How can a scabies mite be eliminated if benzyl benzoate does not help? - briefly
If benzyl benzoate is ineffective, prescribe a single dose of oral ivermectin (200 µg/kg) and repeat after 7–10 days, and/or apply 5 % permethrin cream to the entire body for 8–14 hours, repeating the treatment after one week. Simultaneously wash all clothing, bedding, and towels in hot water and treat household contacts to prevent reinfestation.
How can a scabies mite be eliminated if benzyl benzoate does not help? - in detail
When benzyl benzoate fails to eradicate Sarcoptes scabiei, clinicians must turn to proven alternatives. Oral ivermectin, administered as a single dose of 200 µg/kg, is the first‑line systemic option; a repeat dose after 24 hours improves clearance for resistant infestations. Topical permethrin 5 % cream applied from the neck to the toes, left on for 8–14 hours, and repeated after one week, offers a highly effective contact insecticide. If permethrin is unavailable or contraindicated, sulfur ointment (5–10 %) applied nightly for three consecutive days, then repeated after a week, provides a safe, low‑cost regimen, especially for infants and pregnant women.
Adjunct measures enhance treatment success:
- Wash all bedding, clothing, and towels in hot water (≥ 60 °C) and dry on high heat for at least 30 minutes.
- Seal non‑washable items in airtight plastic bags for a minimum of 72 hours to starve mites.
- Vacuum carpets and upholstered furniture thoroughly; discard vacuum bags promptly.
- Treat close contacts simultaneously, even if asymptomatic, to prevent re‑infestation.
In cases of documented resistance, combination therapy may be required. A regimen of oral ivermectin (200 µg/kg) plus a single application of permethrin 5 % can overcome mite tolerance. For severe crusted scabies, weekly ivermectin (200 µg/kg) combined with daily topical benzoyl benzoate (10 %) or crotamiton 10 % cream may be employed under specialist supervision.
Monitoring involves re‑examination 2–4 weeks after treatment completion. Persistent burrows or new lesions indicate treatment failure and necessitate a repeat course or referral to dermatology for advanced options such as malathion 0.5 % or newer oral agents (e.g., moxidectin).