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Ivermectin for Parasitic Skin Infections of Lice: A Review of Comparative Clinical Effectiveness, Cost-Effectiveness, and Guidelines

Last updated: May 14, 2019
Project Number: RC1115-000
Product Line: Rapid Response
Research Type: Drug
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the comparative clinical effectiveness of oral versus topical ivermectin for parasitic skin infections of lice?
  2. What is the comparative clinical effectiveness of oral ivermectin versus pediculicides for parasitic skin infections of lice?
  3. What is the comparative clinical effectiveness of topical ivermectin versus pediculicides for parasitic skin infections of lice?
  4. What is the comparative cost-effectiveness of oral ivermectin versus pediculicides for parasitic skin infections of lice?
  5. What is the comparative cost-effectiveness of topical ivermectin versus pediculicides for parasitic skin infections of lice?
  6. What are the evidence-based guidelines for the use of ivermectin for parasitic skin infections of lice?

Key Message

One relevant non-randomized study was identified regarding the comparative clinical effectiveness of oral versus topical ivermectin for parasitic skin infections of lice. This evidence of limited quality suggested that both oral and topical ivermectin were effective for the treatment of patients with pediculosis capitis. The study found that the cure rates of lice infestation and pruritus were significantly higher among those receiving topical ivermectin compared to oral ivermectin one week after initial treatment; however, after a second treatment for nonresponders in both groups the cure rates improved to 100% (topical) and 97% (oral), a difference that was not statistically significant. Both treatments were reported as having favourable safety profiles.No evidence regarding the comparative clinical effectiveness of ivermectin versus pediculicides for parasitic skin infections of lice was identified. Additionally, no evidence regarding the comparative cost-effectiveness of oral ivermectin or topical ivermectin versus pediculicides for parasitic skin infections of lice was identified.One evidence-based guideline was identified regarding the use of ivermectin for parasitic skin infections of lice. The guideline provides weak recommendations (based on evidence of limited quality) for the use of oral or topical ivermectin for the treatment of individuals with pediculosis pubis. Oral ivermectin should be considered as a second-line therapy or as an option for individuals with infestation in the eyelashes (with the exception of children weighing  < 15 kg, a group who should not use ivermectin). Topical ivermectin is listed as treatment option that is effective and generally well-tolerated, although it is not recommended as a first- or second-line therapy.