Monitoring
After initial treatment, patients should be re-examined every 2 weeks for 1 month. Suspect treatment failure in the presence of new papules or vesicles or burrows after treatment completion, or persistence of pruritus at least 6 weeks after the first course of treatment with scabicides. Treatment failure may be due to non-treatment of close contacts and family members simultaneously during the patient's therapy, lapses in decontaminating the patient's environment (eg beddings, clothes, towels), and non-adherence to treatment. Repeat drug therapy if there is treatment failure a month after treatment initiation or 4-6 weeks after the last treatment application and alternative agents should be considered. Two concurrent anti-scabies medications applied to the entire body may be considered. Oral Ivermectin with topical agents is also an option. Consider halting treatment in the absence of symptoms after treatment.
Symptoms of reinfestation after successful treatment occur around 1-4 days. Consider Ivermectin-resistant Sarcoptes mites in patients with crusted scabies. Moxidectin may be used for patients with Ivermectin-resistant disease. Monitor for complications such as persistent itching, insomnia, secondary bacterial infections, and community outbreaks. Refer patients to a specialist in the presence of treatment failure or complications and patients with crusted scabies.