N eng jrnl of meds 2006 behandelings.xls

N ENGL J MED 354;16 WWW.NEJM.ORG APRIL 20, 2006 First-line topical therapy in the United States; a second administration 1 wk after the first often routinely prescribed; treatment failure potentially attributable to incorrect application or a failure to treat all contacts Seizures, muscle spasms, aplastic anemia; not for use in Second- or third-line topical therapy; available by prescription in the infants or pregnant or breast-feeding women 10% or 25% Lotion, rinsed off after 24 hr several other Burning and stinging when applied to excoriated skin, Not currently available in the United States; approved in Europe pruritic cutaneous xerosis, or eczematous lesions post-treatment Not currently available in the United States; approved in Europe 10% Cream applied to the nodules for 24 hr, rinsed off, Not very effective; often used on scabies nodules in children and then reapplied for an additional24 hr 3–6% Lotion or 5%, 10%, or 40% in petrolatum applied Often used in children under 2 mo of age and pregnant and breast- feeding women; limited data to support efficacy and safety 24 hr for the next 2 days (with a bath taken betweeneach application) Single dose of 200 μg/kg of body weight (commercially Excess risk of death for elderly patients Approved in France, the Netherlands, and Mexico; cost may vary widely and could be a limitation for use; post-marketing surveillance of various 3-mg tablets); 2nd dose recommended 14 days later age groups (e.g., children and the elderly) and largepopulations needed * FDA denotes Food and Drug Administration.
† For drugs in FDA pregnancy category B, there is no evidence of risk in humans. Drugs in pregnancy category C have had toxic effects in studies of animals, but the results of studiesin humans are inadequate.
‡ The correct application of topical drugs is crucial to a cure. After the patient dries off after a tepid bath or shower, the product should be applied from head to toe (because scalp involvement may be a cause of relapse), including the groin. Special care should be taken at the mucocutaneous junctions to avoid contact between the agent and the mucosa.
§ Permethrin has been approved for use in infants two months of age or older. When a nursing mother with scabies infestation of the breasts has to be treated with permethrin, she should bottle-feed her infant and discard pumped breast milk until residual cream has been thoroughly washed off.
¶ No alcoholic beverages should be consumed for at least 48 hours after application, because of a potential disulfiram-like effect of the interaction.
∥ Pyrethrin is in FDA pregnancy category B. Since allethrin belongs to the family of pyrethrins, it too should probably be in category B.
** The single dose of 200 μg per kilogram equals a dose of 12 mg for a person weighing 60 kg. The absorption of ivermectin may be improved if taken with a fatty meal. The regimen is not approved for children weighing less than 15 kg or for pregnant or lactating women. The drug could be useful in patients with classic scabies, and multiple doses in combinationwith topical therapy could be useful in patients with the acquired immunodeficiency syndrome who have extensive scabies and in patients with crusted scabies.
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