What are the recommended medications for treating lice and scabies?

From the Guidelines

Permethrin 1% cream rinse is the recommended first-line treatment for lice, applied to the hair, left on for 10 minutes, then rinsed off, with a second application 7-10 days later to kill newly hatched lice. This recommendation is based on the most recent and highest quality study available, which prioritizes morbidity, mortality, and quality of life as the outcome 1.

Treatment Options for Lice and Scabies

• Permethrin 1% cream rinse (Nix) is the first-line treatment for lice, with a second application 7-10 days later to kill newly hatched lice.
• Pyrethrin-based products (RID, A-200) are also effective for lice, with similar application instructions.
• For scabies, permethrin 5% cream (Elimite) is the treatment of choice, applied from neck down to the soles of feet and left on for 8-14 hours before washing off, with a second application one week later.
• Oral ivermectin (200 mcg/kg, repeated in 1-2 weeks) is an alternative for widespread or resistant scabies.

Important Considerations

• All household members should be treated simultaneously to prevent reinfestation.
• Bedding, clothing, and personal items should be washed in hot water and dried on high heat to prevent reinfestation.
• Malathion 0.5% lotion (Ovide) and ivermectin lotion 0.5% (Sklice) are prescription options for resistant cases of lice, but have potential risks and side effects, such as high alcohol content and theoretical risk of respiratory depression if accidentally ingested 1.

Resistance and Safety

• Resistance to permethrin and other treatments has been reported, but the prevalence is not well established 1.
• Lindane (1%) is no longer recommended due to its potential for central nervous system toxicity and risk of seizures in children 1.

From the FDA Drug Label

Permethrin Cream, 5% is indicated for the treatment of infestation with Sarcoptes scabiei (scabies). Permethrin, a pyrethroid, is active against a broad range of pests including lice, ticks, fleas, mites, and other arthropods.

The recommended medication for treating scabies is permethrin (TOP), as directly stated in the drug label 2. For lice, although not directly indicated for this use in the provided label, permethrin is active against lice, as mentioned in the clinical pharmacology section of the label 2. Key points:

• Permethrin is indicated for scabies
• Permethrin is active against lice, among other pests However, the label does not explicitly state it is approved for treating lice, only that it is active against them.

From the Research

Medications for Treating Lice and Scabies

• Permethrin 1% lotion or shampoo is a first-line pharmacologic treatment for pediculosis, as stated in the study 3.
• Malathion is an effective treatment for head lice and scabies, with efficacy rates of 97-98% in the treatment of head lice, as reported in the study 4.
• Topical permethrin 5% cream is a first-line treatment for scabies, as mentioned in the study 3.
• Oral ivermectin is an effective treatment for scabies, with a cure rate of 89.1% at the 4-week follow-up, as shown in the study 5.
• Spinosad is a new pediculicide that has demonstrated superior performance compared to permethrin in the treatment of head lice, with 84.6% and 86.7% of patients free of live lice 14 days after treatment, as reported in the study 6.

Comparison of Medications

• A study comparing 1% permethrin cream rinse and 1% lindane shampoo found that permethrin was more effective, with 99% of patients lice-free at 14 days, compared to 85% with lindane, as stated in the study 7.
• A comparison of oral ivermectin and malathion 0.5% lotion for the treatment of scabies found that ivermectin was superior to malathion at the 4-week follow-up, as reported in the study 5.
• Spinosad has been shown to be more effective than permethrin in the treatment of head lice, with fewer adverse events, as mentioned in the study 6.

Safety and Efficacy

• Malathion is considered safe and effective for the treatment of head lice and scabies, with a low risk of adverse events, as stated in the study 4.
• Permethrin 1% lotion or shampoo is generally well-tolerated, with few adverse events reported, as mentioned in the study 3.
• Oral ivermectin has been shown to be safe and effective for the treatment of scabies, with few adverse events reported, as reported in the study 5.
• Spinosad has been found to be well-tolerated, with few adverse events reported, as mentioned in the study 6.