PA01 Treating scabies with oral ivermectin in infants: series of 12 cases

Abstract Scabies is currently a global health problem that affects people of all ages, including children. The incidence is particularly high in children aged < 2 years. The diagnosis of scabies can be challenging in infants because of their inability to express discomfort and the divergent clinical presentation. This can as a result cause delays in diagnosis and facilitate the spread of the infestation. The aim of this study was to evaluate the effectiveness and safety of treating infants with ivermectin for scabies. We included 12 infants < 2 years of age receiving treatment with ivermectin with a clinical diagnosis of scabies at our hospital from January 2024 to January 2025. We recorded age, sex, weight, number of household members affected, symptoms, time to diagnosis, prescribed treatments, complications and time to resolution. We included 12 infants (two boys and 10 girls) with a mean age of 7 months. All patients had a weight < 10 kg with average of 5.6 kg. In all patients the diagnosis was made based on the presence of inflammatory papules and pustules, as well as positive delta sign. All patients were predominantly affected on the hands, feet and trunk. The median duration of symptoms prior to any treatments and diagnosis of scabies was 2.2 months. The predominant symptoms were pruritus (92%), irritability (92%) and rash (100%). Overall, 25% were initially diagnosed with eczema in primary care, which resulted in an average delay of 3.5 months in initiating antiscabetic treatment. One-half (50%) of them lived with four or more people. Regarding treatment, 83% of the infants received topical permethrin, and 25% received topical malathion prior to receiving oral ivermectin. The parents reported no side-effects with ivermectin, including convulsions, flushing, behavioural changes or increased itching. Improvement and clearance of rash were reported to take 8 days for 83%. Ivermectin is a safe, well-tolerated and effective treatment for scabies in infants. Although our study has a small number of patients it adds to growing literature showing comparable and reassuring results. Therapeutic failure was not associated with diagnostic delay or other clinical or epidemiological factors, except a higher number of household members. More education and awareness in primary care regarding scabies diagnosis should be encouraged. Early treatment with oral ivermectin should be emphasized, along with reiteration of the importance of treating contacts to reduce chances of recurrence. Additionally, existing data suggest that oral ivermectin in children weighing < 15 kg is safe, which is also supported by our study.