Higher Ivermectin Dose Does Not Improve Severe Scabies Cure Rates

Scabies remains a significant global health burden, affecting over 200 million people annually and frequently leading to secondary complications such as impetigo, renal disease, and rheumatic heart disease [1, 2]. While standard treatments like topical 5% permethrin and oral ivermectin are generally effective for classic cases, clinicians often face therapeutic failure in profuse or crusted presentations [3, 4]. Recent data suggesting reduced mite sensitivity to permethrin have intensified the search for more robust dosing strategies to ensure complete eradication [5]. Although mass drug administration has successfully utilized ivermectin to lower community prevalence, the optimal dosing for individual patients with high parasite loads remains a subject of clinical debate [6, 7]. A recent randomized trial now evaluates whether escalating the ivermectin dose can improve outcomes for these difficult-to-treat patients.