Ivermectin Dosing for Cutaneous Larva Migrans
The recommended dose of ivermectin for cutaneous larva migrans is 200 mcg/kg (0.2 mg/kg) as a single oral dose. 1, 2, 3
Standard Treatment Regimen
Ivermectin 200 mcg/kg as a single oral dose is the first-line treatment for cutaneous larva migrans, with cure rates approaching 95-100% in patients presenting with typical creeping dermatitis. 1, 2, 4
The medication should be taken on an empty stomach with water to optimize bioavailability. 3
Albendazole 400 mg once daily for 3 days is an alternative first-line option, though it may have higher relapse rates (46% cure rate with single dose) compared to ivermectin. 2, 5
When Additional Doses Are Needed
If symptoms persist after the initial dose, repeat treatment with ivermectin 200 mcg/kg may be necessary. Studies show that 77-95% of patients respond to a single dose, but 1-2 supplementary doses achieve an overall cure rate of 97%. 4, 6
Patients with hookworm folliculitis in addition to creeping dermatitis have lower response rates (66%) compared to those with creeping dermatitis alone (98%), and are more likely to require repeat dosing. 4
The median time for pruritus to resolve is 3 days, and for lesions to disappear is 7 days after treatment. 6
Clinical Pitfalls and Important Considerations
Do not confuse persistent itching from inflammatory response with treatment failure. Pruritus can persist for several days after successful parasite eradication due to allergic dermatitis, and this alone is not an indication for retreatment. 1
No dose adjustments are required for renal impairment, but the safety of multiple doses in severe liver disease is not established. 1, 3
Ivermectin is classified as low risk in pregnancy based on limited human data and appears compatible with breastfeeding due to low excretion into breast milk. 2, 3
Single-dose ivermectin (12 mg fixed dose or 200 mcg/kg) is significantly more effective than single-dose albendazole (400 mg), with 100% cure rate versus 46% cure rate in head-to-head comparison. 5