completed the study was 25.33 years (standard deviation (SD) 12.84). The mean age at baseline of the 62 randomized participants in the study by Ahmad 2016 was 21.8 years (SD 15).…”

“…Diagnostic procedures differed greatly. In six studies clinical diagnosis was confirmed by microscopic examination ( Das 2006 ; Chhaiya 2012 ; Saqib 2012 ; Rohatgi 2013 ; Abdel‐Raheem 2016 ; Ahmad 2016 ). In the study by Wankhade 2016 , participants were included based on clinical criteria, even when the microscopic examination was negative.…”

“…2 Downgraded by 1 for serious risk of bias: assessed as moderate. 3 Abdel‐Raheem 2016 . 4 Downgraded by 1 for serious imprecision: CI crosses line of no effect and minimal clinically important difference thresholds: uncertain whether there is any difference.…”