FRIDAY, May 8, 2026 (HealthDay News) -- For adults with severe scabies, higher-dose ivermectin plus permethrin is not superior to standard-dose ivermectin plus permethrin, according to a study published in the May 7 issue of the New England Journal of Medicine.
Charlotte Bernigaud, M.D., Ph.D., from the Hôpital Henri-Mondor in Créteil, France, and colleagues conducted a blinded randomized trial involving adults with severe scabies to examine the combination of higher- versus standard-dose oral ivermectin and topical scabicides for treatment. Patients were randomly assigned to receive ivermectin 400 μg/kg body weight (higher-dose group) or 200 μg/kg body weight (standard-dose group) on days 0, 7, and 14, combined with head-to-toe application of 5 percent permethrin cream on days 0 and 7 and daily application of emollient cream.
The main analysis included 132 patients (66 in each group). The researchers found that 75 and 82 percent of patients in the higher- and standard-dose groups, respectively, had cure of severe scabies, defined as absence of mites and mite-related products on days 18 and 21 and the absence of active clinical lesions on physical examination on day 28 (odds ratio for cure, 0.64; 95 percent confidence interval, 0.25 to 1.67). There were no safety issues.
"Beyond showing that a higher dose of ivermectin was no better than the standard dose in curing severe scabies, the results of our trial show that repeated administration of oral ivermectin at a dose of 200 μg per kilogram, combined with topical application of 5 percent permethrin and an emollient cream (with or without keratolytic agents), could be used for profuse and crusted scabies," the authors write.
