No participants in the systemic ivermectin or the permethrin group stopped participating in the study because they experienced an adverse event ( moderate-certainty evidence). Likewise, after four weeks, ivermectin lotion probably leads to little or no difference in rates of complete clearance when compared to permethrin cream ( moderate-certainty evidence), and there is little or no difference among treatments with systemic ivermectin in different doses ( high-certainty evidence). There is probably little or no difference in rates of complete clearance between systemic ivermectin at standard dose and topical ivermectin lotion four weeks after initiation of treatment ( moderate-certainty evidence). There is probably little or no difference in complete clearance rates after one week of treatment with oral ivermectin or one application of permethrin lotion ( moderate-certainty evidence). Treatments with one to three doses of ivermectin or one to three applications of permethrin may lead to little or no difference in rates of complete clearance after four weeks ( low-certainty evidence). Oral ivermectin may lead to slightly lower rates of complete clearance after one week compared to permethrin cream ( low-certainty evidence), but little or no difference in rates of complete clearance by week two ( low-certainty evidence). All studies were conducted at a single centre with mostly small numbers of participants per study group. These studies compared systemic ivermectin with topical permethrin, topical ivermectin with topical permethrin, or systemic ivermectin with topical ivermectin to treat people with scabies. Nearly all studies were set in South Asia or North Africa. Other outcomes were the number of participants re-treated, the number of participants with at least one adverse event, and the number of participants who stopped participating in the study because they experienced an adverse event. We assessed efficacy as complete clearance of skin lesions at different time points after the start of the treatment. We examined topical permethrin, topical ivermectin, and systemic ivermectin as a treatment for scabies in women and men of all ages. In recent years, permethrin and ivermectin have become the most relevant treatment options for scabies. It occurs throughout the world, but is particularly problematic in areas of poor sanitation, overcrowding, and social disruption. Scabies is an intensely itchy parasitic infection of the skin. Poor reporting of studies was a major limitation.Īdditional high-certainty studies are needed to strengthen the confidence in the results and improve the evidence base. Our confidence in the effect estimates was mostly low to moderate. Overall, few and mild adverse events were reported. We found that for the most part, there was no difference detected in the efficacy of permethrin compared to systemic or topical ivermectin. We searched for all relevant studies to answer this question and found 15 studies, which we collected and analysed. The aim of this Cochrane Review was to assess the efficacy and safety of topical permethrin and topical or systemic ivermectin for scabies in people of all ages.
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