Scabies: Crotamiton vs Permethrin

Indication as in FUKKM

Crotamiton 10% cream	Permethrin 5% cream
First line agent listed under FUKKM	Second line agent listed under FUKKM
Category: B	Category: A/KK

RED BOOK: Scabies (Sarcoptes scabiei)

	Drug	Adult dose	Paediatric dose
Drug of Choice	Permethrin 5% cream	Topically once	Topically once
Alternative	Ivermectin	200mcg/kg PO once	200mg/kg PO once
	Crotamiton 10% cream	Topically once/d x 2	Topically once/d x 2

• The drug of choice, particularly for infants, young children, and pregnant or nursing women, is Permethrin 5%cream (not approved for children younger than 2 months of age), a synthetic pyrethroid.
• Alternative drugs are oral Ivermectin or 10% Crotamiton cream or lotion.
• Crotamiton is associated with frequent treatment failures and has not been approved for use in children.

Age Restriction

Age	Permethrin	Crotamiton
1 month- 2 months	Not licensed for use in children under 2 months.	On doctor’s advice only : apply once daily
2 months- 2 years	Use under medical supervision	On doctor’s advice only : apply once daily
Above 3 years	One time application. Leave for 8-14 hours.	Apply 2-3 times daily

Evidence:

Treatment of scabies, Permethrin 5% cream vs. Crotamiton 10% cream

Cure rate	Permethrin 5% cream	Crotamiton 10% cream
At the 2-week follow up	70%	45%
At the 4-week follow-up after repeating the treatment	85%	65%

• Two applications of permethrin 5% cream was as effective as single applications of crotamiton 10% cream at the 2-week follow-up. 
• After repeating the treatment, permethrin 5 % cream was superior to crotamiton 10% cream at the 4-week follow up.

References

1.   American Academy of Pediatrics (2009). Scabies. In LK Pickering et al., eds., Red Book: 2009 Report of the Committee on Infectious Diseases, 28th ed., pp. 589–591. Elk Grove Village, IL: American Academy of Pediatrics.
2.   BNF for Chlidren,September 2015-16.
3.   FUKKM bil 2 2016. Updated on Aug 2016
4.   Pourhasan A, Goldust M, Rezaee E. 2013. Treatment of scabies, permethrin 5% cream vs. crotamiton 10% cream. Annals of Parasitology, 59(3), 143–147