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Question 1: Is it safe to use ivermectin in children less than five years of age and weighing less than 15 kg?
  1. Amanda L Wilkins1,
  2. Andrew C Steer1,2,3,
  3. Noel Cranswick1,2,3,
  4. Amanda Gwee1,2,3
  1. 1 Department of General Medicine, The Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia
  2. 2 Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
  3. 3 Murdoch Children’s Research Institute, Parkville, Victoria, Australia
  1. Correspondence to Dr Amanda Gwee, Department of General Medicine, The Royal Children’s Hospital Melbourne, Parkville, VIC 3052, Australia; amanda.gwee{at}rch.org.au

https://doi.org/10.1136/archdischild-2017-314505

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    Scenario

    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 child.

    Structured clinical question

    In a child less than 5 years of age and less than 15 kg (patient), is oral ivermectin (intervention) a safe treatment option (outcome)?

    Search strategy and outcome

    In May 2017, the Ovid interface was used to search English-language articles in MEDLINE (1946 to current) and EMBASE (1974 to present). The following search terms were used: ivermectin AND off-label use OR ivermectin* AND newborn* or neonat* or infan* or pre-school* or preschool* or child* or pediatric* or paediatric*. The search identified a total of 610 articles which were reviewed by a single author (AW). Of these, 30 studies were identified which described the use of ivermectin in children less than 5 years old and, where weight was specified, less than 15 kg.1–30 One study had sufficient demographic and safety data in the original manuscript to fulfil the inclusion criteria.1 For the remaining 29 articles, we attempted to contact the corresponding authors to request further demographic and safety data to confirm inclusion criteria and received 13 responses. In total, nine studies were included in this review (table 1). No additional studies were identified following the review of the references from all articles.

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    Table 1

    Summary of evidence

    Commentary

    Ivermectin has been successfully used as part of large mass drug administration programmes for treatment of onchocerciasis31 32 and lymphatic filariasis.33 It is registered for use …

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    Footnotes

    • Contributors AW conducted the search, prepared the table and drafted the initial manuscript. AG was involved in interpreting the results and edited through multiple revisions. All authors gave final approval for submission of the manuscript from in its current form.

    • Funding None declared.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.