![]() ![]() Adjustments to ivermectin dosing are not required for patients with renal impairment however, the safety of multiple doses among patients with severe liver disease is unknown. Ivermectin should be taken with food because bioavailability is increased, thereby increasing penetration of the drug into the epidermis. Ivermectin has limited ovicidal activity and might not prevent recurrences of eggs at the time of treatment therefore, a second dose of ivermectin should be administered 14 days after the first dose ( 1412). Permethrin is safe and effective with a single application ( 1411). Choice of treatment might be based on patient preference for topical versus oral therapy, drug interactions with ivermectin (e.g., azithromycin, trimethoprim/sulfamethoxazole, or cetirizine ), and cost. Topical permethrin and oral and topical ivermectin have similar efficacy for cure of scabies ( 1405– 1410). Low-technology strategies include the burrow ink test and the adhesive tape test. Alternatively, noninvasive examination of the affected skin by using videodermatoscopy, videomicroscopy, or dermoscopy can be used, each of which has high sensitivity and specificity, particularly when performed by experienced operators ( 1404). Skin scrapings can be examined under the microscope to identify organisms, although this method has low sensitivity and is time consuming ( 1403). Scabies diagnosis is made by identifying burrows, mites, eggs, or the mites’ feces from affected areas. Scabies among adults frequently is sexually acquired, although scabies among children usually is not ( 1400– 1402). However, pruritus might occur <24 hours after a subsequent reinfestation. scabiei, sensitization takes weeks to develop. The first time a person is infested with S. Scabies is a skin infestation caused by the mite Sarcoptes scabiei, which causes pruritus. Persons who have pediculosis pubis and HIV infection should receive the same treatment regimen as those who do not have HIV. Because no teratogenicity or toxicity attributable to ivermectin has been observed during human pregnancy experience, ivermectin is classified as “human data suggest low risk” during pregnancy and probably compatible with breastfeeding ( 431). Special Considerations PregnancyĮxisting data from human participants demonstrate that pregnant and lactating women should be treated with either permethrin or pyrethrin with piperonyl butoxide. Sexual contact should be avoided until patients and partners have been treated, bedding and clothing decontaminated, and reevaluation performed to rule out persistent infection. Sex partners within the previous month should be treated. If no clinical response is achieved to one of the recommended regimens, retreatment with an alternative regimen is recommended. Retreatment might be necessary if lice are found or if eggs are observed at the hair-skin junction. Follow-UpĮvaluation should be performed after 1 week if symptoms persist. Persons with pediculosis pubis should be evaluated for HIV, syphilis, chlamydia, and gonorrhea. Pubic hair removal has been associated with atypical patterns of pubic lice infestation and decreasing incidence of infection ( 537, 1399). Fumigation of living areas is unnecessary. Bedding and clothing should be decontaminated (i.e., machine washed and dried by using the heat cycle or dry cleaned) or removed from body contact for at least 72 hours. Pediculosis of the eyelashes should be treated by applying occlusive ophthalmic ointment or petroleum jelly to the eyelid margins 2 times/day for 10 days. The recommended regimens should not be applied to the eyes. Lindane is not recommended for treatment of pediculosis because of toxicity, contraindications for certain populations (pregnant and breastfeeding women, children aged <10 years, and those with extensive dermatitis), and complexity of administration. Adjustment of ivermectin dosage is not required for persons with renal impairment however, the safety of multiple doses among persons with severe liver disease is unknown. ![]() Ivermectin should be taken with food because bioavailability is increased, thus increasing penetration of the drug into the epidermis. ![]() Ivermectin might not prevent recurrences from eggs at the time of treatment, and therefore treatment should be repeated in 7–14 days ( 1397, 1398). Ivermectin has limited ovicidal activity ( 1396). The odor and longer duration of application associated with malathion therapy make it a less attractive alternative compared with the recommended pediculicides. Malathion can be used when treatment failure is believed to have occurred as a result of resistance. Reported resistance to pediculicides (permethrin and pyrethrin) has been increasing and is widespread ( 1394, 1395). ![]()
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