Interesting article on ivermectin resistant scabies

Posted in the Scabies Forum

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itchy and cratchy

UK

#1 Nov 1, 2006
A lot of information here, not strictly related to ivermectin resistance.
http://www.journals.uchicago.edu/CID/journal/...
[quote]
we commenced therapy with topical 25% benzyl benzoate with tea tree oil added (to make a 5% tea tree oil solution). The rationale for this was that benzyl benzoate and 5% tea tree oil were consistently the topical scabicides that killed scabies mites the quickest in our earlier in vitro studies
[/quote]
[quote]
In light of concerns that a 2-week dosing interval is inadequate, we have further modified our protocol for treating recurrent crusted scabies to a 5-dose regimen with doses of 200 g/kg administered on days 1, 2, 8, 9, and 15 of therapy, with an additional 2 doses on days 22 and 29 for the most severe cases.
[/quote]
[quote]
To our knowledge, this is the first report of in vivo or in vitro ivermectin resistance in S. scabiei.
[/quote]
Important to note that they are treating Norwegian/Crusted scabies.
itchy and cratchy

UK

#2 Nov 1, 2006
Sorry that looks a little messed up, the quotes did not work like I thought they would.

Anyone have any comments on the article?

One of my main thoughts is that if they can get rid of severe resistant scabies, why are we having so much trouble getting rid of the normal variety?
Slomo

Wallingford, CT

#3 Nov 2, 2006
The problem is reinfection most likely.
I can not access your link at the univ chicago. It complains about prvileges.
itchy and cratchy

UK

#4 Nov 2, 2006
slomo

Fall River, MA

#5 Nov 4, 2006
Thanks, the new link you gave worked.
Good article.
I was surprised that ivermectin wqas present for one week. I seem to recall that its half life in blood is 24 hours.. Maybe it sticks around longer in serum.
25 percent Benzyl Benzoate is pretty strong stuff. I have used 10% and that can cause severe burning sensation, esp. after a bath.

I can not find any reason to object to the mixture. There may be some interaction. I have some mixture I tried at some time. The mixture seems to perhaps go bad faster than the 2 separate ingredients.
(Over a few months, the mixture has a different smell to it, I dunnno).

Be mindful that using any stuff that get absorbed tru the skin puta an extra load on your liver/kidneys. so you do not want to do this stuff for weeks on end.
slomo

Fall River, MA

#6 Nov 4, 2006
Hey Itchy & Scratchy.. Have you tried the ivermectin therapy? I have done a fair amount of Benzyl Benzoate + tea tree oil therapy, and I can say that it did not get rid of the mites. It did help and kept them from raging out of control, but it seems some always managed to survive.

2 weeks after taking the 2nd dose of Stromectol, the whole family was symptom free.
Been There

United States

#7 Nov 4, 2006
It should be clear to all that Tea Tree oil does not kill the mites.

Long before I ever caught mites I had been using Tea Tree spray on my feet as an antibiotic and antifungas. When I discovered I had sarcoptic mange most of them were on my feet right were I had the tea tree. They had a party and crusted around my toes and on the soles too. Mites can't see and are attracted to smell and that Tea Tree sure has a strong smell. As far as I'm concerned mites dab it between their eight little legs, love to bath in the stuff and might even like to chew on it. It's useless as a mite killer.

Go with the 2 dose 7-10 days apart treatments of Ivermectin and Permethrin.

Don't waste time or money on anything else to kill mites on your body. I think for now Ivermectin and Permethrin is the answer and far as I know all there is out there that works and is reasonably safe. And do all the other stuff(you've read it) to prevent reinfestation.
Slomo

Fall River, MA

#8 Nov 17, 2006
itchy and cratchy wrote:
Sorry that looks a little messed up, the quotes did not work like I thought they would.
Anyone have any comments on the article?
One of my main thoughts is that if they can get rid of severe resistant scabies, why are we having so much trouble getting rid of the normal variety?
Hi there,

I gave the article a thorough read.
Some key points:
1) The evidence shows, that given enough mites, some resistance of the given mite population on a patient can develop. Here we are talking millions of mites on a patient. Eventually, all of the mites were killed, via increased dose ( 280 mcg) and prolonged treatment.
I see 7 or more treatments, every 4-5 days.
The typical reader of this board would not have crusted scabies, so we have a different ball game here.

2) There is no assertion of resistant mites developing in the wild.

3) conclusion: A combined therapy ( permethrin topical + ivermectin oral)is probably a good idea. Say, 3 doses of Ivermectin, 5 days apart, with 2 doses of permetrin cream in between .
This would effectively give you continuous coverage for 15 days, which should prevent reinfection from your environment.

day1: Ivermectin.

day 3: permethrin cream

day 5: Ivermectin

day 8: permethrin

day 10 : Ivermectin.

day 13: Permethtin
itchy and scratchy

UK

#9 Nov 20, 2006
Slomo wrote:
<quoted text>
The typical reader of this board would not have crusted scabies, so we have a different ball game here.
Yes correct and what I think is something that can be taken from this, is that if such a severe case can be cured in this way, then the rest of us with commone(non crusted) scabies should be able to get rid of it as well.

Yet reading the many posts here it seems this is not the case.

One major advantage the people in the study have is that they were treated in sterile(medical) facility.

However I do wonder about treatment in these aboriginal communities where the patients continue to live in their own homes, where cleanliness is likely not near what would be desired.

They are also extremely unlikely to have hot water washing facilities and defintely would not have a drier. Maybe the medical professionals treating them have ways of dealing with such issues, I am not sure.
Been there

United States

#10 Nov 20, 2006
itchy and scratchy wrote:
<quoted text>
Yes correct and what I think is something that can be taken from this, is that if such a severe case can be cured in this way, then the rest of us with commone(non crusted) scabies should be able to get rid of it as well.
Yet reading the many posts here it seems this is not the case.
One major advantage the people in the study have is that they were treated in sterile(medical) facility.
However I do wonder about treatment in these aboriginal communities where the patients continue to live in their own homes, where cleanliness is likely not near what would be desired.
They are also extremely unlikely to have hot water washing facilities and defintely would not have a drier. Maybe the medical professionals treating them have ways of dealing with such issues, I am not sure.
I read the article too. Severe Crusted Scabies Patients did require unbelieveable numbers of Ivermectin treatments but were improving until returning to their homes and were reinfected.

I looked at the posts on "Scabies is highly contagious". The thought of using Ivermectin seems to be somewhat new to these posts. Correct me if I am wrong but it appears that until I started talking about using Ivermectin it wasn't brought up. Since then at least one person posted past history of use with it. My point is that people were trying OTC, "natural products off the internet", and a few topical anti-parasite medications without a cure. Some of us, including myself followed doctors orders or insert instructions which don't apply to those face and scalp infestations. We were spinning our wheels with little help from MD's. Perscription Ivermectin is no so easy to get and people are struggling with either getting it or worried about if it's even safe to use. Then we have tossed in the possible use of Vet grade or Ivermectin obtained from overseas. So it's taking awhile for people to get onboard with the correct, best or safest treatment for them. Lets give it somemore time and see.

Due to people like yourself and others I think anyone reading these posts has a better shot at ridding themselfs of sarcoptic mites.
Slomo

Fall River, MA

#11 Nov 20, 2006
itchy and scratchy wrote:
<quoted text>
..the rest of us with commone(non crusted) scabies should be able to get rid of it as well.
Yet reading the many posts here it seems this is not the case.
One majo
Well.. the folks who post have a varying level of understanding and discipline, never mind resources. I think a lot of it comes down to managing the environment and reinfection. Like, clean clothes and clean bed sheets daily are useful, but I see people going totally nuts, wasting a lot of energy on non-prductive OC cleaning.
Someone posted about " how you can prevent the mites getting into your mattress". If you consider the size fo these things, they do not fit through the gaps of typical linens/fabric. That particular poster probably confused scabies with dust mites.

People also develop superstitions and rituals. when people are coincidentally do something, and think they notice a coincidental improvement in their condition, they tend to posite a connection. I see some of the emotional and well meaning posters, describing the virtues of their tedious and ritualistic routine, that you absolutely must follow ( including the daily meditation on the demise of the mites) to be cured.
I for one dismiss out of hand anything that does not come with a well-resoned rationale or some verifiable factual information.
I firmly believe that 2-4 applications of oral ivermectin definitely is curative, if reinfection can be prevented. Some topical may be useful for reinfection control. W/o a systemic med, it is just a war of attrition, which may eventually thin out the mites enough to cause a population
collapse. But, this takes a long time, and set-backs are possible.
Slomo

Fall River, MA

#12 Nov 20, 2006
Been there wrote:
<quoted text>
Due to people like yourself and others I think anyone reading these posts has a better shot at ridding themselfs of sarcoptic mites.
Well, I see people not reading the posts. They come in, post their story, and expect someone to post a custom tailored answer for them.
Been there

United States

#13 Nov 20, 2006
Slomo wrote:
<quoted text>
Well, I see people not reading the posts. They come in, post their story, and expect someone to post a custom tailored answer for them.
Their loss. How about someone saying they don't have time to read all the posts. I'm getting tired of repeating myself.
Been there

Brawley, CA

#14 Nov 21, 2006
Japan is onboard using Stomectol(Ivermectin) for treatment of Scabies.

http://www.medicalnewstoday.com/medicalnews.p...
Slomo

Fall River, MA

#15 Nov 21, 2006
There seems to be a lot of noise in some of the higher traffic threads. Well meaning but perhaps naive/superstitious folks posting their own version of complicated rituals.

I expect some verifiable source, or rational reasoning as a basis for any proposed solution.

Ivermectin or its related drugs work, buth in animals and humans.
Permethrin works, if properly applied and more than once. There are some reported treatment failures for reasons not fully understood. One of the additives is suspected cancer causing agent (Leukemia), so I would be concerned about prolonged use.
Some other older drugs seem to work.(Benzyl benzoate, Lindane) There are many reported treatment failures. Lindane is dangerous in several aspects.

Nothing else seems to work. IMO there is placebo effect, and perhaps mistakes in self-diagnosis that makes folks think that vinegar mixed with bleach and liquid laundry detergent is helpful.(The formula given was meant to be a jest, do not go out and try it for Pete's sake!)

I am getting tired of posting. Can you tell? ;-)
Slomo

Fall River, MA

#16 Nov 21, 2006
itchy and scratchy wrote:
<quoted text>
One major advantage the people in the study have is that they were treated in sterile(medical) facility.
OK. How does that "sterile facility" come about? There are people (staff) following certain practices to make it that way. If you could only duplicate that in your own environment...
My wife happens to be a nurse. Guess why I am using lysol at home. It is standard practice in many US nursing homes.

Perhaps an inquiry with a staff of some conveniently located medical facility may prove fruitful. A nursing home, or adult day care center. I forget.. someone wrote a best practices document already, the JEN scabies manual. You read that by any chance?
Slomo

Fall River, MA

#17 Nov 21, 2006
itchy and cratchy wrote:
we commenced therapy with topical 25% benzyl benzoate with tea tree oil added (to make a 5% tea tree oil solution).
I have posted somewhere some info on the use of Benzyl Benzoate. If you are interested/ can not find it I repost a summary. It was in reponse to someone asking about benzoine.

It is effective in killing all stages of mites except eggs.
I theorize that it is not very good in penetrating the layer of skin where mites hide,( it appears it does not work as a stand-alone cure, at least not in a short amound of time. Short, as in 3 applications every other day. Nope, that did not do the trick)
itchy and scratchy

UK

#18 Nov 21, 2006
Slomo wrote:
There seems to be a lot of noise in some of the higher traffic threads.
The organisation of this board is not very good. As you'll be aware there are only 2 or 3 threads which everyone seems to post in regardless.

People should start new threads for new topics.

In fact I might just go and do that now.
itchy and scratchy

UK

#19 Nov 21, 2006
Slomo wrote:
<quoted text>
OK. How does that "sterile facility" come about? There are people (staff) following certain practices to make it that way. If you could only duplicate that in your own environment...
My wife happens to be a nurse. Guess why I am using lysol at home. It is standard practice in many US nursing homes.
Perhaps an inquiry with a staff of some conveniently located medical facility may prove fruitful. A nursing home, or adult day care center. I forget.. someone wrote a best practices document already, the JEN scabies manual. You read that by any chance?
Yes I have read it.

I think the point I am trying to make is that a medical facility/hospital is more sterile than almost any home. That is bound to help prevent reinfestation.
itchy and scratchy

UK

#20 Nov 21, 2006
Slomo wrote:
<quoted text>
I theorize that it is not very good in penetrating the layer of skin where mites hide,( it appears it does not work as a stand-alone cure, at least not in a short amound of time. Short, as in 3 applications every other day. Nope, that did not do the trick)
I have used it several times with no sucess. It is common here in the UK, brand name Ascabiol. You are more likely to be given it than premethrin, no prescription required.

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