From the Guidelines
The recommended dose of ivermectin for scabies treatment is 200 micrograms per kilogram (mcg/kg) of body weight, taken as a single oral dose, repeated in 2 weeks. This dose is based on the guidelines from the MMWR Recommendations and Reports 1. For most adults, this works out to about 12-18 mg depending on weight.
Important Considerations
- The medication should be taken with water on an empty stomach.
- All household members and close contacts should be treated simultaneously to prevent reinfestation.
- In addition to medication, patients should wash all clothing, bedding, and towels in hot water and dry on high heat to kill remaining mites.
- Itching may persist for 2-4 weeks after successful treatment due to the body's allergic reaction to dead mites.
- Ivermectin works by paralyzing the nervous system of the mites, causing their death.
- It's particularly useful for widespread or severe infestations, elderly patients, or those who cannot tolerate topical treatments.
- Pregnant women, children weighing less than 15 kg, and people with certain neurological conditions should consult a doctor before using ivermectin.
Special Cases
- For crusted scabies, combination treatment with a topical scabicide and oral ivermectin 200 ug/kg on days 1,2,8,9, and 15 may be recommended, with additional ivermectin treatment on days 22 and 29 for severe cases 1.
- Infants and young children should be treated with permethrin, and those aged <10 years should not be treated with lindane 1.
From the Research
Dose of Ivermectin for Scabies Treatment
- The recommended dose of ivermectin for scabies treatment is 200 mcg/kg body weight, taken in a single dose with food 2, 3, 4, 5.
- A second dose 7-10 days later may be necessary to substantially improve the cure rate 2, 5.
- The treatment dose for non-crusted scabies is 200 µg/kg, taken in a single dose with food, with a retreat in 10-14 days to enhance effectiveness 5.
- For example, a 70 kg person would take 15 mg (5 tablets) of ivermectin for non-crusted scabies 5.
Administration and Efficacy
- Oral ivermectin is safe, easier to use, cheaper, more effective, and more economical than topicals in widespread institutional scabies, for those nonadherent to topicals, and in crusted scabies 5.
- Ivermectin use is outlined as a single dose of 200 mcg/kg, with a possible second dose 7-10 days later 2, 3, 4, 5.
- The efficacy of ivermectin in preventing scabies was 100% in a study of healthcare workers who received a single dose of ivermectin as pre-emptive therapy 4.