What is the treatment for acariasis?

Treatment of Acariasis

For acariasis caused by Ascaris lumbricoides (ascariasis), the recommended treatment is either albendazole 400 mg orally as a single dose, mebendazole 500 mg orally as a single dose, or ivermectin 200 μg/kg orally as a single dose. 1

Types of Acariasis and Their Treatments

Ascariasis (Ascaris lumbricoides)

• Albendazole 400 mg orally as a single dose is effective for treating intestinal ascariasis 1
• Mebendazole 500 mg orally as a single dose is an equally effective alternative 1
• Ivermectin 200 μg/kg orally as a single dose can also be used 1
• Treatment may need to be repeated if symptoms persist or in cases of heavy worm burden 2

Scabies (Sarcoptes scabiei)

• First-line treatment is topical permethrin 5% cream applied for 8-12 hours 3
• Permethrin should be applied to the entire body from the neck down, left on for 8-12 hours, then washed off 4
• For severe or treatment-resistant cases, oral ivermectin at 200 μg/kg as a single dose, repeated after 1-2 weeks, is recommended 4
• Alternative topical treatments include:
  • Crotamiton (good second-line option) 3
  • Benzyl benzoate (good second-line option) 3
• For crusted (Norwegian) scabies, combination therapy with topical permethrin and oral ivermectin is preferred 3

Cutaneous Larva Migrans

• Ivermectin 200 μg/kg orally as a single dose 1
• Albendazole 400 mg orally daily for 3 days is an effective alternative 1

Special Considerations

Contact Management

• All close contacts of patients with scabies should be treated simultaneously, even if asymptomatic, to prevent reinfestation 3
• For animal-associated acariasis, treatment of domestic animals is essential to cure the human infection 5

Environmental Measures for Scabies

• Clothing, bedding, and towels used by the infected person should be machine washed in hot water and dried on high heat 3
• Items that cannot be washed should be sealed in plastic bags for at least 72 hours 3

Treatment Failure Considerations

• Common causes of treatment failure include:
  • Improper application of topical agents 4
  • Failure to repeat treatment when indicated 4
  • Incomplete decontamination of environment 4
  • Failure to treat all contacts simultaneously 4
  • Belonging to high-risk groups 4

Monitoring and Follow-up

• Improvement in symptoms should be expected within 1-2 weeks after treatment 4
• Persistent symptoms beyond 2-4 weeks may indicate treatment failure requiring reassessment and possibly alternative therapy 6
• Pruritus may persist for 1-2 weeks after successful treatment, particularly with scabies, and does not necessarily indicate treatment failure 3

Special Populations

• For pregnant women and infants under 3 months, permethrin can be considered for off-label use 3
• For immunocompromised patients or those with severe dermatitis, oral ivermectin is preferred 3
• For patients with poor adherence to topical treatments, oral ivermectin should be considered 3

Remember that prompt and appropriate treatment is essential to prevent complications and transmission to others, particularly in institutional settings where outbreaks can occur rapidly 3.