Permethrin (Elimite) Indications and Dosage
- pediculosis
- pediculosis prophylaxis
- Pediculus capitis
- Sarcoptes scabiei
- scabies
Permethrin (Elimite) Indications and Dosage
For the treatment of infestation with Sarcoptes scabiei (scabies):
Topical dosage (Elimite® Topical Cream):
Adults, children, and infants >= 2 months: Thoroughly massage 5% topical cream into the skin from the head to the soles of the feet. Scabies rarely infests the scalp of adults, although the hairline, neck, temple, and forehead may be infested in infants and geriatric patients. Usually 30 g is sufficient for the average adult. The cream should be removed by washing after 8 - 14 hours. One application is generally curative. Although pruritus may persist after treatment, this is rarely a sign of treatment failure and is not an indication for retreatment. Retreatment is indicated if living mites persist after 14 days of initial treatment.
For the treatment of pediculosis:
NOTE: For proper treatment of pediculosis, nits (eggs) should be removed with a nit comb. Also, all personal headgear, scarfs, coats, and bed linen should be disinfected by machine washing in hot water and drying using the hot cycle of a dryer for at least 20 minutes. Personal articles that cannot be washed may be dry-cleaned, sealed in a plastic bag for about 2 weeks, or sprayed with a product specifically designed for this purpose. Personal combs and brushes may be disinfected by soaking in hot water (above 130 degrees F) for 5 - 10 minutes.
- for the treatment of pediculosis capitis (head lice infestation) due to Pediculus capitis:
Topical dosage:
Adults, children, and infants >= 2 months: Shampoo hair with regular shampoo, rinse and towel dry. Then, apply
permethrin 1% lotion sufficient to saturate the hair and scalp (usually 25 - 30 ml), especially behind the ears and on the nape of the neck. Leave on hair for 10 minutes but no longer. Then, rinse thoroughly with water. Retreatment is required in less than 1 - 2% of patients. If live lice are seen 7 days or more after the first application, a second treatment should be given. In cases of multiple treatment failures or resistance, combination therapy may be an effective alternative. In one study, 115 children aged 2 - 13 years randomly received one of 3 treatment regimens: topical 1%
permethrin, SMX-TMP [5 mg/kg/dose (based on the trimethoprim component) PO twice daily for 10 days], or the combination of topical 1%
permethrin and oral SMX-TMP. At 2-week follow-up, the success rates were 79.5%, 83%, and 95%, respectively. At 4-weeks, the success rates were 72%, 78%, and 92.5%, respectively. Oral SMX-TMP either alone or combined with topical 1%
permethrin was an effective alternative for head lice infestation; however, this therapy should be reserved for cases of resistant lice or multiple treatment failures.
- for the treatment of pediculosis pubis † :
Topical dosage:
Adults and adolescents: The CDC recommends applying
permethrin 1% creme rinse topically to affected areas and washed off after 10 minutes. In one study, 53 men were treated with either
permethrin 1% lotion for 10 minutes or lindane 1% shampoo for 4 minutes. All patients combed with fine-toothed combs immediately after therapy. Ten days after treatment, 43% of patients treated with
permethrin and 40% of patients treated with lindane were still infested. Due to the relatively high failure rate, these investigators recommended that a second treatment be given 10 days after the initial application.
For pediculosis prophylaxis:
NOTE: Prophylaxis is only recommended for individuals exposed to head lice epidemics in which at least 20% of the population at an institution are infested and for immediate household members of the infested individuals.
Topical dosage:
Adults, children, and infants >= 2 months: Shampoo hair with regular shampoo, rinse and towel dry. Then, apply topical permethrin 1% lotion sufficient to saturate the hair and scalp (usually 25 - 30 ml), especially behind the ears and on the nape of the neck. Leave on hair for 10 minutes but no longer. Then, rinse thoroughly with water. One application has been shown to protect > 95% of patients against reinfestation for at least 2 weeks. In epidemic settings, a second prophylactic application is recommended two weeks after the first since the life cycle of a head louse is approximately 4 weeks.
Patients with hepatic impairment:
Specific guidelines for dosage adjustments in hepatic impairment are not available.
Patients with renal impairment:
Specific guidelines for dosage adjustments in renal impairment are not available.
[ Last revised: 6/19/2003 1:11:00 PM ]
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