Drug of Choice

Permethrin 5% is the drug of choice in the first world and has been since shortly after its introduction in 1989. Skabi-Rid® (Permethrin 5%) was introduced in South Africa as treatment of choice for scabies in 2012.

The evidence base

• WHO – listed as an Essential Medicine
• BMJ: Clinical Evidence — Scabies, Oct 2007: “Topical permethrin is highly effective at increasing clinical and parasitic cure of scabies within 28 days.”
• NEJM, April 2006: Current treatment for scabies — permethrin 5% is first line therapy in the United States.
• Cochrane Library: Interventions for treating scabies, assessed Issue 1, 2009. Permethrin appeared to be the most effective topical treatment for scabies.
• IJAVMS Vol. 3, Issue 1, 2009:43-48: Comparative Therapeutic Efficacy of Permethrin, Benzyl benzoate and Sulphur in the treatment of Scabies Patients.
• NHS: Treatments of choice are 11.1 Permethrin 5% — NHS Bolton preferred treatment.
• SAPJ, April 2010: This (permethrin 5%) would be the first line of treatment in a pregnant woman.
• Canterbury DHB: “We consider this agent (permethrin 5%) to remain the treatment of choice of scabies or head lice (1%) in pregnancy and lactation.”
• DRUGDEX Drug Evaluation 2009: The recommended treatment regimen for scabies is topical permethrin cream 5%.
• Michigan Dept of Health 2005: Currently, 5% permethrin cream is the recommended treatment for scabies infestation.
• Paediatric Dermatology Vol. 11 No. 3 264-266: Neonatal Scabies Treated With Permethrin 5% Cream.
• OTIS Report, Dec 2009: “The CDC recommends that breastfeeding women use pyrethrins or permethrin to treat lice and scabies.”
• International Foundation of Dermatology: Management of scabies — Permethrin 5% listed as first treatment for scabies.
• Merck Manual Professional, Sep 2008: Parasitic Skin Infections — Permethrin is the 1st line topical drug.
• South African Medicines Formulary 7, p474: “Permethrin is effective for scabies and pediculosis. Due to its low human toxicity, it is becoming increasingly important for the control of resistant organisms.”
• American Family Physician, Clinical Evidence Handbook: “Topical permethrin is highly effective at increasing clinical and parasitic cure of scabies within 28 days.”
• Oxford Handbook of Paediatrics, Southern Africa, 6th Edition, ch.32 p420: “Permethrin 5% left on for 24 hours is the preferred treatment for all ages.”
• SA Medicines Formulary 8, Ectoparasiticides p503, Permethrin (SA EDL: Primary).
• Martindale 34th Edition: “Treatment (of scabies) is with the acaricides permethrin or malathion applied preferably as aqueous lotions.”
• Martindale 37th Edition: “It is used as a 5% application for pubic pediculosis (p.2181) and as an acaricide in the treatment of scabies (p.2182).”
• European Guideline for the Management of Scabies: “Permethrin cream 5% (once for 8-14 hours) is effective, well-tolerated (level of evidence Ib; grade A recommendation).”
• Oxford Journals: Review of common therapeutic options in the United States for the treatment of pediculosis capitis — “Permethrin 5% (FDA-approved for scabies infestation) has the advantage of having been proven safe for children as young as 1 month of age.”