Richards Robert N
8613 Departments of Medicine, North York General Hospital and Baycrest Health Sciences, Courtesy Staff Dermatology, Toronto, ON, Canada.
J Cutan Med Surg. 2021 Jan-Feb;25(1):95-101. doi: 10.1177/1203475420960446. Epub 2020 Sep 30.
Scabies is globally ubiquitous and is a significant health issue for institutions, the economically disenfranchised, resource-poor areas, and for those with weakened immune systems. Topicals are usually effective, but are cumbersome and expensive to use in large populations and for those nonadherent to topicals. Oral ivermectin became available in Canada for the off-label treatment of scabies in the fall 2018.
To review the diagnosis and management of scabies. Dose schedules and concomitant management measures are outlined for scabies simplex and for crusted scabies. Ivermectin use is outlined.
Medline, colleague discussions, practice review, and experience from managing scabies in institutions.
Oral ivermectin is safe, easier to use, cheaper, more effective, and more economical than topicals in widespread institutional scabies, for those nonadherent to topicals, and in crusted scabies.
Oral ivermectin is the treatment of choice in large populations, the nonadherent, and for crusted scabies. Oral ivermectin is produced by Merck Canada as Stromectol 3 mg. The treatment dose for noncrusted scabies is 200 µg/kg, taken in a single dose with food. For example, 15 mg (5 tablets) for a 70 kg person. Retreat in 10-14 days to enhance effectiveness, and perhaps to reduce scabicide resistance.
疥疮在全球普遍存在，对于机构、经济上处于不利地位的人群、资源匮乏地区以及免疫系统较弱的人群而言，是一个重大的健康问题。局部用药通常有效，但在大量人群中使用以及对于那些不坚持使用局部用药的人来说，使用起来繁琐且昂贵。口服伊维菌素于2018年秋季在加拿大可用于疥疮的非标签治疗。
综述疥疮的诊断和管理。概述了单纯性疥疮和结痂性疥疮的剂量方案及伴随的管理措施。概述了伊维菌素的使用。
检索医学期刊数据库、与同事讨论、回顾实践以及总结在机构中管理疥疮的经验。
在广泛的机构性疥疮、对于不坚持使用局部用药的人以及结痂性疥疮中，口服伊维菌素比局部用药更安全、使用更方便、更便宜、更有效且更经济。
口服伊维菌素是大量人群、不坚持用药者以及结痂性疥疮的首选治疗方法。加拿大默克公司生产的口服伊维菌素商品名为Stromectol 3毫克。非结痂性疥疮的治疗剂量为200微克/千克，与食物一起单次服用。例如，一名7０千克的人服用15毫克（5片）。在10 - 14天后进行再次治疗以提高疗效，并可能降低杀疥剂耐药性。
