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Arthropod and parasitic antibiotics
From WikEM
Contents
Antibiotics by diagnosis
- Bone and joint antibiotics
- Cardiovascular antibiotics
- ENT antibiotics
- Eye antibiotics
- GI antibiotics
- GU antibiotics
- Neuro antibiotics
- OB/GYN antibiotics
- Pulmonary antibiotics
- Skin and soft tissue antibiotics
- Bioterrorism antibiotics
- Environmental exposure antibiotics
- Immunocompromised antibiotics
- Post exposure prophylaxis antibiotics
- Pediatric antibiotics
- Sepsis antibiotics
- Arthropod and parasitic antibiotics
For antibiotics by organism see Microbiology (Main)
Lice
Over the Counter (OTC)
- Permethrin 1% lotion shampoo (if >2 months old)[1]
- Wash hair with non-conditioned shampoo
- Apply Permethrin for 10 min and rinse
- Repeat on day 9
- Pyrethrin lotion
- Apply to affected areas and wash off after 10 min
- Repeat in 7 days
Prescription
Reserved for failed OTC treatment
- Spinosad 0.9% topical suspension (if >6 months old)
- Apply to scalp and air and wash off after 10 min.
- Repeat in 10 days
- Malathion 0.5% lotion (if >6 years old)
- Applied to affected areas and wash after 8 hrs
- Repeat in 7 days
- Benzyl Alcohol 5% lotion (> 6 months old)
- Apply to dry hair and wash off after 10 min
- Repeat in 7 days
- Ivermectin 400mcg/kg PO
- Once on day 1 THEN once in 7 days
- Reserved for patients failing topical treatment
- Lindane therapy
- Only consider if patient has failed two prior prescription treatments
- Avoid in children <50 kg due to seizure association
Eyelash Infestation
- Apply ophthalmic petroleum jelly q12hrs x 10 days
Pediatrics <2yo
- Wet combing is an alternative to medical therapy
Pinworm
Treatment targeted against Enterobius vermicularis
- Mebendazole 100mg PO once THEN repeat in 2 weeks OR
- Albendazole 400mg PO once (100mig if < 2yo) THEN repeat in 2 weeks OR
- Pyrantel Pamoate (Pin-x) 11mg/kg (max 1g) THEN repeat in 2 weeks
- Recommended for pregnant patients
Scabies
General Care
- Wash all linens/clothes in hot water or bag bulky items and keep sealed for 2wks
- Pruritus may continue for weeks despite successful elimination of infestation
- Consider steroids for symptom relief
Adults
- Permethrin 5% cream for all family members[2]
- Apply from neck down
- Leave on for 8-12hr before washing off
- Has 95-98% success rate, may reapply in 1-2wks if incomplete effect
- Ivermectin 200 mcg/kg may be necessary for severe infection
- Also viable option in adolescent or adult with insecure social situation
- Success rate 70%, increases if give repeat dose 2wks after
- Contraindicated in lactating women and children < 15kg
Infants
- Permethrin 5% is FDA approved for > 2 months of age although still recommended for neonatal scabies[3]
- May require application head to toe (avoid mucus membranes)
- Leave on for 8-12 hours, then wash off
Avoid
- Lindane - effective treatment but associated with potential for toxic manifestations (seizures, neurotoxicity)
- Reserved for refractory cases
References
- ↑ Devore CD and Schutze G. Head Lice. Pediatrics. 2015; 135(5) e1355-e1365.
- ↑ Strong M. Johnstone P. Interventions for treating scabies. Cochrane Database Syst Rev. 2007;(3):CD000320
- ↑ Subramaniam S. Rutman MS. Wnger JK. A papulopustular, vesicular, crusted rash in a 4-week old neonate. Pediatric Emergency Care. 2013;29:1210-1212
