EBMA01,

Clinical scenario3(Scabies) , ?

Search strategy

Background knowledgeIt is transmitted from person to person via direct skin contact. At standard room conditions infectious mites can survive for up to 36 hours off the host.Pruritic response to infestation of human mite Sarcoptes scabiei. Severely itchy lesions typically present as small papules with noticeable curvy or straight burrows commonly located in skin folds.Secondary signs may include general rash, urticaria, eczema, excoriation, and impetigo Patients may be asymptomatic for the first 2-4 weeks of infestation

Problem 1, PICOPatient and/or problem: No symptomatic staff who contact scabies patient Intervention : Mediation for treat scabiesComparison intervention : No interventionOutcomes : Prevent scabies outbreak

Search strategy Search terms: scabies and asymptomatic result: 17 papers found Discard irrelevant papers Finally, 1 paper is cited

terms: scabies and outbreak 221 papers limits: published in the last 10 years, English result: 45 papers found Discard irrelevant papers Finally, 1 paper is cited

Citations1.Chambliss NL. Treating asymptomatic bodily contacts of patients with scabies. Arch Fam Med. 2000 May;9(5):473-4.

2.Scheinfeld N. Controlling scabies in institutional settings: a review of medications, treatment models, and implementation. Am J Clin Dermatol. 2004;5(1):31-7

Level: 2cLevel: 2c

Evidence appraisalControl of an epidemic can only be achieved by treatment of the entire population at risk. Ivermectin, the only oral treatment, is not approved for scabies in the US. In an outbreak of scabies in a nursing home, residents, staff, and frequent visitors should all be treated even if they are not symptomatic. Ivermectin is useful in treating patients with Norwegian or crusted scabies, or who are debilitated. Ivermectin has no serious reported adverse effects. Scheinfeld N. Am J Clin Dermatol. 2004

Evidence appraisalPatients who are first exposed to scabies often do not develop symptoms for several weeks.A well documented case report detailed the spread of scabies in a day care center, in which 21% of the staff and children were eventually infected. More than 570 family members of the children also became symptomatic.The standard treatment for scabies is 5% permethrin cream applied from the neck down and left.Alternatives include 1% lindane, which should be avoided in children and pregnant women. In adults, ivermectin is effective as a single oral dose. Arch Fam Med. 2000 May.

Scabies treatments Am J Clin Dermatol 2004;5(1)

Conclusion3(Scabies) ,

Plain language explanation

Problem 2, PICOPatient and/or problem: No symptomatic staff who contact scabies patientIntervention : LindanceComparison intervention : Permethrin or IvermectinOutcomes : Cure rate

Search strategyTerms: scabies and lidaneLevel :IcLevel :Ic

Evidence appraisalEvidence regarding the effectivess of permethrin vs lindane is conflicting. This systematic review found four RCTs comparing these agents. Two small trials found clinical cure at 28 days was greater with permethrin, but the other two RCTs, including the largest of the four trials, failed to show any significant difference in clinical outcome. Permethrin, however, to be more effective in controlling persistent itch (Level A) Walker GJA, Johnstone PW. Interventions for treating scabies. Cochrane Database of Systematic Reviews 2004, Issue 1

Walker GJA, Johnstone PW. Interventions for treating scabies. Cochrane Database of Systematic Reviews 2004, Issue 1

Drug comparsionEvidence regarding the effectivess of permethrin vs lindane is conflicting. This systematic review found four RCTs comparing these agents. Two small trials found clinical cure at 28 days was greater with permethrin, but the other two RCTs, including the largest of the four trials, failed to show any significant difference in clinical outcome. Permethrin, however, to be more effective in controlling persistent itch (Level A) Walker GJA, Johnstone PW. Interventions for treating scabies. Cochrane Database of Systematic Reviews 2004, Issue 1

Evidence appraisal An RCT comparing the use of lindane with oral ivermectin found similar cure rates at 15 days with both treatments (Level A) A subsequent RCT found that although the effects of topical lindane and oral ivermectin were similar at 2 weeks, ivermectin produced significanlty greater cure rates at 4 weeks (Level A)

Walker GJA, Johnstone PW. Interventions for treating scabies. Cochrane Database of Systematic Reviews 2004, Issue 1

Comparison of the efficacy of topical 1% lindane vs 5% permethrin in scabies: a randomized, double-blind study Permethrin provided an improvement rate of 84.6% after two weeks, whereas lindane was effective only in 48.9% of patients. CONCLUSION: Permethrin (5%) cream was found to be significantly more effective in the treatment of scabies in comparison with lindane in this study, and it seems that it could be an alternative treatment.

The Cochrane Central Register of Controlled Trials (CENTRAL) 2008 Issue 2

Cost effectivenessIn The UK, permethrin is at least 10 times moreexpensive per treatment (5.52 per 30 g of cream),than benzyl benzoate (0.62 per 100ml),and about twice as expensive as crotamiton (2.99 per 100ml) and malathion (2.35 per 100ml)

Walker GJA, Johnstone PW. Interventions for treating scabies. Cochrane Database of Systematic Reviews 2004, Issue 1

Cost effectivenessWalker GJA, Johnstone PW. Interventions for treating scabies. Cochrane Database of Systematic Reviews 2004, Issue 1

Benzyl benzoateCrotamitonLindaneMalathionMesulfen (scaphen)Sulfur

Gamma-benzene hexachlorideDelice(Lindane)1%, 10ml/pk Benzyl Benzoate(B.B lotion)25%,100ml/bot Mesulphen(Scalphen) 330mg/g,15g/tube

Cost comparison and

ConclusionPatients with documented scabies should be isolated and placed in a single ward to optimize staff infection control precautions.it may be asymptomatic for the first 2-4 weeks of infestation, so if have outbreak of scabies , the staff who contract scabies patient need give prevent medication. permethrine B.B lotion scalphenLindane B.B lotion

Plain language explanation PermethrinIvermectinLindanePermethrinIvermectinLindane

Lake District !!

3.Scabies,,4. Sarcoptes scabiei, , 5.,1.2., 2.21%scabies,570,