Ivermectin versus benzyl benzoate applied once or twice to treat human scabies in Dakar, Senegal: a randomized controlled trial

Abstract

Objective To compare the effectiveness of oral ivermectin (IV) and two different modalities of topical benzyl benzoate (BB) for treating scabies in a community setting. Methods The trial included patients aged 5-65 years with scabies who attended the dermatology department at the Institut d'Hygiène Sociale in Dakar, Senegal. The randomized, open trial considered three treatments: a single application of 12.5% BB over 24 hours (BB1 group), two applications of BB, each over 24 hours (BB2 group), and oral IV, 150-200 µg/kg (IV group). The primary endpoint was the disappearance of skin lesions and itching at day 14. If necessary, treatment was repeated and patients were evaluated until cured. Results were analysed on an intention-to-treat basis. A pre-planned intermediate analysis was carried out after the BB1, BB2 and IV groups had recruited 68, 48 and 65 patients, respectively. Findings At day 14, 33 patients (68.8%) in the BB2 group were cured versus 37 (54.4%) in the BB1 group and 16 (24.6%) in the IV group (P < 10 -6 ). Bacterial superinfection occurred more often in the IV group than in the BB1 and BB2 groups combined (28% versus 7.8%, respectively; P = 0.006). At day 28, 46 patients (95.8%) in the BB2 group were cured versus 52 (76.5%) in the BB1 group and 28 (43.1%) in the IV group (P < 10 -5 ). These clear findings prompted early study cessation. Conclusion Topical BB was clearly more effective than oral IV for treating scabies in a Senegalese community.Une traduction en français de ce résumé figure à la fin de l'article. Al final del artículo se facilita una traducción al español. ‫املقالة.‬ ‫لهذه‬ ‫الكامل‬ ‫النص‬ ‫نهاية‬ ‫يف‬ ‫الخالصة‬ ‫لهذه‬ ‫العربية‬ ‫الرتجمة‬

Ivermectin worthy of further investigation

“…1 The authors described a randomized controlled trial of treatment of scabies in a community setting in Senegal. They concluded that oral ivermectin is inferior to topical application of benzyl benzoate; indeed the trial was stopped following intermediate analysis because of the apparent superiority of benzyl benzoate and increased rate of bacterial superinfection in the ivermectin group.…”

In Vitro Efficacy of Moxidectin versus Ivermectin against Sarcoptes scabiei

“…There have been no empirical dose-finding studies for scabies. It is acknowledged that doses of Յ150 g/kg have reduced efficacy (5)(6)(7), and it has been suggested that higher doses may be advantageous (8). Suboptimal responses to ivermectin in some groups (9)(10)(11) indicate that a more detailed investigation of optimal therapeutic doses in scabies is warranted.…”

Le prix Nobel de Médecine 2015 au service des pays tropicaux

“…Elle est systématiquement prescrite, en région tropicale, chez les sujets immunodéprimés pour éviter la diffusion à tout l'organisme de larves responsables d'une anguillulose maligne éventuellement mortelle [28]. L'ivermectine devient le médicament quasi incontournable dans le traitement des larva migrans cutanées [29], des gales à sarcoptes, en privilégiant l'administration de 2 doses à 10 jours d'intervalle [30,31] et, plus récemment, des poux [32].…”