Comparison of Ivermectin and Benzyl Benzoate Lotion for Scabies

8/13/2019 Comparison of Ivermectin and Benzyl Benzoate Lotion for Scabies

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INTROD"CTION

Scaie% occ&r% $or!'$i'e $it( a $i'e%)rea' 'i%tri&tion in t(e tro)ic%, T(e (i+(!* conta+io&%

%4in in.ection ca&%e' * t(e mite Sarcoptes scabiei var, hominis i% one o. t(e mo%t common )r&ritic 'ermato%e%,8 Scaie% i% en'emic in man* 'eve!o)in+ co&ntrie%0; &%&a!!* a%%ociate'

$it( con'ition% o. overcro$'in+ !o$ %ocioeconomic %tan'ar'% an' )oor (*+iene,@:=

Preva!ence o. %caie% in A.rican c(i!'ren can e a% (i+( a% @1=17<81 a!t(o&+( a .i+&re o.@,;7 (a% een re)orte' in Ni+erian %c(oo! c(i!'ren,; Intro'&ction o. a %in+!e ca%e o. %caie% into

cro$'e' !ivin+ con'ition% can re%&!t in an e)i'emic,8880 Scaie% ca&%e% con%i'era!e

'i%com.ort an' can re%&!t in %evere %econ'ar* com)!ication% %&c( a% im)eti+o ce!!&!iti% )*o'erma acteremia an' )o%t%tre)tococca! +!omer&!one)(riti%, 08>8@ Scaie% occ&r% in 0

@7 o. )atient% $it( IV in.ection,8

PENDA"L"AN

S4aie% mer&)a4an )en*a4it *an+ ter9a'i 'i %e!&r&( '&nia 'en+an 'i%tri&%i !&a% 'i 'aera(tro)i%, In.e4%i 4&!it *an+ %an+at men&!ar ini *an+ 'i%ea4an o!e( Sarcoptes scabiei var,

hominis mer&)a4an %a!a( %at& *an+ )en*a4it *an+ )a!in+ %erin+ men*ea4an 4&!it men9a'i+ata!+ata!,8 S4aie% mer&)a4an )en*a4it en'emi4 'i ne+arane+ara er4eman+ 0; ia%an*a er(&&n+an 'en+an 4on'i%i 4e)a'atan )en'&'&4 %o%ia! e4onomi *an+ ren'a( 'an (*+iene

*an+ &r&4, @:= Preva!en%i %4aie% )a'a ana4ana4 A.ri4a 'a)at %etin++i @1=17 <81 me%4i)&n

an+4a @;7 4a%&% %caie% te!a( 'i!a)or4an 'i %e4o!a( ,; i4a ter9a'i %at& 4a%&% %4aie% 'a!am )o)&!a%i *an+ )a'at %4aie% a4an men9a'i e)i'emic,88 80 S4aie% 'a)at men*ea4an

4eti'a4n*amanan )a'a )en'eritan*a 'an 'a)at men+a4iat4an 4om)!i4a%i %e4&n'er *an+ erat

%e)erti im)eti+o %e!&!iti% )io'erma a4teremia 'an post-streptococcal glomerulonefritis, 08>8@

S4aie% 'a)t ter9a'i )a'a 0@7 )a%ien 'en+an in.e4%i IV in.ection,8

Vario&% o)tion% .or t(e treatment o. %caie% eHi%t,886 To)ica! treatment (a% t(e 'i%a'vanta+e% o.

ein+ c&mer%ometimecon%&min+ an' a%%ociate' $it( treatment .ai!&re ca&%e' * )oorcom)!iance in%&..icient a))!ication o. %caici'e ina))ro)riate .re&enc* or tec(ni&e o.

a))!ication an' ina'e&ate treatment o. c!o%e contact%,8@ Beca&%e e..ective to)ica! %caie%

treatment re!ie% on 9&'icio&% an' %im&!taneo&% a))!ication o. cream or !otion to )revent rein.ection accom)!i%(in+ t(i% on a comm&nit* or in%tit&tiona! %ca!e i% 'i..ic&!t, Ora! ivermectin i%

%a.e in (&man% an' ea%* to &%e in in'ivi'&a!% an' .ami!ie% an' on a !ar+e %ca!e,0868; It (a%

a!%o )roven &%e.&! in IVre!ate' %caie% an' a.ter treatment .ai!&re% $it( to)ica! a+ent%,808=

08Ter'a)at era+ai )i!i(an &nt&4 )en+oatan %4aie% ,8 86 Pen+oatan %ecara to)i4a! mem)&n*ai

an*a4 4e!ema(an 4arena r&mitmema4an $a4t& 'an ter4ait 'en+an 4e+a+a!an )en+oatan

'i%ea4an o!e( 4eti'a4 )at&(an ter(a'a) )en+oatan )en++&naan scabicide *an+ ti'a4

menc&4&)i ti'a4 4era)an )en++&naan ata& te4ni4 a)!i4a%i 'an ti'a4 mema'ai )en+oatan4e)a'a 4onta4 'e4at ter(a'a) )en'erita,8@ #arena e.e4tivita% )en++&naan oat to)i4a! )a'a

)en+oatan %4aie% er+ant&n+ )a'a )en++&naan 4rim ata& !otion &nt&4 mence+a( in.e4%i&!an+ cara ini %an+at %&!it 'ia)!i4a%i4an 4e)a'a 4om&nita%, Pemerian ivermectin %ecara ora!

aman )a'a man&%ia 'an m&'a( 'i+&na4an )a'a in'ivi'& 'an 4e!&ar+a'a!am %4a!a *an+ e%ar ,0

868; a! ini 9&+a ter&4ti er+&na )a'a )a%ien IV *an+ ter4ena %4aie% 'an )a'a )en+oatan*an+ +a+a! %ete!a( )e++&naan oat to)ica!,808=08



Ivermectin (a% een &%e' in Ni+eria .or onc(ocercia%i% contro! 000> &t !imite' $or4 on t(e

&%e o. ivermectin in %caie% (a% een re)orte',0@ A!t(o&+( ivermectin (a% een 'emon%trate' to

e e..ective in treatin+ %caie% .e$ %t&'ie% (avecom)are' ivermectin 'irect!* $it( to)ica! a+ent%in 'eve!o)in+ co&ntrie%, -e com)are' t(e e..ectivene%% o. ora! ivermectin $it( t(e %tan'ar'

to)ica! treatment &%e' in Ni+eria /067 enz*! enzoate !otion an' mono%&!.iram %oa)5,

Ivermectin te!a( 'i+&na4an 'i Ni+eria &nt&4 4ontro! onc(ocercia%i% 000> teta)i )en++&naan tivermectin )a'a )en'erita %4aie% *an+ terata% te!a( 'i!a)or4an ,0@ Me%4i)&n ivermectin te!a(

'i&4ti4an e.e4ti. 'a!am men+oati %4aie% eera)a %t&'i te!a( meman'in+4an )en++&naan

ivermectin 'en+an oat to)i4a! 'i ne+arane+ara er4eman+, #ami meman'in+4an e.e4tivita%

)en++&naan ivermectin %ecara ora! 'en+an )en+oatan to)i4a! *an+ 'i+&na4an 'i Ni+eria *ait&!otion enz*! enzoat 067 'an 'en+an %a&n mono%&!.iram5,

METODSS&9ect% o. a+e 6 *ear% an' aove $ei+(in+ more t(an 86 4+ )re%entin+ at t(e Genera!

O&t)atient De)artment o. o% "niver%it* Teac(in+ o%)ita! $it( c!inica!!* %&%)ecte' %caie%$ere e!i+i!e .or t(e %t&'*, S&9ect% $ere eHc!&'e' .or an* o. t(e .o!!o$in+ rea%on%J %erio&% i!!ne%% )re+nant or !actatin+ $omen or treatment o. %caie%

$it(in t(e )rece'in+ 8 mont(,

T(e %t&'* $a% a))rove' * t(e o% "niver%it* Teac(in+ o%)ita! Et(ica! Committee, -rittenin.orme' con%ent $a% otaine' .rom a'&!t %&9ect% an' .rom t(e )arent% or +&ar'ian% o. c(i!'ren,

METODE

S&*e4 'ari &%ia 6 ta(&n 4e ata% 'en+an erat !ei( 'ari 86 4+ 'atan+ 4e R&ma( Sa4it"niver%ita% Pen'i'i4an o% 'en+an %&%)e4 4!ini% %4aie% 'an *an+ memen&(i %*arat &nt&4

)ene!itian, S&4riteria e4!&%i a'a!a( %e)erti eri4&tJ )en*a4it 4roni4 )erem)&an (ami! ata&

men*&%&i ata& %&'a( men9a!ani )en+oatan %4aie% 'a!am 8 &!an %ee!&mn*a,St&'i ini 'i%et&9&i o!e( #omite Eti4 R&ma( Sa4it "niver%ita% Pen'i'i4an o% #omite Eti4,

In.orme' con%ent tert&!i% 'i)ero!e( 'ari %&*e4 'e$a%a 'an 'ari oran+ t&a ata& $a!i ana4ana4,

One eH)erience' .ami!* )(*%ician /MS5 recor'e' 'emo+ra)(ic an' c!inica! 'ata an' )!otte' t(e

'i%tri&tion o. !e%ion% /&rro$% )a)&!e% ve%ic!e% cr&%t%5 on a o'* 'ia+ram, T(e %everit* o.

'i%ea%e $a% recor'e' a% mi!' /81 or .e$er !e%ion%5 mo'erate /88@< !e%ion%5 %evere /61 or more

!e%ion%5 or cr&%te', Severit* %core% o. 8 0 > an' @ $ere a%%i+ne' to %caie% ca%e% recor'e' a%mi!' mo'erate %evere an' cr&%te' re%)ective!*, B&rro$% $ere i'enti.ie' $it( a ma+ni.*in+

!en% an' micro%co)* o. %4in %cra)in+% $a% )er.orme' to %earc( .or mite% e++% or .eca! )e!!et%

Sat& 'o4ter 4e!&ar+a *an+ er)en+a!aman /MS5 mencatat 'emo+ra.i 'an 'ata 4!ini% 'an 'i)!ot'i%tri&%i !e%i /tero$on+an )a)&!a ve%i4e! 4r&%ta5 )a'a 'ia+ram, Tin+4at 4e)ara(an )en*a4it

tercatat %ea+ai rin+an /81 ata& !ei( %e'i4it !e%i5 %e'an+ /88@< !e%i5 erat /61 ata& !ei( !e%i5ata& 4r&%ta, S4or 4e)ara(an 'ari 8 0 > 'an @ *an+ 'ieri4an &nt&4 4a%&% %4aie% 'icatat %ea+ai

rin+an %e'an+ erat 'an 4r&%ta, Tero$on+an 'ii'enti.i4a%i 'en+an !en%a )eme%ar 'an

mi4ro%4o) 'ari 4ero4an 4&!it *an+ 'i!a4&4an &nt&4 mencari t&n+a& ata& te!&r,



Criteria .or t(e 'ia+no%i% o. %caie% $ereJ (i%tor* o. contact $it( a )er%on in.ecte' $it( %caie%

)r&rit&% )re%ence o. &rro$% or %econ'ar* !e%ion% /)a)&!e% no'&!e% eHcoriation% cr&%t% or

.o!!ic&!iti%5 in c(aracteri%tic %ite% or +ro%% %ca!in+ $it( (*)er4eratotic )!a&e% an' .i%%&rin+,T(ree or more )o%itive .in'in+% $ere acce)te' a% 'ia+no%tic o. %caie% even $it(o&t )o%itive

micro%co)*, o$ever a )o%itive micro%co)* re%&!t $a% con%i'ere' 'ia+no%tic

#riteria &nt&4 'ia+no%i% %4aie% a'a!a(J a'an*a ri$a*at 4onta4 'en+an oran+ *an+ terin.e4%i

%4aie% +ata!+ata! a'an*a tero$on+an ata& !e%i %e4&n'er /)a)&!a no'&! e4%4oria%i 4r&%ta

ata& .o!i4&!iti%5 'i !o4a%i 4ara4teri%ti4 ata& %4a!a +ro%% 'en+an )!a4 (i)er4erato%i% 'an .i%%&ra,Ti+a ata& !ei( tem&an )o%iti. 'iterima %ea+ai 'ia+no%ti4 %caie% a(4an tan)a mi4ro%4o)

)o%iti., Nam&n )enem&an 'en+an mi4ro%4o) )o%iti. mer&)a4an 4riteria 'ia+no%ti4,

,

E!i+i!e %&9ect% $ere a!ternate!* a%%i+ne' to receive ora! ivermectin /MectizanK Merc4 Co,Ra($a* N5 at 011 2+3 4+ o'* $ei+(t or to)ica! treatment $it( enz*! enzoate !otion

/Scacare BB 067 $3$ Vitaiotic% Ni+eria Lt',I4e9a Ni+eria5 an' tetraet(*t(i&ram

mono%&!.i'e 67 %oa) /Tetmo%o! a+a! P(arma Lt', I4e9a Ni+eria5, To)ica! treatment

con%i%te' o. a t(oro&+( at( $it( t(e mono%&!.iram %oa) .o!!o$e' * a))!ication o. enz*! enzoate !otion to t(e entire o'* e!o$ t(e nec4 re)eate' 'ai!* .or > con%ec&tive 'a*%, S&9ect%

in ot( +ro&)% $ere in%tr&cte' to $a%( t(eir c!ot(in+ an' e' !inen% in (ot $ater 'r* t(em in t(e%&n an' )re%% t(em $it( a (ot iron, -(ere )o%%i!e c!o%e contact% o. %&9ect% $it( %caie% $ere

eHamine' an' t(o%e c!inica!!* con.irme' to (ave %caie% $ere invite' to enro!! in t(e %t&'*,

S&*e4 *an+ memen&(i %*arat 'ieri4an ivermectin )erora! /Mectizan Merc4 Co Ra($a*

N5 'en+an 'o%i% 011+ 3 4+ erat a'an ata& )en+oatan to)i4a! 'en+an )emerian !otion

enz*! enzoate /Scacare BB 067 3 Vitaiotic% Ni+eria Lt' I4e9a Ni+eria5 'an %a&n

tetraet(*t(i&ram mono%&!.i'e 67 /Tetmo%o! a+a! P(arma Lt' I4e9a Ni+eria5, Pen+oatanto)i4a! ter'iri 'ari man'i 'en+an men++&na4an %a&n mono%&!.iram 'an 'ii4&ti 'en+an

)en++&naan !otion enz*! enzoat 4e %e!&r&( t&&( *ait& 'i a$a( !e(er 'an 'i&!an+ %etia) (ari

%e!ama > (ari ert&r&tt&r&t , S&9e4 )a'a 4e'&a'&a 4e!om)o4 'i%&r&( &nt&4 menc&ci )a4aian'an %e)rai mere4a 'en+an air )ana% 'an 'i4erin+4an 'i a$a( %inar mata(ari 'an 'i%eteri4a,

Bi!a mem&n+4in4an 4onta4 *an+ 'e4at 'en+an %&*e4 *an+ %4aie% 'i)eri4%a 'an mere4a

'en+an 4!ini% men'erita %4aie%t&r&t 'i&n'an+ &nt&4 i4&t %erta 'a!am )ene!itian ini ,

A%*m)tomatic contact% $ere a!%o treate' &t not enro!!e', A!! %&9ect% an' c!o%e contact% $ere

treate' %im&!taneo&%!*,

#onta4 *an+ a%imtomati4 9&+a 'ite!iti teta)i ti'a4 ter'a.tar, Sem&a %&*e4 'an 4onta4 'e4at

'ite!iti %ecara er%amaan,



S&9ect% $ere .o!!o$e' &) at 0 $ee4% to a%%e%% com)!iance an' eHamine t(e )atient, A %in+!e

inve%ti+ator /MS5 $(o $a% not !in'e' to t(e treatment receive' recor'e' t(e n&mer o.

!e%ion% )re%ent, On!* t(o%e $it( ne$ or )er%i%tent !e%ion% an' )r&rit&% $ere treate' $it( a %econ'co&r%e o. t(eir a%%i+ne' treatment an' t(e* $ere eva!&ate' a+ain 0 $ee4% !ater, Criteria .or c&re

$ere a%ence o. )r&rit&% an' a%ence o. ne$ !e%ion%,

S&*e4 'i follow-up %e!ama '&a min++& &nt&4 meni!ai 4e)at&(an 'an memeri4%a )a%ien,

Seoran+ )emeri4%a /MS5 memeri4%a !e%i *an+ a'a, an*a mere4a 'en+an !e%i ar& ata&

)er%i%ten 'an )r&rit&% 'ioati 'en+an )en+oatan 4e'&a 'an mere4a 'ieva!&a%i !a+i '&a min++&4em&'ian, #riteria &nt&4 )en*em&(an a'a!a( ti'a4 a'an*a )r&rit&% 'an ti'a4 a'an*a !e%i ar&,

Stati%tica! ana!*%i% $a% 'one &%in+ E)i In.o 0111 /CDC At!anta GA5, Di..erence% in

)ro)ortion% $ere com)are' $it( t(e 20 %tati%tic, Severit* %core% $ere com)are' &%in+ t(e Mann-(itne* te%t eca&%e t(e* $ere or'ina! an' $it(o&t a norma! 'i%tri&tion, M&!ti)!e !inear

re+re%%ion /ana!*%i% o. covariance5 $a% &%e' to a'9&%t .or a%e!ine %everit* in com)arin+

%&%e&ent %everit* %core% et$een treatment +ro&)%, Lo+i%tic re+re%%ion $a% &%e' to 'etermine

t(e a'9&%te' o''% o. treatment %&cce%% $(i!e contro!!in+ .or con.o&n'in+ .actor%, P va!&e% ? 1,16$ere con%i'ere' %i+ni.icant, In ca!c&!atin+ t(e %am)!e %ize $e a%%&me' c&re rate% o. <67 an'

;67 $it( ivermectin an' enz*! enzoate re%)ective!*, A %am)!e %ize o. => in eac( treatment+ro&) $o&!' )rovi'e <67 )o$er to 'etect t(i% 'i..erence $it( <67 con.i'ence, -e %o&+(t to

enro!! 811 in eac( treatment +ro&) to a!!o$ .or incom)!ete .o!!o$&),

Ana!i%i% %tati%ti4 'i!a4&4an 'en+an men++&na4an E)i In.o 0111 /CDC At!anta GA5, Pere'aan

'a!am )ro)or%i 'ian'in+4an %ecara c(i%&are, S4or 4e)ara(an 'ian'in+4an 'en+an

men++&na4an te% Mann-(itne* 4arena %4a!a or'ina! 'an tan)a 'i%tri&%i norma!, Re+re%i

!inier er+an'a /ana!i%i% 4ovarian%5 'i+&na4an &nt&4 men*e%&ai4an tin+4at 4e)ara(an 'a%ar'a!am meman'in+4an %4or 4e)ara(an eri4&tn*a antara 4e!om)o4, Re+re%i !o+i%ti4 'i+&na4an

&nt&4 menent&4an o''% 4eer(a%i!an )en+oatan %ementara men+en'a!i4an .a4tor cofounding ,

Ni!ai P ?116 'ian++a) %i+ni.i4an, Da!am men+(it&n+ &4&ran %am)e! 4ami men)re'i4%i tin+4at4e%em&(an <67 'an ;67 'en+an ivermectin 'an enz*! enzoat, Sam)e! %ean*a4 => )a'a

%etia) 4e!om)o4 a4an memeri4an <67 &nt&4 men'ete4%i )ere'aan ini 'en+an ni!ai

4e*a4inan %ean*a4 <67, #ami er&%a(a &nt&4 men'a)at4an %&*e4 %ean*a4 811 )a'a %etia)4e!om)o4 %&)a*a ti'a4 ter9a'i 4etin++a!an 'a!am follow up,

RES"LTS

A tota! o. 081 %&9ect% $ere recr&ite' /Ta!e 85, T(eir mean / SD5 a+e $a% 8:,0 /80,<5 *ear%/ran+e 6:6 *ear%5K <<

/@;,875 $ere ma!e an' 888 /60,<75 $ere .ema!e, O. t(e%e 81 $ere !o%t to .o!!o$&) a.ter t(e

initia! treatment /; receive' ivermectin an' > receive' to)ica! treatment5, T$o t(ir'% /::75 o.t(e %&9ect% $ere c(i!'ren 68@ *ear% o. a+e

ASILSean*a4 081 %&*e4 'i9a'i4an %am)e! /Tae! 85, Mean &%ia mere4a 8:0 /80< SD5 /4i%aran

6:6 ta(&n5K <</@;875 a'a!a( !a4i!a4i 'an 888 /60<75 a'a!a( )erem)&an, Dari 9&m!a(

ter%e&t 81 (i!an+ &nt&4 'i follow up %ete!a( )en+oatan a$a! /; menerima ivermectin 'an >

menerima )en+oatan to)i4a!5, D&a )erti+a /::75 'ari %&9e4 a'a!a( ana4 68@ ta(&n,



O. t(e 011 %&9ect% $(o com)!ete' t(e %t&'* <= receive' ivermectin an' 810 receive' to)ica!treatment,

O. t(e <= %&9ect% $(o receive' ivermectin 6> /6@,875 (a' mo'erate !e%ion% @0 /@0,=75 (a'%evere !e%ion% an' > />,875

(a' cr&%te' !e%ion%, O. t(e 810 %&9ect% $(o receive' to)ica! treatment ;6 %&9ect% /;>,675 (a'

mo'erate !e%ion% 0;/0:,675 (a' %evere !e%ion% an' none (a' cr&%te' !e%ion%, None o. t(e %&9ect% in eit(er +ro&)

(a' mi!' !e%ion% at )re%entation,

Prior to treatment t(e %everit* %core o. t(e ivermectin +ro&) /0,6 1,:K me'ian 0,15 $a%

%i+ni.icant!* +reater t(an t(at o. t(e to)ica! treatment +ro&) /0,> 1,@K me'ian 0,1K P 1,11@5,

Dari 011 %&*e4 *an+ men*e!e%ai4an %t&'i <= menerima ivermectin 'an 810 menerima

)en+oatan to)i4a!, Dari <= %&*e4 *an+ menerima ivermectin 6> /6@875 memi!i4i !e%i

mo'erat @0 /@0=75 memi!i4i !e%i erat 'an > />875 memi!i4i !e%i 4r&%ta, Dari 810 %&*e4*an+ menerima to)i4a! )en+oatan ;6 %&*e4 /;>675 memi!i4i !e%i mo'erat 0;

/0:675 memi!i4i !e%i *an+ )ara( 'an ti'a4 a'a *an+ !e%i 4r&%ta, Ta4 %at& )&n 'ari %&*e4 )a'a4e'&a 4e!om)o4 memi!i4i !e%i rin+an )a'a )re%enta%i, See!&m )en+oatan %4or 4e)ara(an )a'a

4e!om)o4 *an+ men++&na4an ivermectin /06 1: me'ian 0,15 %ecara %i+ni.i4an !ei( e%ar

'ian'in+4an 'en+an 4e!om)o4 *an+ men++&na4an oat %ecara to)i4a! /0> 1@K me'ian 01KP111@5,

%&9ect% /0875 in t(e ivermectin +ro&) an' in @0 %&9ect% /@875 in t(e to)ica! treatment +ro&)

/ P 2 1,11>5, In t(e ivermectin +ro&) 86 /8675 (a' mi!' !e%ion% : /:75 (a' mo'erate !e%ion%an' none (a' %evere or cr&%te' !e%ion%, In t(e to)ica! treatment +ro&) 0: /0675 (a' mi!'

!e%ion% 8: /8:75 (a' mo'erate !e%ion% an' none (a' %evere or cr&%te' !e%ion% /Fi+&re 85, T(e

im)rovement /re'&ction5 in %everit* %core $a% %i+ni.icant!* +reater in t(e ivermectin +ro&) /0,01,:K me'ian 0,15 t(an in t(e to)ica! treatment +ro&) /8,; 1,=K me'ian 0,1K P ? 1,118

a'9&%tin+ .or a%e!ine %everit*5, O. t(o%e $it( )er%i%tent !e%ion% 6 %&9ect% /0@75 in t(e

ivermectin +ro&) (a' )o%itive micro%co)* com)are' $it( 8< /@675 in t(e to)ica! treatment+ro&) / P 2 1,815, A!! %&9ect% $it( )er%i%tent !e%ion% receive' a %econ' co&r%e o. t(eir a%%i+ne'

treatment, T$o $ee4% a.ter t(e %econ' treatment 6 o. 08 /0@75 in t(e ivermectin +ro&) (a'

!e%ion% /a!! mi!'5 com)are' $it( 8@ o. @0 />>75 in t(e to)ica! treatment +ro&) /88 (a' mi!'

!e%ion% an' > (a' mo'erate !e%ion%5 &t t(i% 'i..erence $a% not %i+ni.icant / P 2 1,@@5 an' t(emean re'&ction in %everit* %core $a% t(e %ame in ot( +ro&)% /8,15, O. t(e > %&9ect% $it(

cr&%te' !e%ion% 0 $ere com)!ete!* c&re' a.ter 0 'o%e% o. ivermectin,

S&*e4 / 08 7 5 )a'a 4e!om)o4 ivermectin 'an @0 %&*e4 / @8 7 5 )a'a 4e!om)o4 )en+oatan

to)i4a! / P 111> 5 , Da!am 4e!om)o4 )emerian ivermectin 86 / 86 7 5 memi!i4i !e%i rin+an

: / : 7 5 memi!i4i !e%i mo'erat 'an ti'a4 memi!i4i !e%i )ara( ata& er4&!it , Pa'a 4e!om)o4 )en+oatan to)i4a! 0: / 06 7 5 memi!i4i !e%i rin+an 8: / 8: 7 5 memi!i4i !e%i mo'erat 'an

ti'a4 a'a *an+ )ara( ata& er4&!it !e%i / Gamar 8 5 , Penin+4atan / )en&r&nan 5 'a!am %4or

4e)ara(an %ecara %i+ni.i4an !ei( e%ar )a'a 4e!om)o4 ivermectin / 0,0 1: me'ian 0,1 5

'ari)a'a 4e!om)o4 )en+oatan to)i4a! / 8,; 1,= me'ian 0,1 P ? 1,118 'i%e%&ai4an &nt&4



tin+4at 4e)ara(an a%e!ine5 , Dari mere4a 'en+an !e%i )er%i%ten 6 / 0@ 7 5 )a'a 4e!om)o4

ivermectin 'ian'in+4an 'en+an 8< / @6 7 5 )a'a 4e!om)o4 'en+an )en+oatan to)i4a!

/ P 181 5 , Sem&a %&*e4 'en+an !e%i )er%i%ten menerima )en+oatan 4e'&a *an+ , D&amin++& %ete!a( )era$atan 4e'&a 6 'ari 08 / 0@ 7 5 )a'a 4e!om)o4 ivermectin memi!i4i !e%i

/%em&a rin+an5 'ian'in+4an 'en+an 8@ 'ari @0 / >> 7 5 )a'a 4e!om)o4 )en+oatan to)i4a! / 88

memi!i4i !e%i rin+an 'an > memi!i4i !e%i mo'erate 5 nam&n )ere'aan ini ti'a4 %i+ni.i4an/P 1,@@5 'an )en&r&nan erarti 'a!am %4or 4e)ara(an a'a!a( %ama )a'a 4e'&a 4e!om)o4

/)8,1 5 , Dari > %&*e4 'en+an !e%i 4r&%ta '&a enarenar %em&( %ete!a( 0 'o%i% ivermectin ,

T(e overa!! c&re rate a.ter @ $ee4% $a% <67 in t(e ivermectin +ro&) an' =:7 in t(e to)ica!

treatment +ro&) / P 2

1,1@5, A %trati.ie' ana!*%i% 'i' not %&++e%t an* 'i..erence in re%)on%e et$een c(i!'ren an'

a'&!t% / P 2 1,::5, T(e re%&!t%$ere a!%o ana!*ze' on an intention to treat a%i% $it( t(e 81 'ro)o&t% inc!&'e' a% treatment

.ai!&re%, B* t(i% ana!*%i% =<7 o. t(e ivermectin +ro&) an' =@7 o. t(e to)ica! treatment +ro&)

ac(ieve' c&re &t t(i% 'i..erence $a% not %i+ni.icant / P 2 1,>05,

An+4a 4e%em&(an 4e%e!&r&(an %ete!a( @ min++& a'a!a( <67 )a'a 4e!om)o4 ivermectin 'an

=:7 )a'a 4e!om)o4 )en+oatan to)i4a! /P 11@5, Se&a( ana!i%i% *an+ 'i4e!om)o44an ti'a4men*aran4an a'an*a )ere'aan re%)on% antara ana4ana4 'an oran+ 'e$a%a /P 1::5, a%i!

9&+a 'iana!i%i% )a'a )en+oatan 'a%ar 'en+an 81 drop-out 'ima%&44an %ea+ai 4e+a+a!an

)en+oatan, Den+an ana!i%i% ini =<7 'ari 4e!om)o4 ivermectin 'an =@7 'ari 4e!om)o4 )en+oatan to)i4a! menca)ai )en*em&(an teta)i )ere'aan ini ti'a4 %i+ni.i4an /P 1>05,

In a !o+i%tic re+re%%ion ana!*%i% $it( c&re rate a.ter @ $ee4% a% t(e 'e)en'ent varia!e an'

treatment +ro&) a+e %eH )o%itivemicro%co)* an' initia! %everit* a% in'e)en'ent varia!e% on!* treatment +ro&) / P 2 1,11;5 an'

initia! %everit* / P 2

1,11>5 $ere %i+ni.icant )re'ictor% o. c&re, Com)are' $it( to)ica! treatment ivermectin $a%%i+ni.icant!* more !i4e!* to

re%&!t in c&re /a'9&%te' o''% ratio 6,0K <67 CIJ 8,: to 8;5,

Da!am ana!i%i% re+re%i !o+i%ti4 'en+an an+4a 4e%em&(an %ete!a( @ min++& %ea+ai variae!

'e)en'en 'an 4e!om)o4 &m&r 9eni% 4e!amin )o%iti. mi4ro%4o) 'an tin+4at 4e)ara(an a$a!

%ea+ai variae! in'e)en'en(an*a 4e!om)o4 )en+oatan /P 111;5 'an tin+4at 4e)ara(an

a$a! /P 111>5 a'a!a( )re'i4tor %i+ni.i4an )en*em&(an, 'ian'in+4an 'en+an )en+oatanto)i4a! ivermectin %ecara %i+ni.i4an !ei( m&n+4in &nt&4 men+(a%i!4an oat /ra%io o''% *an+

'i%e%&ai4an 60 <67 CIJ 8:8;5

DISC"SSION



-e .o&n' t(at ivermectin (a% %imi!ar or etter e..icac* com)are' $it( t(e common!* &%e'

to)ica! treatment o. 067 enz*! enzoate !otion an' mono%&!.iram %oa), T(e%e re%&!t% are

%imi!ar to t(o%e o. ot(er $or4er%, A %in+!e 'o%e o. ivermectin re%&!te' in re%o!&tion o. )r&rit&%a.ter @ $ee4% in <>7 o. )atient% in %o&t(ern Ni+eria com)are' $it( @=7 $(o receive'

enz*! enzoate,0@ A !o$er 'o%e o. ivermectin /811 2+34+5 ac(ieve' a ;17 re%)on%e rate in

Frenc( Po!*ne%ia com)are' $it( a @=7 re%)on%e rate in t(o%e treate' $it( 817 enz*! enzoate &t t(e%e 'i..erence% $ere not %i+ni.icant,06 In contra%t com)!ete re%o!&tion o. %4in !e%ion% $a%

o%erve' in on!* 6:7 o. )atient% $it( %caie% $(o receive' a %in+!e 'o%e o. ivermectin

com)are' $it( 687 o. t(o%e $(o $ere treate' $it( 817 enz*! enzoate in Van&at&,0: T(ea&t(or% attri&te' t(e re!ative!* !o$ re%)on%e rate to t(e )o%%i!e )er%i%tence o. )a)&!e% an'

no'&!e% $it(o&t %caie% mite% at t(e .ina! a%%e%%ment > $ee4% )o%ttreatment, In a %t&'* o.

IVa%%ociate' %caie% :>7 o. )atient% re%)on'e' to a %in+!e 'o%e o. ivermectin )rimari!* t(o%e

c!a%%i.ie' $it( mi!' or mo'erate %everit* com)are' $it( @;7 o. )atient% $(o receive' enz*! enzoate,08 T(e comination o. ivermectin $it( enz*! enzoate $a% e..ective in a!! 8;

ca%e% in $(ic( it $a% &%e' inc!&'in+ in %evere an' cr&%te' .orm%,

PEMBAASAN

#ami menem&4an a($a ivermectin memi!i4i 4(a%iat *an+ %ama ata& !ei( ai4 'ian'in+4an'en+an )en+oatan to)i4a! *an+ &m&m 'i+&na4an *ait& !otion enzi! enzoat 067 'an %a&n

mono%&!.iram , Do%i% t&n++a!)emerian ivermectin men+(a%i!4an re%o!&%i )r&rit&% %ete!a( @

min++& )a'a <>7 )a%ien 'i Ni+eria %e!atan 'ian'in+4an 'en+an @= 7 *an+ menerima enz*! enzoate,0@ Do%i% ren'a( ivermectin / 811 + 3 4+ 5 menca)ai tin+4at tan++a)an ;1 7 'i

Po!ine%ia Pranci% 'ian'in+4an 'en+an tin+4at re%)on @= 7 )a'a mere4a *an+ 'ira$at 'en+an

!otion enzi! enzoat 817 nam&n )ere'aan ter%e&t ti'a4 %i+ni.icant,06 Sea!i4n*a re%o!&%i

!en+4a) !e%i 4&!it 'iamati (an*a 6: 7 )a%ien 'en+an %4aie% *an+ menerima %at& 'o%i%ivermectin 'ian'in+4an 'en+an 68 7 'ari mere4a *an+ 'ioati 'en+an 81 7 enzi! enzoat

'a!am Van&at& ,0: Da!am %e&a( %t&'i IV %4aie% :> 7 'ari )a%ien menan++a)i 'o%i% t&n++a!

'ari ivermectin ter&tama *an+ 'i4!a%i.i4a%i4an 'en+an rin+an ata& %e'an+ 4e)ara(an 'ian'in+4an 'en+an @; 7 'ari )a%ien *an+ menerima enzi! enzoate,08 #omina%i ivermectin

'en+an enz*! enzoat e.e4ti. 'a!am %em&a 8; 4a%&% 'i mana it& 'i+&na4an terma%&4 'a!am

ent&4 )ara( 'an er4&!it ,



O&r %t&'* (a' a !ar+er n&mer o. )atient% t(an ot(er %t&'ie% com)arin+ ivermectin $it( enz*!

enzoate an' t(&% (a' +reater )o$er to 'etect a 'i..erence et$een t(e%e t$o treatment%,

o$ever $(en 'ro)o&t% $ere inc!&'e' in t(e ana!*%i% a% treatment .ai!&re% t(e 'i..erence et$een t(e t$o treatment +ro&)% $a% not %tati%tica!!* %i+ni.icant, Beca&%e t(e n&mer o.

'ro)o&t% in t(e ivermectin +ro&) $a% +reater t(an in t(e to)ica! treatment +ro&) com)ari%on o.

t(e t$o +ro&)% * an intention to treat ana!*%i% 'emon%trate' no %i+ni.icant 'i..erence intreatment re%)on%e, o$ever it i% &n!i4e!* t(at a!! o. t(e 'ro)o&t% re)re%ente' treatment .ai!&re%

eca&%e t(o%e $(o re%)on' to treatment no !on+er (ave incentive to ret&rn .or .o!!o$&),0: In

a''ition 'e%)ite t(e +reater %everit* o. !e%ion% at )re%entation in t(e ivermectin +ro&) t(an int(e to)ica! treatment +ro&) t(e ivermectin +ro&) (a' a etter re%)on%e to treatment in t(o%e $(o

com)!ete' t(e %t&'*,

Pene!itian 4ami memi!i4i %e9&m!a( e%ar )a%ien 'ian'in+4an )ene!itian !ain *an+meman'in+4an ivermectin 'en+an enzi! enzoat 'an 'en+an 'emi4ian memi!i4i 4e4&atan

*an+ !ei( e%ar &nt&4 men'ete4%i )ere'aan antara '&a 4e!om)o4 )en+oatan, Nam&n 4eti4a

drop out 'ima%&44an 'a!am ana!i%i% %ea+ai 4e+a+a!an )en+oatan )ere'aan antara '&a

4e!om)o4 %ecara %tati%ti4 ti'a4 %i+ni.i4an, #arena an+4a drop out )a'a 4e!om)o4 ivermectin!ei( e%ar 'ari )a'a 4e!om)o4 )en+oatan to)i4a! )eran'in+an 'ari '&a 4e!om)o4 &nt&4

men+oati ana!i%i% men&n9&44an ti'a4 a'a *an+ %i+ni.i4an )ere'aan 'a!am re%)on )en+oatan, Nam&n ti'a4 m&n+4in a($a %em&a drop out 'i$a4i!i 4e+a+a!an )en+oatan

4arena oran+oran+ *an+ mere%)on )en+oatan ti'a4 !a+i memi!i4i in%enti. &nt&4 4ema!i &nt&4

follow up ,0: Se!ain it& me%4i)&n !ei( e%ar 4e)ara(an !e%i )a'a )re%enta%i )a'a 4e!om)o4ivermectin 'ian'in+4an 4e!om)o4 )en+oatan to)i4a! 4e!om)o4 ivermectin memi!i4i re%)on

*an+ !ei( ai4 ter(a'a) )en+oatan )a'a mere4a *an+ men*e!e%ai4an %t&'i,

At !ea%t t$o !imitation% o. o&r %t&'* co&!' intro'&ce )otentia! ia%, T(e .ir%t i% t(at )atient% $erea!ternate!* a%%i+ne' rat(er t(an ran'om!* a%%i+ne' to treatment +ro&)%, Con%e&ent!* $e 'i'

not maintain a!!ocation concea!ment, o$ever ever* e!i+i!e %&9ect $a% enro!!e' an' t(e or'er

o. a%%i+ne' treatment $a% not a!tere' t(&% minimizin+ )otentia! %e!ection ia%, A %econ'!imitation i% t(at t(e inve%ti+ator $(o eva!&ate' t(e re%)on%e to treatment $a% not !in'e' to t(e

treatment +ro&) a%%i+nment, o$ever $e con%i'er t(e criteria .or eva!&atin+ t(e re%)on%e to

treatment /no, o. !e%ion%)atient% re)ort o. )r&rit&%5 %&..icient!* o9ective to )revent a ma9or'e+ree o. ia%,

Seti'a4n*a '&a 4eterata%an )a'a )ene!itian 4ami a'a!a( 4arena ia%, Yan+ )ertama a'a!a(

a($a )a%ien 'i)i!i( &4an %ecara aca4 &nt&4 4e!om)o4 )en+oatan, Setia) %&9e4 *an+memen&(i %*arat te!a( ter'a.tar 'an &r&tan )en+oatan *an+ 'ieri4an ti'a4 er&a( %e(in++a

meminima!4an )oten%i ia% %e!e4%i, #eterata%an 4e'&a a'a!a( a($a )en*i'i4 *an+

men+eva!&a%i re%)on ter(a'a) )en+oatan men+eta(&i )en+oatan &n&t4 t&+a% 4e!om)o4, Nam&n 4ami mem)ertiman+4an 4riteria &nt&4 men+eva!&a%i re%)on ter(a'a) )en+oatan

/nomor !e%i La)oran )a%ien )r&rit&%5 c&4&) o*e4ti. &nt&4 mence+a( ia%,



Ivermectin (a% %evera! c!inica! a'vanta+e% t(at ma4e it %&)erior to to)ica! treatment in

'eve!o)in+ co&ntrie%, It i% %a.e ineH)en%ive %im)!e to a'mini%ter ea%i!* %&)ervi%e' an' treat%

t(e entire %4in %&r.ace $it(o&t ne+!ecte' area%,0; Ivermectin i% etter to!erate' t(an to)ica!treatment in t(o%e $it( eHcoriation% or o)en &!ceration%,0: T(e 'r&+ (a% %&cce%%.&!!*

een &%e' .or ma%% treatment an' in e)i'emic%,0680 It a!%o (a% t(e a''itiona! ene.it o.

re'&cin+ t(e )reva!ence o. ot(er (&man )ara%itic in.ection% common in t(e tro)ic% inc!&'in+onc(ocercia%i% Ascaris in.ection !*m)(atic .i!aria%i% )e'ic&!o%i% c&taneo&% !arva mi+ran% an'

%tron+*!oi'ia%i%,8;0>0; A!t(o&+( ivermectin re'&ce% Loa loa micro.i!aremia !i.et(reatenin+

ence)(a!o)at(* can occ&r in (eav* in.ection% $(ic( $arrant% ca&tion in en'emic area%,0> L. loain.ection i% in.re&ent in nort(ern Ni+eria $(ere t(i% %t&'* $a% )er.orme', Ivermectin i% a!%o

%&)erior to to)ica! a+ent% in treatin+ imm&nocom)romi%e' )er%on% $it( %caie%080; $(ic(

m&%t e con%i'ere' in A.rican %ettin+% $it( a (i+( )reva!ence o. IV in.ection /67 )reva!ence

in Ni+eria in 011>5, Even $(en e&iva!ent e..icac* $it( enz*! enzoate i% a%%&me' t(e%ea''itiona! a'vanta+e% o. ivermectin ma4e it a %&)erior c(oice in 'eve!o)in+ co&ntrie% !i4e

Ni+eria $(ere con'ition% .avor ra)i' %)rea' t(at can &ic4!* reac( e)i'emic )ro)ortion%, Lon+

term eva!&ation o. t(e ri%4 o. rein.e%tation an' rate% o. 'i%ea%e in c!o%e contact% $arrant% .&rt(er

%t&'*,

Ivermectin memi!i4i eera)a 4e&nt&n+an 4!ini% *an+ mem&atn*a &n++&! &nt&4 )en+oatanto)i4a! 'i ne+ara er4eman+ , Ini a'a!a( 4arena aman m&ra( %e'er(ana &nt&4 men+e!o!a

m&'a( 'ia$a%i 'an mera$at %e!&r&( )erm&4aan 4&!it,0; Ivermectin 'ito!eran%i !ei( ai4

'ari)a'a )en+oatan to)i4a! )a'a mere4a 'en+an e4%o4ria%i ata& &!%era%i ter&4a,0: Oat er(a%i! te!a( 'i+&na4an &nt&4 )en+oatan ma%%a! 'an )a'a e)i'emi%,0 680 a! ini 9&+a memi!i4i

man.aat tama(an 'en+an men+&ran+i )reva!en%i in.e4%i )ara%it man&%ia !ainn*a *an+ &m&m 'i

'aera( tro)i% terma%&4 onc(ocercia%i% in.e4%i A%cari% .i!aria%i% !im.ati4 )e'ic&!o%i% !arva

mi+ran% c&taneo&% 'an %tron+*!oi'ia%i%,8; 0>0; Me%4i)&n ivermectin men+&ran+i Loa !oamicro.i!aremia , lifethreatening en%e.a!o)ati 'a)at ter9a'i )a'a in.e4%i erat,0> in.e4%i L, !oa

a'a!a( 9aran+ 'i a+ian &tara Ni+eria 'i mana %t&'i ini 'i!a4&4an , Ivermectin 9&+a &n++&!

&nt&4 oat to)i4a! 'a!am men+oati oran+ imm&nocom)romi%e' 'en+an %4aie%, 080; *an+(ar&% 'i)er(ati4an 'a!am )en+at&ran A.ri4a 'en+an )reva!en%i tin++i in.e4%i IV / )reva!en%i

67 'i Ni+eria )a'a ta(&n 011> 5 , Ba(4an 4eti4a e.e4tivita%n*a %etara 'en+an enzi! enzoat

4e&nt&n+an tama(an ivermectin mem&atn*a &n++&! )i!i(an 'i ne+ara er4eman+ %e)erti Ni+eria 'i mana 4on'i%i )en*earan ce)at *an+ 'a)at menca)ai )ro)or%i e)i'emi , Eva!&a%i

9an+4a )an9an+ ri%i4o re in.e%ta%i 'an tin+4at )en*a4it 'i 'e4at 4onta4 %t&'i !ei( !an9&t ,

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