Drug of Choice

Permethrin 5% is the drug of choice in the first world and has been since shortly after its introduction in 1989. Skabi-Rid® was introduced in South Africa in and overwhelming evidence exists in favour of permethrin as treatment of choice for scabies:

  • WHO – listed as an Essential Medicine
  • BMJ: CLINICAL EVIDENCE - SCABIES, Oct 2007: Topical permethrin is highly effective at increasing clinical and parasitic cure of scabies within 28 days.
  • NEJM: April 2006, Current treatment for scabies- (PERMETHRIN 5%) is first line therapy in the United States
  • COCHRANE Library: Interventions for treating scabies, assessed Issue 1, 2009 Permethrin appeared to be the most effective topical treatment for scabies
  • IJAVMS Vol. 3, Issue 1, 2009:43-48: Comparative Therapeutic Efficacy of Permethrin, Benzyl benzoate and Sulphur in the treatment of Scabies Patients: Conclusion: We concluded from the study that each patient of scabies should be treated with permethrin topically once a week after that followed by an antihistamine for pruritus if needed for one week only.
  • NHS: Treatments of choice are: 11.1 Permethrin 5% NHS Bolton preferred treatment
  • SAPJ, April 2010 - This (permethrin 5%) would be the first line of treatment in a pregnant woman.
  • CANTERBURY DHB: We consider this agent (permethrin 5%) to remain the treatment of choice of scabies or head lice (1%) in pregnancy and lactation.
  • DRUGDEX Drug Evaluation 2009: - The recommended treatment regimen for scabies is topical permethrin cream 5%
  • MICHIGAN Dept of Health 2005: Currently, 5% permethrin cream is the recommended treatment for scabies infestation.
  • PAEDIATRIC DERMATOLOGY Vol. 11 No. 3 264-266: Neonatal Scabies Treated With Permethrin 5% Cream
  • OTIS REPORT: Lice scabies & pregnancy Dec 2009. The CDC recommends that breastfeeding women use pyrethrins or permethrin to treat lice and scabies.
  • INTERNATIONAL FOUNDATION OF DERMATOLOGY: Management of scabies – Permethrin 5% listed as first treatment for scabies.
  • MERCK MANUAL PROFESSIONAL Sep 2008 Scabies: Parasitic Skin Infections, Permethrin is the 1-st line topical drug
  • SOUTH AFRICAN MEDICINES FORMULARY 7, Page 474: Permethrin is effective for scabies and pediculosis. Due to its low human toxicity, it is becoming increasingly important for the control of resistant organisms
  • AMERICAN FAMILY PHYSICIAN, Clinical Evidence Handbook : Topical permethrin is highly effective at increasing clinical and parasitic cure of scabies within 28 days
  • OXFORD HANDBOOK OF PAEDIATRICS, Southern Africa, – Sixth Edition, chapter 32, page 420: Permethrin 5% left on for 24 hours is the preferred treatment for all ages but is unavailable in South Africa.
  • SA MEDICINES FORMULARY 8, Ectoparasiticides page 503, Permethrin (SA EDL: Primary) Permethrin is used in the treatment of scabies as a 5% cream, but this formulation is not currently available in South Africa.
  • MARTINDALE 34th Edition: Treatment (of scabies) is with the acaricides permethrin or malathion applied preferably as an aqueous lotions.
  • MARTINDALE 37th Edition: It is used as a 5% application for pubic pediculosis (p.2181) and as a acaricide in the treatment of scabies (p2182).
  • EUROPEAN GUIDELINE FOR THE MANAGEMENT OF SCABIES: Permethrin cream 5% (once for 8-14 hours) is effective(9,13), well-tolerated (14, 15), (level of evidence Ib; grade A recommendation) Benzyl benzoate lotion (10 to 25%) is also cheap and effective, but requires application on more than one day (2 to 3 applications) (level of evidence III; grade B recommendation).
  • OXFORD JOURNALS: REVIEW OF COMMON THERAPEUTIC OPTIONS IN THE UNITED STATES FOR THE TREATMENT OF PEDICULOSIS CAPITIS; Permethrin 5% (FDA-approved for scabies infestation) has the advantage of having been proven safe for children as young as 1 month of age.

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