What question did this study set out to answer?

This study evaluates the safety and efficacy of ivermectin in comparison to permethrin for treating scabies.

June 21, 2026Open Access

Is Ivermectin Associated With Better Treatment Success and Tolerability Than Topical Permethrin in Scabies Patients? A Systematic Review and Meta‐Analysis

ABAsia BatoolSir Syed University of Engineering and Technology MAMuhammad Sharjeel AbbasYale New Haven Hospital MAMakhzan Ali AkbarNorth Sichuan Medical University

Key Points

This study evaluates the safety and efficacy of ivermectin in comparison to permethrin for treating scabies.
Conducted a systematic search across four databases (PubMed, Google Scholar, Scopus, Embase) until November 2025.
Utilized a random-effects model to calculate risk ratios and mean differences for data analysis.
Employed influence diagnostics to ensure data stability and outcome reliability.
Permethrin showed a significant cure advantage over ivermectin at Week 1 (RR 1.40; 95% CI 1.22–1.62; p < 0.0001).
At Week 2, permethrin demonstrated marginal superiority (RR 1.11; 95% CI 1.01–1.22), but this finding was fragile and dependent on outliers.
By Weeks 3, 4, and beyond, no significant differences in efficacy were observed between treatments (RR 1.02 at ≥ 6 weeks).

Abstract

Background Scabies is an infectious parasitic integumentary pathology affecting both pediatric and adult participants globally, specifically in resource‐limited settings. Topical permethrin is commonly advised as the preferred regimen, whereas oral and topical ivermectin have emerged as alternative regimens. Objective This study aims to assess the safety and efficacy of oral or topical ivermectin compared to topical permethrin alone for the treatment of scabies in both pediatric and adult patients. Methods A systematic search of four databases (PubMed, Google Scholar, Scopus, and Embase) was conducted from inception to November 2025. Data were analyzed using a random‐effects model (REML estimator) to calculate risk ratios (RRs) and mean differences. To prevent unit‐of‐analysis errors, overarching estimates utilized deduplicated data. Advanced influence diagnostics (leave‐one‐out sensitivity, Baujat plots, and GOSH plots) were employed to rigorously evaluate data stability and outcome fragility. Results In this meta‐analysis, 38 studies met the inclusion criteria, encompassing 5604 participants. Permethrin demonstrated a robust and highly significant early clinical cure advantage over ivermectin at Week 1 (RR 1.40; 95% CI 1.22–1.62; p < 0.0001; I 2 = 81.1%). While permethrin maintained a marginal statistical superiority at Week 2 (RR 1.11; 95% CI 1.01–1.22), extensive sensitivity analyses revealed this finding to be highly fragile and dependent on outliers. By Weeks 3, 4, and ≥ 6 , comparative efficacy converged, demonstrating no significant difference between the two treatments (RR 1.02 at ≥ 6 weeks; I 2 = 0%). Continuous meta‐regression indicated no significant temporal shift in comparative efficacy over the last 25 years. Conclusion Low‐to‐moderate certainty evidence suggests that permethrin exhibits superior acute efficacy and faster initial clearance during the first week of treatment compared to ivermectin. However, long‐term efficacy is equivalent. Ivermectin remains a highly viable and equally effective alternative for the definitive management of scabies, particularly when topical application is infeasible or poorly tolerated.

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