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Page 1 of 2 SCABIES (Sarcoptes scabiei) Drug Adult dosage Pediatric dosage Drug of choice: 5% Permethrin Topically once1 Topically once1 Alternative:2 Ivermectin3,4,5 200 mcg/kg PO once1 200 mcg/kg PO once1 10% Crotamiton Topically once/d x 2 Topically once/d PO x 2 1. Treatment may need to be repeated in 10-14 days. A second dose taken 2 weeks later increases the cure rate to 95%, which is equivalent to that of 5% permethrin (V Usha et al, J Am Acad Dermatol 2000; 42:236; O Chosidow, N Engl J Med 2006; 354:1718; J Heukelbach and H Feldmeier, Lancet 2006; 367:1767). 2. Lindane (γ-benzene hexachloride) should be reserved for treatment of patients who fail to respond to other drugs. The FDA has rec- ommended it not be used for immunocompromised patients, young children, the elderly, pregnant and breast-feeding women, and patients weighing <50 kg. 3. Not FDA-approved for this indication. 4 Safety of ivermectin in young children (<15 kg) and pregnant women remains to be established. Ivermectin should be taken on an empty stomach with water. 5. Ivermectin, either alone or in combination with a topical scabicide, is the drug of choice for crusted scabies in immunocompromised patients (P del Giudice, Curr Opin Infect Dis 2004; 15:123).

Information provided by The Medical Letter. For a copy of the entire Drugs for Parasitic article, go to: www.medicalletter.org/parasitic_cdc

MANUFACTURERS OF DRUGS USED TO TREAT PARASITIC INFECTIONS – Albenza (GlaxoSmithKline) † Lampit (Bayer, Germany) – nifurtimox Albenza (GlaxoSmithKline) – albendazole Lariam (Roche) – mefloquine Alinia (Romark) – nitazoxanide § Leshcutan (Teva, Israel) – topical paromomycin AmBisome (Gilead) – amphotericin B, liposomal – Ergamisol (Janssen) amphotericin B – Fungizone (Apothecon), others lumefantrine/artemether – Coartem, Riamet amphotericin B, liposomal – AmBisome (Gilead) (Novartis) Ancobon (Valeant) – flucytosine Malarone (GlaxoSmithKline) – § Antiminth (Pfizer) – pamoate atovaquone/proguanil • Aralen (Sanofi) – chloroquine HCl and chloroquine malathion – Ovide (Medicis) phosphate – Vermox (McNeil), others § artemether – Artenam (Arenco, Belgium) mefloquine – Lariam (Roche) § artemether/lumefantrine – Coartem, Riamet § meglumine antimonate – Glucantime (Aventis, (Novartis) France) § Artenam (Arenco, Belgium) – artemether † melarsoprol – Mel-B § artesunate – (Guilin No. 1 Factory, People’s † Mel-B – melarsoprol Republic of China) Mepron (GlaxoSmithKline) – atovaquone atovaquone – Mepron (GlaxoSmithKline) metronidazole – Flagyl (Pfizer), others atovaquone/proguanil – Malarone § miconazole – Monistat i.v. (GlaxoSmithKline) § miltefosine – Impavido (Zentaris, Germany) azithromycin – Zithromax (Pfizer), others § Monistat i.v. – miconazole • Bactrim (Roche) – TMP/Sulfa NebuPent (Fujisawa) – pentamidine isethionate § benznidazole – Rochagan (Brazil) § – Yomesan (Bayer, Germany) • Biaxin (Abbott) – clarithromycin † nifurtimox – Lampit (Bayer, Germany) § Biltricide (Bayer) – nitazoxanide – Alinia (Romark) † – Bitin (Tanabe, Japan) Nix (GlaxoSmithKline) – permethrin † Bitin (Tanabe, Japan) – bithionol • Nizoral (Janssen) – § Brolene (Aventis, Canada) – propamidine § ornidazole – Tiberal (Roche, France) isethionate Ornidyl (Aventis) – eflornithine chloroquine HCl and chloroquine phosphate – (Difluoromethylornithine, DFMO) Aralen (Sanofi), others Ovide (Medicis) – malathion clarithromycin – Biaxin (Abbott), others § – Vansil (Pfizer) • Cleocin (Pfizer) – clindamycin § Paludrine (AstraZeneca, United Kingdom) – proguanil clindamycin – Cleocin (Pfizer), others paromomycin – Humatin (Monarch); Leshcutan Coartem (Novartis) – artemether/lumefantrine (Teva, Israel; topical formulation not available crotamiton – Eurax (Westwood-Squibb) in US) dapsone – (Jacobus) Pentam 300 (Fujisawa) – pentamidine isethionate § Daraprim (GlaxoSmithKline) – pyrimethamine USP pentamidine isethionate – Pentam 300 (Fujisawa), † diethylcarbamazine citrate (DEC) – Hetrazan NebuPent (Fujisawa) • Diflucan (Pfizer) – fluconazole † Pentostam (GlaxoSmithKline, United Kingdom) – § diloxanide furoate – Furamide (Boots, United sodium stibogluconate Kingdom) permethrin – Nix (GlaxoSmithKline), Elimite doxycycline – Vibramycin (Pfizer), others (Allergan) eflornithine (Difluoromethylornithine, DFMO) – § praziquantel – Biltricide (Bayer) Ornidyl (Aventis) primaquine phosphate USP § Egaten (Novartis) – § proguanil – Paludrine (AstraZeneca, United Kingdom) Elimite (Allergan) – permethrin proguanil/atovaquone – Malarone Ergamisol (Janssen) – levamisole (GlaxoSmithKline) Eurax (Westwood-Squibb) – crotamiton § propamidine isethionate – Brolene (Aventis, • Flagyl (Pfizer) – metronidazole Canada) § Flisint (Sanofi-Aventis, France) – fumagillin § pyrantel pamoate – Antiminth (Pfizer) fluconazole – Diflucan (Pfizer), others pyrethrins and piperonyl butoxide – RID (Pfizer), flucytosine – Ancobon (Valeant) others § fumagillin – Flisint (Sanofi-Aventis, France) § pyrimethamine USP – Daraprim (GlaxoSmithKline) • Fungizone (Apothecon) – amphotericin Qualaquin – quinine sulfate (Mutual Pharmaceutical § Furamide (Boots, United Kingdom) – diloxanide Co/AR Scientific) furoate quinacrine § furazolidone – Furozone (Roberts) * quinidine gluconate (Eli Lilly) § Furozone (Roberts) – furazolidone § quinine dihydrochloride † Germanin (Bayer, Germany) – sodium quinine sulfate – Qualaquin (Mutual Pharmaceutical § Glucantime (Aventis, France) – meglumine Co/AR Scientific) antimonate Riamet (Novartis) – artemether/lumefantrine † Hetrazan – diethylcarbamazine citrate (DEC) • RID (Pfizer) – pyrethrins and piperonyl butoxide Humatin (Monarch) – paromomycin • Rifadin (Aventis) – rifampin § Impavido (Zentaris, Germany) – miltefosine rifampin – Rifadin (Aventis), others iodoquinol – Yodoxin (Glenwood), others § Rochagan (Brazil) – benznidazole – Sporanox (Janssen-Ortho), others * Rovamycine (Aventis) – spiramycin ivermectin – Stromectol (Merck) † sodium stibogluconate – Pentostam ketoconazole – Nizoral (Janssen), others (GlaxoSmithKline, United Kingdom) (continued) Page 2 of 2 * spiramycin – Rovamycine (Aventis) TMP/Sulfa – Bactrim (Roche), others • Sporanox (Janssen-Ortho) – itraconazole § triclabendazole – Egaten (Novartis) Stromectol (Merck) – ivermectin § Vansil (Pfizer) – oxamniquine sulfadiazine – (Eon) • Vermox (McNeil) – mebendazole † suramin sodium – Germanin (Bayer, Germany) • Vibramycin (Pfizer) – doxycycline § Tiberal (Roche, France) – ornidazole • Yodoxin (Glenwood) – iodoquinol Tindamax (Mission) – tinidazole § Yomesan (Bayer, Germany) – niclosamide tinidazole – Tindamax (Mission) • Zithromax (Pfizer) – azithromycin

* Available in the US only from the manufacturer. § Not available commercially. It may be obtained through compounding pharmacies such as Panorama Compounding Pharmacy, 6744 Balboa Blvd, Van Nuys, CA 91406 (800-247-9767) or Medical Center Pharmacy, New Haven, CT (203-688-6816). Other com- pounding pharmacies may be found through the National Association of Compounding Pharmacies (800-687-7850) or the Professional Compounding Centers of America (800-331-2498, www.pccarx.com). † Available from the CDC Drug Service, Centers for Disease Control and Prevention, Atlanta, Georgia 30333; 404-639-3670 (evenings, weekends, or holidays: 770-488-7100). • Also available generically.

Information provided by The Medical Letter. For a copy of the entire Drugs for Parasitic Infections article, go to: www.medicalletter.org/parasitic_cdc