THE TREATMENT OF SCABIES WITH IVERMECTIN

Background. Ivermectin is an anthelmintic agent that has been a safe, effective treatment for on- chocerciasis (river blindness) when given in a single oral dose of 150 to 200 m g per kilogram of body weight. An- ecdotal reports of improvement in patients who suffered from infestation with the mite Sarcoptes scabiei suggest that the ectoparasitic disease scabies might be treated with ivermectin. Methods. We conducted an open-label study in which ivermectin was administered in a single oral dose of 200 m g per kilogram to 11 otherwise healthy patients with sca- bies and to 11 patients with scabies who were also infect- ed with the human immunodeficiency virus (HIV), 7 of whom had the acquired immunodeficiency syndrome. All patients received a full physical and dermatologic exami- nation; scrapings from the skin of all patients tested pos- itive for scabies. Patients were reexamined two and four weeks after treatment, when the scrapings for scabies were repeated. The patients used no other scabicides during the 30 days before ivermectin treatment or during the 4-week study period. Results. None of the 11 otherwise healthy patients had evidence of scabies four weeks after a single dose of ivermectin. Of the 11 HIV-infected patients, 2 had � 10 scabies lesions before treatment, 3 had 11 to 49 lesions, 4 had � 50 lesions, and 2 had heavily crusted skin le- sions. In eight of the patients the scabies was cured af- ter a single dose of ivermectin. Two patients received a second dose two weeks after the first. Ten of the 11 pa- tients with HIV infection (91 percent) had no evidence of scabies four weeks after their first treatment with iver- mectin. Conclusions. The anthelmintic agent ivermectin, giv- en in a single oral dose, is an effective treatment for sca- bies in otherwise healthy patients and in many patients with HIV infection. (N Engl J Med 1995;333:26-30.)