Page 120 - Learnwell EVS
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bies
I verm ectin is n ot recom m en d ed for child ren < 1 5 k g or p regn an t w om en ( safety n ot
established )1 .
A d m in istration of iverm ectin to p atien ts w ith loiasis carries a risk of severe n euro -
logical com p lication s w hen sign ifican t Loa loa m icrofilaraem ia is p resen t (see Filariasis,
p age 1 527 ) .
Weight 15 to 24 kg 25 to 35 kg 36 to 50 kg 51 to 65 kg
Iverm ectin 3 m g tab 1 tab 2 tab 3 tab 4 tab
Iverm ectin 6 m g tab 1 / 2 tab 1 tab 1 1 / 2 tab 2 tab
T reatm en t effectiven ess is jud ged on clin ical groun d s. I tch in g m ay p ersist for 1 to
3 w eek s after elim in ation of the p arasite.
P ersisten ce of typ ical burrow s beyon d 3 w eek s sh ould lead to susp icion of treatm en t
failure (in sufficien t treatm en t, e.g. the scalp w as n ot in clud ed in top ical treatm en t or
th e p atien t w ash ed h is h an d s d urin g th e treatm en t p eriod ) , or early re- in festation
( con tacts an d en viron m en t n ot treated ) . I n these cases, p atien t an d con tacts sh ould be
retreated .
P ersisten t itchin g m ay be d ue to an other con d ition , in itially m ask ed by scabies.
Crusted scabies
T reatm en t com bin es sim ultan eous ad m in istration of oral iverm ectin an d top ical
scabicid e at regular in tervals, e.g. every w eek for 2 to 3 w eek s or m ore, accord in g to
severity an d clin ical resp on se.
C rusts should be soften ed (salicylic acid oin tm en t) an d rem oved before ap p lyin g local
treatm en t (oth erw ise, local treatm en t is in effective).
A s exfoliated sk in scales m ay sp read the p arasite, the p atien t should be isolated d urin g
th e treatm en t, staff sh ould use p rotection ( gloves, gow n s an d h an d w ash in g after
con tact), an d en viron m en t (bed d in g, floors an d surfaces) should be d econ tam in ated .
1 Treatment with ivermectin in these patients is reserved for severe cases for which no alternative exists (see
crusted scabies).
2 In areas where loiasis is endemic, certain precautions are recommended before administering ivermectin: e.g.
measure the Loa loa microfilaraemia, if possible, or ensure that the patient has no history of loiasis (migration of
an adult worm under the conjunctiva or transient « Calabar » swellings), nor history of severe adverse reactions
following a previous treatment with ivermectin, or if in doubt, use topical treatment in preference to oral.
100
I verm ectin is n ot recom m en d ed for child ren < 1 5 k g or p regn an t w om en ( safety n ot
established )1 .
A d m in istration of iverm ectin to p atien ts w ith loiasis carries a risk of severe n euro -
logical com p lication s w hen sign ifican t Loa loa m icrofilaraem ia is p resen t (see Filariasis,
p age 1 527 ) .
Weight 15 to 24 kg 25 to 35 kg 36 to 50 kg 51 to 65 kg
Iverm ectin 3 m g tab 1 tab 2 tab 3 tab 4 tab
Iverm ectin 6 m g tab 1 / 2 tab 1 tab 1 1 / 2 tab 2 tab
T reatm en t effectiven ess is jud ged on clin ical groun d s. I tch in g m ay p ersist for 1 to
3 w eek s after elim in ation of the p arasite.
P ersisten ce of typ ical burrow s beyon d 3 w eek s sh ould lead to susp icion of treatm en t
failure (in sufficien t treatm en t, e.g. the scalp w as n ot in clud ed in top ical treatm en t or
th e p atien t w ash ed h is h an d s d urin g th e treatm en t p eriod ) , or early re- in festation
( con tacts an d en viron m en t n ot treated ) . I n these cases, p atien t an d con tacts sh ould be
retreated .
P ersisten t itchin g m ay be d ue to an other con d ition , in itially m ask ed by scabies.
Crusted scabies
T reatm en t com bin es sim ultan eous ad m in istration of oral iverm ectin an d top ical
scabicid e at regular in tervals, e.g. every w eek for 2 to 3 w eek s or m ore, accord in g to
severity an d clin ical resp on se.
C rusts should be soften ed (salicylic acid oin tm en t) an d rem oved before ap p lyin g local
treatm en t (oth erw ise, local treatm en t is in effective).
A s exfoliated sk in scales m ay sp read the p arasite, the p atien t should be isolated d urin g
th e treatm en t, staff sh ould use p rotection ( gloves, gow n s an d h an d w ash in g after
con tact), an d en viron m en t (bed d in g, floors an d surfaces) should be d econ tam in ated .
1 Treatment with ivermectin in these patients is reserved for severe cases for which no alternative exists (see
crusted scabies).
2 In areas where loiasis is endemic, certain precautions are recommended before administering ivermectin: e.g.
measure the Loa loa microfilaraemia, if possible, or ensure that the patient has no history of loiasis (migration of
an adult worm under the conjunctiva or transient « Calabar » swellings), nor history of severe adverse reactions
following a previous treatment with ivermectin, or if in doubt, use topical treatment in preference to oral.
100
