In February 2007, we searched the Cochrane
Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2006, Issue 1), MEDLINE, EMBASE, LILACS, and INDMED. In March 2007, we also searched the grey literature and sources for registered trials. We also checked the reference lists of retrieved studies.
SELECTION CRITERIA: Two authors independently assessed trial quality and extracted data. Results were presented as relative risks with 95% confidence intervals and data combined where appropriate.
MAIN RESULTS: Twenty small trials involving 2392 people were included. One trial was placebo controlled, 16 compared two or more
drug treatments, two compared treatment regimens, and one compared different
drug vehicles.Fewer treatment failures occurred by day seven with oral
ivermectin in one small trial (55 participants). Topical
permethrin appeared more effective than oral
ivermectin (85 participants, 1 trial), topical
crotamiton (194 participants, 2 trials), and topical
lindane (753 participants, 5 trials).
Permethrin also appeared more effective in reducing itch persistence than either
crotamiton (94 participants, 1 trial) or
lindane (490 participants, 2 trials). One small trial did not detect a difference between
permethrin (a synthetic
pyrethroid) and a natural
pyrethrin-based topical treatment (40 participants). No significant difference was detected in the number of treatment failures between
crotamiton and
lindane (100 participants, 1 trial),
lindane and
sulfur (68 participants, 1 trial),
benzyl benzoate and
sulfur (158 participants, 1 trial), and
benzyl benzoate and natural synergized
pyrethrins (240 participants, 1 trial); all were topical treatments. No trials of
malathion were identified. No serious adverse events were reported. A number of trials reported skin reactions in participants randomized to topical treatments. There were occasional reports of
headache,
abdominal pain, diarrhoea,
vomiting, and
hypotension.
AUTHORS' CONCLUSIONS: Topical
permethrin appears to be the most effective treatment for
scabies.
Ivermectin appears to be an effective oral treatment. More research is needed on the effectiveness of
malathion, particularly when compared to
permethrin, and on the management of
scabies in an institutional setting and at a community level.