Successful Treatment of Scabies with Oral Ivermectin in Nigeria

Abstract

Currently, several topical scabicides are available but there is yet no oral or parenteral drug which has been established for the treatment of scabies in Nigeria. Ivermectin which is a modified avermectin, known to be an ectoparasiticidal agent in animals, has been used in adults for systemic parasitosis. In Nigeria, 25% benzyl benzoate is being extensively used for the treatment of scabies in adults. It is effective and readily available. The present study was carried out to evaluate the efficacy and safety of ivermectin in the treatment of patients with scabies at the skin clinic of the University of Nigeria Teaching Hospital, Enugu. Fifty-eight patients with scabies were recruited for the study; 13 (22.4%) were children aged between 5-14 years. Oral ivermectin was given in a single dose of 200 [microg/kg body weight to 29 patients. The remaining 29 patients had to apply 25% benzyl benzoate emulsion. All patients received a full physical and dermatological examination prior to onset of treatment and weekly for 4 weeks. Skin scrapings were taken to confirm the diagnosis of scabies. There was a 93% resolution of pruritus with ivermectin and 48% with benzyl benzoate. No side effects were observed with ivermectin. Our results show that oral ivermectin is a promising, effective and safe alternative in both children and adults of Nigeria when compared to 25% benzyl benzoate topical application.

Impact of scabies in resource-poor communities

“…Similarly, another recent trial from India reported lower efficacy of a single dose of ivermectin as compared to application of topical permethrin [70]. These results from Senegal and India are in contrast to a series of trials comparing oral ivermectin with different topical compounds, which reported similar or superior therapeutic efficacy of ivermectin [71][72][73][74][75][76][77][78][79]. As some of these trials were not controlled, and methods were not standardized, the results should be interpreted with care.…”

Ivermectin versus benzyl benzoate applied once or twice to treat human scabies in Dakar, Senegal: a randomized controlled trial

“…Of seven randomized trials that compared topical scabicides to IV, [12][13][14][15][16][17][18] the four that compared IV and BB showed that IV was either an equivalent or a superior treatment (Table 4). We believe our results differ from those previously reported for several reasons.…”

Ivermectin worthy of further investigation

“…Since that meta-analysis, two out of three studies comparing ivermectin to benzyl benzoate have demonstrated significantly higher cure rates for ivermectin (the third study found equivalence of the treatments). [2][3][4] This was an equivalence study based on the assumption that the difference in effectiveness between the treatment arms was less than 15%. Ivermectin is known to have limited ovicidal action which means that a single dose may not prevent recrudescence from eggs residing on the skin at the time of treatment (which hatch approximately every four days), compared to benzyl benzoate and permethrin, which have ovicidal activity.…”