Scabies (sarcoptes scabiei) - Antibiotic Prescribing

Comments from Expert Advisory Committee

History
  • Itchy rash over hands/feet and genital areas, worse at night and after a bath
  • Household contacts itchy
Exam
  • Burrows at wrist and webspaces, papules in interdigital web spaces of hands/wrists and feet
  • Rash on feet/fingers/webspaces/wrist/elbow/axilla/umbilicus/areolae
  • Also seen on palms & soles in infants
Example
Scabies image-1 Scabies image-2

Image source/credit: DermNet

General advice for scabies
  • Treatment of scabies is recommended for all members of the infected household (even if asymptomatic) and all members must be treated simultaneously within 24 hours.
  • Visiting asymptomatic relatives and sexual contacts within the last month could be potential sources of infestation and may also require treatment.
  • Seek specialist advice for children under two months of age.
  • For difficult to treat scabies, cases in assisted care facilities or immunocompromised hosts, seek advice from microbiology/ public health. 
  • Adults and children can return to work or school 24 hours after the first application of scabicide.
  • Most people with scabies are cured after two applications of scabicide but itching may continue for a few weeks after successful treatment. If this is problematic it may be relieved using an oral antihistamine and/or a topical steroid.
  • If new burrows appear after a treatment course (two applications) consider a second treatment course.
  • Bedding and clothing should be washed at a high temperature to destroy the mites. Items that can’t be washed or dry cleaned should be sealed in a plastic bag for at least 72 hours or put in a freezer.
Resistant Scabies
  • Prior to considering resistant scabies ensure: previous adequate application of appropriate product at correct intervals (as below) and that all household contacts (even if asymptomatic) were appropriately treated.
  • Oral ivermectin (unlicensed and usually prescribed in tertiary care) has been shown to be effective in treating resistant scabies. Seek advice from Public Health, Dermatology or Microbiology if you suspect resistant scabies.
Crusted Scabies
  • Patients who have impaired mobility or are immunocompromised may be susceptible to a severe form of scabies known as crusted scabies. Seek advice from a specialist if you suspect crusted scabies.
Outbreaks
  • For outbreaks, particularly in assisted care facilities, the local Public health office should be contacted.

Treatment

Scabies

Technique of application of topical agents listed below is extremely important to ensure effectiveness.Manufacturer's directions for product use need to be followed closely. Do not apply after a hot bath.

Adults & Children over 2 years:

  • Apply to the whole body below the ears paying particular attention to the areas between the fingers and toes, wrists, axillae, external genitalia, buttocks and under finger and toenails.
  • Face, neck & scalp application is necessary in immunosuppressed and adults over 65 years.

Children 2 months-2 years:

  • As per adults but also apply to face, neck, scalp and ears.

The product should be re-applied to the hands if they are washed with soap and water.

Pregnancy & Breastfeeding: Either product may be used in Pregnancy. Care must be taken that a breastfeeding infant does not suckle on treated skin (thereby avoiding oral ingestion of the scabicide).

Drug Dose Contact time Repeat application

Permethrin 5% Cream
(Lyclear® Dermal Cream)
30g tube

Adults & Children > 12yrs:
Apply up to 30g at night

Children 6-12yrs:
Apply up to 15g (½ of a 30g tube) at night

Children ≥ 2mths-5yrs:
Apply up to 7.5g (¼ of a 30g tube) at night

12 hours One week later
2nd line option

Malathion 0.5% Liquid
(Derbac M®)

Adults & Children ≥6mths:
Apply as directed

24 hours One week later

Patient Information

Scabies Patient Information Leaflet February 2022.pdf (size 618.4 KB)

Safe Prescribing (visit the safe prescribing page)

  • Visit the Health Products Regulatory Authority (HPRA) website for detailed drug information (summary of product characteristics and patient information leaflets). Dosing details, contraindications and drug interactions can also be found in the Irish Medicines Formulary (IMF) or other reference sources such as British National Formulary (BNF) / BNF for children (BNFC).

Reviewed February 2022

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