A NEW observational study suggests that combining oral ivermectin with the standard topical permethrin treatment may dramatically improve cure rates in children whose scabies persists after at least one course of permethrin alone.
Assessing Treatment Response Under Ivermectin/Permethrin Dual Treatment
Researchers enrolled 230 children (aged under 18, weight over 15 kg) between 2022 and 2024 whose scabies symptoms had not resolved with at least one prior permethrin treatment. Families chose whether to continue permethrin monotherapy or to add two doses of oral ivermectin (on days 0 and 14). Because treatment choice was influenced by out-of-pocket cost (ivermectin was expensive), the authors used propensity-score matching and inverse probability weighting to control for socioeconomic and clinical confounders. The children were assessed weekly for the first four weeks, then monthly for the next three months, with lesion counts, pruritus scores, recurrences and adverse events recorded at each visit.
The combination therapy group experienced faster symptom relief, with time to 50% pruritus reduction averaging around 7.2 days, versus 9.8 days in the monotherapy group (p < 0.001). By week 4, the clinical cure rate (defined as no active lesions + no itch) reached 83.8% in the combined group, compared to 66.0% in the monotherapy group. Importantly, recurrence over three months was lower when ivermectin was added: 7.1% vs 17.1%.
In terms of safety, children receiving ivermectin did report more mild, transient side‑effects (around 14.3% vs 4.3%), including “itch flares” and headache, but no serious or treatment-limiting adverse events occurred.
Future Research Directions for Ivermectin/Permethrin Dual Treatment
The authors emphasise that, although the clinical benefits are clear, cost remains a major barrier. In Turkey, the treatment cost represents a significant portion of minimum wage, limiting access for poorer families. They call for policy changes, such as per-tablet dispensing, generic licensing, or insurance reimbursement, to make this combined regimen more accessible.
They also recommend larger randomised clinical trials and cost-effectiveness studies to further validate the findings, and to explore broader implementation strategies, especially in regions where scabies is endemic.
Reference
Haytoglu Z et al. Efficacy of combination therapy with oral Ivermectin and topical permethrin versus permethrin monotherapy in pediatric patients with persistent scabies: a propensity score–adjusted observational study. BMC Infect Dis. 2025;25:1545
