Question 1: Is it safe to use ivermectin in children less than five years of age and weighing less than 15 kg?

@article{Wilkins2018Question1I,
  title={Question 1: Is it safe to use ivermectin in children less than five years of age and weighing less than 15 kg?},
  author={Amanda L Wilkins and Andrew C. Steer and Noel E. Cranswick and Amanda Gwee},
  journal={Archives of Disease in Childhood},
  year={2018},
  volume={103},
  pages={514 - 519}
}
You are working in a remote clinic in Northern Australia and see an 18-month-old girl (weight 10 kg) who presents with a pruritic rash on her extremities. She has a history of persistent scabies despite multiple treatments with topical permethrin 5%. You diagnose her with scabies and although you are aware that oral ivermectin is used for scabies in children over 5 years and weighing more than 15 kg, you consider whether it would be safe to use ivermectin for the treatment of scabies in this… 

A systematic review and an individual patient data meta-analysis of ivermectin use in children weighing less than fifteen kilograms: Is it time to reconsider the current contraindication?

Existing limited data suggest that oral ivermectin in children weighing less than 15 kilograms is safe, and data from well-designed clinical trials are needed to provide further assurance.

Skin infections in Australian Aboriginal children: a narrative review

Only four of 60 children aged under 5 years or weighing less than 15 kg who had been treated with ivermectin at a dose range of 150–200 μg/kg developed an adverse reaction, all of which were benign and transient, with no long term sequelae.

Population pharmacokinetics of ivermectin for the treatment of scabies in Indigenous Australian children

Using modelling, a dosing strategy for ivermectin in children aged 2 to 4 years and weighing less than 15 kg that can be prospectively evaluated for safety and efficacy is identified.

Skin infections in Australian Aboriginal children: a narrative review

There is accumulating evidence that ivermectin is likely to be safe in small children and pregnancy, but it is only licensed for use in children aged over 5 years and weighing more than 15 kg and when treatment with first line scabicides has failed or is contraindicated.

Ivermectin safety in infants and children under 15 kg treated for scabies: a multicentric observational study

Oral ivermectin is approved for the treatment of scabies in several countries, but its use in infants and children weighing < 15 kg is off label.

Current pharmacotherapeutic strategies for Strongyloidiasis and the complications in its treatment.

Current and emerging pharmacotherapeutic strategies for strongyloidiasis are highlighted and treatment protocols according to patient cohort are discussed and discussed.

Broadening the range of use cases for ivermectin - a review of the evidence.

This review outlines the evidence base to date on these emerging indications for ivermectin MDA with reference to clinical and public health data and discusses the rationale for evaluating the range of impacts of a malaria iVermect in MDA on other NTDs.

High infection rates for onchocerciasis and soil-transmitted helminthiasis in children under five not receiving preventive chemotherapy: a bottleneck to elimination

The findings reveal that children under five years of age are highly infected with STH and onchocerciasis, and could contribute to the spread of these diseases, perpetuating a vicious circle of transmission and hampering elimination efforts, and reveal the urgent need to provide treatments to these preschool-aged children.

High burden and seasonal variation of paediatric scabies and pyoderma prevalence in The Gambia: A cross-sectional study

High prevalence of scabies and pyoderma and fungal infections in children <5 years of 15.9%, 17.4% and 9.7% respectively, with increased bacterial skin infections in the rainy season are revealed.

References

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Comparing the efficacy of oral ivermectin vs malathion 0.5% lotion for the treatment of scabies.

The delay in clinical response with ivermectin suggests that it may not be effective against the parasite at all stages in the life cycle.

Comparison of efficacy and safety of oral ivermectin with topical permethrin in treatment of scabies

Ivermectin is as effective as permethrin in the treatment of scabies when used in two doses over a period of 4 weeks.

Treatment of 18 children with scabies or cutaneous larva migrans using ivermectin

ivermectin is a safe and effective alternative treatment of cutaneous parasitosis in children and there is concern regarding the safety of its use in children under 5’years of age or weighing less than 15’kg.

Oral ivermectin versus malathion lotion for difficult-to-treat head lice.

For difficult-to-treat head-lice infestation, oral ivermectin, given twice at a 7-day interval, had superior efficacy as compared with topical 0.5% malathion lotion, a finding that suggests that it could be an alternative treatment.

Comparison of oral ivermectin versus crotamiton 10% cream in the treatment of scabies

The delay in clinical response with ivermectin suggests that it may not be effective against all the stages in the life cycle of the parasite.

Efficacy of albendazole and its combinations with ivermectin or diethylcarbamazine (DEC) in the treatment of Trichuris trichiura infections in Sri Lanka.

Single-dose treatment with the albendazole-ivermectin combination appears to be highly effective against trichuriasis and could prove valuable for routine use.

Advantages of ivermectin at a single dose of 400 micrograms/kg compared with 100 micrograms/kg for community treatment of lymphatic filariasis in Polynesia.

The safety and the effectiveness of 400 micrograms/kg of ivermectin for lymphatic filariasis control are confirmed and the geometric mean microfilaraemia was reduced.

Before Using Ivermectin Therapy for Scabies

Given the expanding use of ivermectin for scabies, we would like to make a few points in its applicability to pediatric patients. First, we need some background. Ivermectin has been used in

Cutaneous larva migrans in travelers: a prospective study, with assessment of therapy with ivermectin.

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Single-dose ivermectin therapy appears to be effective and well tolerated, even if several treatments are sometimes necessary, and Physicians' knowledge of CLM is poor.
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