Friday, September 9, 2016

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

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