Saturday, June 29, 2019

Should ivermectin-based mass drug administration for scabies be combined with albendazole in affected areas?

Dr KK Aggarwal

When I was a student at MGIMS, scabies was rampant in the society. It was among the most prevalent condition in OPDs. Ascabiol ointment was our standard treatment.

Scabies is an infestation of the skin caused by the itch mite Sarcoptes scabiei var. hominis.

In 2017, the World Health Organization (WHO) added scabies to its list of neglected tropical disease

Today Scabies is amenable to mass drug administration, as shown by the Skin Health Intervention Fiji Trial (SHIFT). The trial demonstrated that the mass administration of an ivermectin-based regimen decreased the prevalence of scabies 24 months after ivermectin-based mass drug administration, with an additional effect on impetigo.

In the trial, three island communities in Fiji were randomized to one of three scabies intervention strategies:

·         standard care involving the administration of topical permethrin to persons with scabies and their contacts (standard-care group)
·         mass administration of topical permethrin (permethrin group), or
·         mass administration of an oral ivermectin-based regimen (ivermectin group)

In the ivermectin group, a single dose of ivermectin-based treatment was provided to all participants, with a second treatment provided 7 days later to those with scabies. The participants ranged in age from infants to the elderly.

At 12 months, the ivermectin-based regimen was the most effective, with a 94% relative reduction from baseline in the prevalence of scabies (from 32.1% at baseline to 1.9%) and a 67% relative reduction in impetigo.

At 24 months, the prevalence of scabies was 3.6% in the ivermectin group, 13.5% in the permethrin group, and 15.2% in the standard-care group.

The prevalence of scabies was lower at 24 months than at 12 months in the permethrin and standard-care groups and slightly higher in the ivermectin group.

The prevalence of impetigo at 24 months was 2.6% in the ivermectin group, 8.9% in the permethrin group, and 13.0% in the standard-care group. The relative reduction from baseline in the prevalence of impetigo was greatest in the ivermectin group at 90%.

Evaluation of effectiveness in larger, less isolated populations over a longer period is required to extend these findings.

In scabies affected areas in the country, in addition to albendazole being mass-administered on 10th February and 10th August every year (National Deworming Day), why not give a combination of  ivermectin-albendazole ( It is available in the country)?

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA

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