From the Guidelines
The best treatment for recurrent scabies is a combination of topical and oral medications, specifically 5% topical permethrin cream and oral ivermectin 200 ug/kg 1.
Treatment Approach
- For recurrent scabies, retreatment 2 weeks after the initial treatment regimen can be considered for those persons who are still symptomatic or when live mites are observed 1.
- An alternative regimen is recommended for those persons who do not respond initially to the recommended treatment 1.
Medication Details
- 5% topical permethrin cream should be applied to the full body, repeated daily for 7 days, then 2 times weekly until discharge or cure 1.
- Oral ivermectin should be administered at a dose of 200 ug/kg on days 1,2,8,9, and 15, with additional treatment on days 22 and 29 for severe cases 1.
Important Considerations
- Lindane should be avoided due to the risks of neurotoxicity with heavy applications or denuded skin 1.
- In institutional settings, such as nursing homes, ivermectin can be considered if treatment with topical scabicides fails, and epidemics should be managed in consultation with a specialist 1.
From the Research
Treatment Options for Recurrent Scabies
The treatment of recurrent scabies involves various options, including topical and oral medications.
- Topical treatments such as permethrin 5% cream, crotamiton 10%, and benzyl benzoate are effective against scabies 2, 3, 4.
- Oral ivermectin is also an effective treatment option, especially for crusted scabies, patients who are bedridden, and in institutional outbreaks 2, 3, 4, 5.
- The choice of treatment depends on the severity of the infestation, the patient's age and health status, and the presence of any contraindications to certain medications.
Efficacy of Treatment Options
Studies have compared the efficacy of different treatment options for scabies.
- Permethrin 5% cream and oral ivermectin have been shown to be equally effective or more effective than other topical treatments such as crotamiton and benzyl benzoate 2.
- Single and double administrations of ivermectin have been found to be similarly effective 2.
- In trials involving entire populations with a high prevalence of scabies, systemic ivermectin has been found to be superior to topical permethrin 2.
Treatment Recommendations
Based on the available evidence, the following treatment recommendations can be made:
- Permethrin 5% cream is considered the gold standard therapy for scabies, with malathion being an excellent topical alternative 3.
- Oral ivermectin is an effective treatment option, especially for crusted scabies, patients who are bedridden, and in institutional outbreaks 3, 5.
- Treatment should involve routine treatment of the scalp and face, and re-treating patients at day 4 to ensure more efficient mite eradication 3.
- All close contacts should be treated simultaneously with the source patient, and all fomites should be decontaminated to prevent the spread of scabies 3, 4.