Ivermectin and the treatment of outbreaks of scabies in medical facilities

In cramped facilities, including hospital wards and nursing homes, secondary spread of scabies to staff and patients can be widespread. This is frequently facilitated by a delay in diagnosis, which is not infrequent in elderly and immune compromised patients. A particular problem is presented in cases of crusted scabies--a form of hyperinfection. The common topical treatments for scabies share several drawbacks including compliance, slow regression of symptoms and failure with non-meticulous application. In crusted scabies treatment failure is not infrequent. Ivermectin is a drug effective against various ecto and endo-parasites. We describe 2 typical cases of crusted scabies, one leading to an outbreak of scabies in a medical ward and another that was treated with Ivermectin. An evidence-based review of the literature shows Ivermectin to be at least as effective as topical treatment, with the advantages of the ease in treating large populations, good compliance and safety. Approval of this drug for this indication should be considered.