Permethrin 5% cream applied to all areas of the body from the neck down and washed off after 8–14 hours
Ivermectin 200 ug/kg body weight orally, repeated in 14 days*
Ivermectin 1% lotion applied to all areas of the body from the neck down and washed off after 8–14 hours; repeat treatment in 1 week if symptoms persist
*Oral ivermectin has limited ovicidal activity; a second dose is required for eradication.
Lindane 1% 1 oz of lotion or 30 g of cream applied in a thin layer to all areas of the body from the neck down and thoroughly washed off after 8 hours*
* Infants and children aged <10 years should not be treated with lindane.
Combination treatment is recommended with a topical scabicide, either 5% topical permethrin cream (full-body application to be repeated daily for 7 days then 2 times/week until cure)
25% topical benzyl benzoate, and oral ivermectin 200 ug/kg body weight on days 1, 2, 8, 9, and 15.
Additional ivermectin treatment on days 22 and 29 might be required for severe cases.
Infants and young children should be treated with permethrin; the safety of ivermectin for children weighing <15 kg has not been determined. Infants and children aged <10 years should not be treated with lindane.
Ivermectin likely poses a low risk to pregnant women and is likely compatible with breastfeeding; however, because of limited data regarding ivermectin use for pregnant and lactating women, permethrin is the preferred treatment.
Persons with HIV infection who have uncomplicated scabies should receive the same treatment regimens as those who do not have HIV.
Persons with HIV infection and others who are immunosuppressed are at increased risk for crusted scabies and should be managed in consultation with a specialist.