What oral medication can be used to treat scabies in a child?

Oral Ivermectin for Scabies Treatment in Children

Oral ivermectin at a dosage of 200 μg/kg is an effective treatment for scabies in children weighing over 15 kg, with a second dose recommended 7-10 days after the first dose to improve cure rates. 1

Treatment Options for Scabies in Children

First-line Treatment:

• For children weighing ≥15 kg:
  • Oral ivermectin 200 μg/kg, with a second dose 7-10 days later 1
  • Should be taken with food to increase bioavailability 1

Alternative for Children <15 kg:

• Traditionally, oral ivermectin was not recommended for children weighing less than 15 kg
• However, recent evidence suggests it may be safe and effective in this population:
  • A multicentric observational study of 170 infants and children (1-64 months, 4-14.5 kg) treated with oral ivermectin found only 7 mild adverse events (4%) with no severe adverse events 2
  • The study showed 85% achieved healing, with better outcomes when:
    • Dose exceeded 200 μg/kg
    • Interval between doses was <10 days 2

Important Considerations

Efficacy Factors:

• Single dose cure rates are insufficient (typically <70%)
• A second dose 7-10 days later substantially improves cure rates 3
• This timing addresses the parasite life cycle, as ivermectin may not be effective against all developmental stages 3

Safety Profile:

• Ivermectin has demonstrated a good safety profile in pediatric populations 4
• The medication should be administered with food to enhance absorption 1

Treatment Protocol:

1. Administer first dose: 200 μg/kg orally
2. Schedule second dose 7-10 days later (critical timing for optimal efficacy) 1, 2
3. Consider environmental measures:
   • Machine wash bedding and clothing using hot cycle
   • Remove items from body contact for at least 72 hours 1
4. Treat all household members and close contacts simultaneously to prevent reinfection 1

Important Caveats

• While recent evidence supports ivermectin's safety in children <15 kg, this remains technically off-label use in many countries 2, 4
• For very young infants (under 2 months), topical permethrin 5% cream is often preferred by dermatologists despite not being officially approved for this age group in many regions 5
• For cases not responding to oral ivermectin, consider combination therapy with topical agents 1
• Follow-up evaluation is essential to confirm eradication of infection 1

Oral ivermectin offers significant advantages over topical treatments, including improved compliance and effectiveness in treating widespread or severe infestations, making it particularly valuable for managing scabies in children.