Comparison of topical 5% permethrin and oral ivermectin for treatment of childhood scabies: a randomized controlled trial.

Topical permethrin (5%), though considered the treatment of choice for scabies, has few drawbacks (expensive, poor compliance). This study aimed to compare the efficacy, safety, and cost-effectiveness of topical permethrin (5%) and oral ivermectin for treating childhood scabies. This randomized controlled trial was conducted in the dermatology and pediatric outpatient clinic of a tertiary care center between August 2023 and December 2024. Children in the study and control groups received oral ivermectin (200 µg/kg) and 5% permethrin, respectively, at an interval of 7 days. The cure rate at the 4th week was the primary outcome. Secondary outcomes were cure rate (1st and 2nd week), lesion count per patient (1st, 2nd, and 4th weeks), microscopic clearance (1st, 2nd, and 4th weeks), treatment failure (4th week), adverse events, reinfestation at the 6-month follow-up period, and cost to successfully treat one case. Three hundred and fifty-five children were included in either group. Though a significantly higher proportion of children in the control group were cured at the 1st week (41.8% vs 62.9%, p-value <.001), the cure rate was similar between the groups at the 2nd and 4th weeks (P-value >.05). Treatment failure was also similar in both groups (5.1% vs 3.9%, P-value = .47). The cost to treat one case successfully in the study and control groups was ₹44.2 ($0.46) and ₹140.4 ($1.47), respectively. Reinfestation during the follow-up period was similar in the two groups (P-value >.05). Oral ivermectin may be a cost-effective alternative treatment of childhood scabies. The trial was registered in the Clinical Trial Registry of India (Registration no.: CTRI/2023/07/055910, dated 31 July 2023).