Interventions for treating scabies.
BACKGROUND
Scabies is a common public health problem with an estimated prevalence of 300 million. Infestation can cause considerable discomfort and intense itching. Severe adverse effects have been reported for some drugs used to treat scabies.


OBJECTIVE
The objective of this review is to assess the effects and toxicity of topical and systemic drug treatment for scabies.


METHODS
We searched the Cochrane Infectious Diseases Group trials register, the Cochrane Controlled Trials Register, Medline, Embase, military records, traditional medicine databases. We also contacted international specialist centres and drug manufacturers.


METHODS
Randomised controlled trials of any drug treatment for scabies. Tolerability and toxicity were sought in any study of humans taking any drug treatments for scabies.


METHODS
Two reviewers assessed trial quality and extracted data.


RESULTS
Eleven trials were included (7 compared drug treatments, 2 compared treatment regimes, 1 compared the drug vehicle and 1 was a community intervention). Compared with placebo in one small trial, ivermectin was associated with a significant higher clinical cure rate at seven days. Permethrin appeared to be more effective than crotamiton for clinical and parasitic cure rates. Permethrin appeared to be better than gamma benzene hexachloride for clinical cure rates in two small trials but had no advantage in the largest trial (test for heterogeneity p< 0.001). Permethrin also appeared more effective in reducing itch persistance than gamma benzene hexachloride. There appeared to be no difference in clinical cure rates between crotamiton and gamma benzene hexachloride. Single trials assessed: the effectiveness of oral versus topical treatment (ivermectin versus benzyl benzoate); treatment vehicle (pork fat versus cold cream); and mass community treatment (ivermectin) but were too small to demonstrate an effect. No randomised trials of malathion were identified. Serious adverse drug reactions (including death and convulsions) have been reported in other studies of scabies drugs, most notably gamma benzene hexachoride and ivermectin.


CONCLUSIONS
The evidence that permethrin is more effective than gamma benzene hexachloride is inconsistent. Permethrin appears to have less potential serious drugs reactions than gamma benzene hexachloride although this is not derived from trial data. More research is needed of the safety and effectiveness of ivermectin and malathion compared to permethrin, on community management, and on different regimes and vehicles for topical treatment.
Walker
G J
GJ
Country Support Team for Central and South Asia, UNFPA, PO Box 5940, Kathmandu, Nepal. gwalker@unfpa.wlink.com.np
Johnstone
P W
PW
D001556:Hexachlorocyclohexane / Q000627:therapeutic use; D006801:Humans; D007306:Insecticides / Q000627:therapeutic use; D007559:Ivermectin / Q000627:therapeutic use; D026023:Permethrin; D011722:Pyrethrins / Q000627:therapeutic use; D012532:Scabies / Q000188:drug therapy / Q000628:therapy*; D013455:Sulfur / Q000627:therapeutic use; D014052:Toluidines / Q000627:therapeutic use
D007306:Insecticides; D011722:Pyrethrins; D014052:Toluidines; D026023:Permethrin; D001556:Hexachlorocyclohexane; D007559:Ivermectin; D013455:Sulfur; C005553:crotamiton