COMPARISON OF IVERMECTIN AND BENZYL BENZOATE LOTION FOR SCABIES IN NIGERIAN PATIENTS PERBANDINGAN LOTION Benzoat ivermectin DAN

enzi! "NT"# #"DIS PADA PENDERITA NIGERIA Abstract. Fe$ %t&'ie% (ave com)are' ivermectin 'irect!* $it( to)ica! a+ent% in 'eve!o)in+ co&ntrie%, -e com)are' t(e e..ectivene%% o. ora! ivermectin /011 2+34+5 $it( to)ica! 067 enz*! enzoate an' mono%&!.iram %oa) in 081 %& 9ect% o. a+e 6 to :6 *ear% $it( %ca ie%, S& 9ect% $it( )er%i%tent !e%ion% a.ter 0 $ee4% receive' a %econ' co&r%e o. treatment,A!! !e%ion% (a' re%o!ve' a.ter 0 $ee4% in ;; o. <= /;<75 %& 9ect% treate' $it( ivermectin an' in :1 o. 810 /6<75 %& 9ect% treate' to)ica!!* /P 2 1,11>5, T(e im)rovement in %everit* %core $a% +reater in t(e ivermectin +ro&) t(an in t(e to)ica! treatment +ro&) /P ? 1,1185, T(e overa!! c&re rate a.ter @ $ee4% $a% <67 in t(e ivermectin +ro&) an' =:7 in t(e to)ica! treatment +ro&) /P 2 1,1@5, Com)are' $it( to)ica! enz*! enzoate an' mono%&!.iram in t(e treatment o. %ca ie%A ivermectin $a% at !ea%t a% e..ective an' !e' to more ra)i' im)rovement, Abstrak. Be era)a )ene!itian te!a( 'i!a4&4an &nt&4 mem an'in+4an )en++&naan ivermectin 'en+an )en++&naan o at to)i4a! 'i ne+ara er4em an+, #ami mem an'in+4an e.e4tivita% )em erian ivermectin %ecara ora! /011B+ 3 4+5 'en+an )en++&naan o at enz*! enzoat 067 %ecara to)i4a! 'an 'en+an )en++&naan %a &n mono%&!.iram )a'a 081 %& *e4 'ari &%ia 6 %am)ai :6 ta(&n 'en+an %4a ie%, S& *e4 'en+an !e%i )er%i%ten %ete!a( 0 min++& menerima )en+o atan 4e'&a, Sete!a( '&a min++&A %em&a !e%i te!a( %em &( )a'a ;; 'ari <= /;<75 %& *e4 *an+ 'io ati 'en+an ivermectin 'an :1 'ari 810 /6<75 %& *e4 *an+ 'io ati %ecara to)i4a! /PC 1A11>5, Tin+4at )en*em &(an )a'a )em erian ivermectin !e i( tin++i 'ari )em erian o at %ecara to)ica! /P?1A1185, An+4a 4e%em &(an 4e%e!&r&(an %ete!a( @ min++& a'a!a( <67 )a'a 4e!om)o4 ivermectin 'an =:7 )a'a )em erian o at enz*! enzoate %ecara to)ica! /PC 1A1@5, Di an'in+4an 'en+an )em erian enz*! enzoat %ecara to)i4a! 'an mono%&!.iram 'a!am )en+o atan %4a ie%A ivermectin mem)&n*ai e.e4tivita% *an+ %ama a(4an men*e a 4an )en*em &(an 'en+an !e i( ce)at,

INTROD"CTION Sca ie% occ&r% $or!'$i'e $it( a $i'e%)rea' 'i%tri &tion in t(e tro)ic%, T(e (i+(!* conta+io&% %4in in.ectionA ca&%e' * t(e mite Sarcoptes scabiei var, hominisA i% one o. t(e mo%t common )r&ritic 'ermato%e%,8 Sca ie% i% en'emic in man* 'eve!o)in+ co&ntrie%A0D; &%&a!!* a%%ociate' $it( con'ition% o. overcro$'in+A !o$ %ocioeconomic %tan'ar'%A an' )oor (*+iene,@A:A= Preva!ence o. %ca ie% in A.rican c(i!'ren can e a% (i+( a% @1D=17A<A81 a!t(o&+( a .i+&re o. @,;7 (a% een re)orte' in Ni+erian %c(oo! c(i!'ren,; Intro'&ction o. a %in+!e ca%e o. %ca ie% into cro$'e' !ivin+ con'ition% can re%&!t in an e)i'emic,88A80 Sca ie% ca&%e% con%i'era !e 'i%com.ort an' can re%&!t in %evere %econ'ar* com)!ication% %&c( a% im)eti+oA ce!!&!iti%A )*o'ermaA acteremiaA an' )o%tE%tre)tococca! +!omer&!one)(riti%, 0A8>A8@ Sca ie% occ&r% in 0D @7 o. )atient% $it( FIV in.ection,8 PENDAF"L"AN S4a ie% mer&)a4an )en*a4it *an+ ter9a'i 'i %e!&r&( '&nia 'en+an 'i%tri &%i !&a% 'i 'aera( tro)i%, In.e4%i 4&!it *an+ %an+at men&!ar ini *an+ 'i%e a 4an o!e( Sarcoptes scabiei var, hominisA mer&)a4an %a!a( %at& *an+ )en*a4it *an+ )a!in+ %erin+ men*e a 4an 4&!it men9a'i +ata!E+ata!,8 S4a ie% mer&)a4an )en*a4it en'emi4 'i ne+araEne+ara er4em an+A 0E; ia%an*a er(& &n+an 'en+an 4on'i%i 4e)a'atan )en'&'&4A %o%ia! e4onomi *an+ ren'a(A 'an (*+iene *an+ &r&4, @A:A= Preva!en%i %4a ie% )a'a ana4Eana4 A.ri4a 'a)at %etin++i @1E=17A <A81 me%4i)&n an+4a @A;7 4a%&% %ca ie% te!a( 'i!a)or4an 'i %e4o!a( ,; Gi4a ter9a'i %at& 4a%&% %4a ie% 'a!am )o)&!a%i *an+ )a'atA %4a ie% a4an men9a'i e)i'emic,88A 80 S4a ie% 'a)at men*e a 4an 4eti'a4n*amanan )a'a )en'eritan*a 'an 'a)at men+a4i at4an 4om)!i4a%i %e4&n'er *an+ erat %e)erti im)eti+oA %e!&!iti%A )io'ermaA a4teremiaA 'an post-streptococcal glomerulonefritis, 0A8>A8@ S4a ie% 'a)t ter9a'i )a'a 0E@7 )a%ien 'en+an in.e4%i FIV in.ection,8 Vario&% o)tion% .or t(e treatment o. %ca ie% eHi%t,8A86 To)ica! treatment (a% t(e 'i%a'vanta+e% o. ein+ c&m er%omeAtimeEcon%&min+A an' a%%ociate' $it( treatment .ai!&re ca&%e' * )oor com)!ianceA in%&..icient a))!ication o. %ca ici'eA ina))ro)riate .reI&enc* or tec(niI&e o. a))!icationA an' ina'eI&ate treatment o. c!o%e contact%,8@ Beca&%e e..ective to)ica! %ca ie% treatment re!ie% on 9&'icio&% an' %im&!taneo&% a))!ication o. cream or !otion to )revent reE in.ectionA accom)!i%(in+ t(i% on a comm&nit* or in%tit&tiona! %ca!e i% 'i..ic&!t, Ora! ivermectin i% %a.e in (&man% an' ea%* to &%e in in'ivi'&a!% an' .ami!ie% an' on a !ar+e %ca!e,0A86D8; It (a% a!%o )roven &%e.&! in FIVEre!ate' %ca ie% an' a.ter treatment .ai!&re% $it( to)ica! a+ent%,80A8=D 08 Ter'a)at er a+ai )i!i(an &nt&4 )en+o atan %4a ie% ,8A 86 Pen+o atan %ecara to)i4a! mem)&n*ai an*a4 4e!ema(an 4arena r&mitAmema4an $a4t&A 'an ter4ait 'en+an 4e+a+a!an )en+o atan 'i%e a 4an o!e( 4eti'a4 )at&(an ter(a'a) )en+o atan A )en++&naan scabicide *an+ ti'a4 menc&4&)i A ti'a4 4era)an )en++&naan ata& te4ni4 a)!i4a%iA 'an ti'a4 mema'ai )en+o atan 4e)a'a 4onta4 'e4at ter(a'a) )en'erita,8@ #arena e.e4tivita% )en++&naan o at to)i4a! )a'a )en+o atan %4a ie% er+ant&n+ )a'a )en++&naan 4rim ata& !otion &nt&4 mence+a( in.e4%i &!an+A cara ini %an+at %&!it 'ia)!i4a%i4an 4e)a'a 4om&nita%, Pem erian ivermectin %ecara ora! aman )a'a man&%ia 'an m&'a( 'i+&na4an )a'a in'ivi'& 'an 4e!&ar+a'a!am %4a!a *an+ e%ar ,0 86E8; Fa! ini 9&+a ter &4ti er+&na )a'a )a%ien FIV *an+ ter4ena %4a ie% 'an )a'a )en+o atan *an+ +a+a! %ete!a( )e++&naan o at to)ica!,80A8=E08

Ivermectin (a% een &%e' in Ni+eria .or onc(ocercia%i% contro!A 00A0> &t !imite' $or4 on t(e &%e o. ivermectin in %ca ie% (a% een re)orte',0@ A!t(o&+( ivermectin (a% een 'emon%trate' to e e..ective in treatin+ %ca ie%A .e$ %t&'ie% (avecom)are' ivermectin 'irect!* $it( to)ica! a+ent% in 'eve!o)in+ co&ntrie%, -e com)are' t(e e..ectivene%% o. ora! ivermectin $it( t(e %tan'ar' to)ica! treatment &%e' in Ni+eria /067 enz*! enzoate !otion an' mono%&!.iram %oa)5,

Ivermectin te!a( 'i+&na4an 'i Ni+eria &nt&4 4ontro! onc(ocercia%i%A 00A0> teta)i )en++&naan t ivermectin )a'a )en'erita %4a ie% *an+ ter ata% te!a( 'i!a)or4an ,0@ Me%4i)&n ivermectin te!a( 'i &4ti4an e.e4ti. 'a!am men+o ati %4a ie%A e era)a %t&'i te!a( mem an'in+4an )en++&naan ivermectin 'en+an o at to)i4a! 'i ne+araEne+ara er4em an+, #ami mem an'in+4an e.e4tivita% )en++&naan ivermectin %ecara ora! 'en+an )en+o atan to)i4a! *an+ 'i+&na4an 'i Ni+eria *ait& !otion enz*! enzoat 067 'an 'en+an %a &n mono%&!.iram5, METFODS S& 9ect% o. a+e 6 *ear% an' a oveA $ei+(in+ more t(an 86 4+A )re%entin+ at t(e Genera! O&t)atient De)artment o. Go% "niver%it* Teac(in+ Fo%)ita! $it( c!inica!!* %&%)ecte' %ca ie% $ere e!i+i !e .or t(e %t&'*, S& 9ect% $ere eHc!&'e' .or an* o. t(e .o!!o$in+ rea%on%J %erio&% i!!ne%%A )re+nant or !actatin+ $omenA or treatment o. %ca ie% $it(in t(e )rece'in+ 8 mont(, T(e %t&'* $a% a))rove' * t(e Go% "niver%it* Teac(in+ Fo%)ita! Et(ica! Committee, -ritten in.orme' con%ent $a% o taine' .rom a'&!t %& 9ect% an' .rom t(e )arent% or +&ar'ian% o. c(i!'ren, METODE S& *e4 'ari &%ia 6 ta(&n 4e ata%A 'en+an erat !e i( 'ari 86 4+A 'atan+ 4e R&ma( Sa4it "niver%ita% Pen'i'i4an Go% 'en+an %&%)e4 4!ini% %4a ie% 'an *an+ memen&(i %*arat &nt&4 )ene!itian, S& 4riteria e4!&%i a'a!a( %e)erti eri4&tJ )en*a4it 4roni4A )erem)&an (ami! ata& men*&%&iA ata& %&'a( men9a!ani )en+o atan %4a ie% 'a!am 8 &!an %e e!&mn*a, St&'i ini 'i%et&9&i o!e( #omite Eti4 R&ma( Sa4it "niver%ita% Pen'i'i4an Go% #omite Eti4, In.orme' con%ent tert&!i% 'i)ero!e( 'ari %& *e4 'e$a%a 'an 'ari oran+ t&a ata& $a!i ana4Eana4, One eH)erience' .ami!* )(*%ician /FMS5 recor'e' 'emo+ra)(ic an' c!inica! 'ata an' )!otte' t(e 'i%tri &tion o. !e%ion% / &rro$%A )a)&!e%A ve%ic!e%A cr&%t%5 on a o'* 'ia+ram, T(e %everit* o. 'i%ea%e $a% recor'e' a% mi!' /81 or .e$er !e%ion%5A mo'erate /88D@< !e%ion%5A %evere /61 or more !e%ion%5A or cr&%te', Severit* %core% o. 8A 0A >A an' @ $ere a%%i+ne' to %ca ie% ca%e% recor'e' a% mi!'A mo'erateA %evereA an' cr&%te'A re%)ective!*, B&rro$% $ere i'enti.ie' $it( a ma+ni.*in+ !en%A an' micro%co)* o. %4in %cra)in+% $a% )er.orme' to %earc( .or mite%A e++%A or .eca! )e!!et% Sat& 'o4ter 4e!&ar+a *an+ er)en+a!aman /FMS5 mencatat 'emo+ra.i 'an 'ata 4!ini% 'an 'i)!ot 'i%tri &%i !e%i /tero$on+anA )a)&!aA ve%i4e!A 4r&%ta5 )a'a 'ia+ram, Tin+4at 4e)ara(an )en*a4it tercatat %e a+ai rin+an /81 ata& !e i( %e'i4it !e%i5A %e'an+ /88E@< !e%i5A erat /61 ata& !e i( !e%i5A ata& 4r&%ta, S4or 4e)ara(an 'ari 8A 0A >A 'an @ *an+ 'i eri4an &nt&4 4a%&% %4a ie% 'icatat %e a+ai rin+anA %e'an+A eratA 'an 4r&%ta, Tero$on+an 'ii'enti.i4a%i 'en+an !en%a )em e%arA 'an mi4ro%4o) 'ari 4ero4an 4&!it *an+ 'i!a4&4an &nt&4 mencari t&n+a& ata& te!&r,

Criteria .or t(e 'ia+no%i% o. %ca ie% $ereJ (i%tor* o. contact $it( a )er%on in.ecte' $it( %ca ie%A )r&rit&%A )re%ence o. &rro$% or %econ'ar* !e%ion% /)a)&!e%A no'&!e%A eHcoriation%A cr&%t%A or .o!!ic&!iti%5 in c(aracteri%tic %ite%A or +ro%% %ca!in+ $it( (*)er4eratotic )!aI&e% an' .i%%&rin+, T(ree or more )o%itive .in'in+% $ere acce)te' a% 'ia+no%tic o. %ca ie% even $it(o&t )o%itive micro%co)*, Fo$everA a )o%itive micro%co)* re%&!t $a% con%i'ere' 'ia+no%tic #riteria &nt&4 'ia+no%i% %4a ie% a'a!a(J a'an*a ri$a*at 4onta4 'en+an oran+ *an+ terin.e4%i %4a ie%A +ata!E+ata!A a'an*a tero$on+an ata& !e%i %e4&n'er /)a)&!aA no'&!A e4%4oria%i A 4r&%taA ata& .o!i4&!iti%5 'i !o4a%i 4ara4teri%ti4A ata& %4a!a +ro%% 'en+an )!a4 (i)er4erato%i% 'an .i%%&ra, Ti+a ata& !e i( tem&an )o%iti. 'iterima %e a+ai 'ia+no%ti4 %ca ie% a(4an tan)a mi4ro%4o) )o%iti., Nam&nA )enem&an 'en+an mi4ro%4o) )o%iti. mer&)a4an 4riteria 'ia+no%ti4, , E!i+i !e %& 9ect% $ere a!ternate!* a%%i+ne' to receive ora! ivermectin /MectizanK Merc4 L Co,A Ra($a*A NG5 at 011 2+3 4+ o'* $ei+(t or to)ica! treatment $it( enz*! enzoate !otion /Sca care BB 067 $3$A Vita iotic%A Ni+eria Lt',AI4e9aA Ni+eria5 an' tetraet(*t(i&ram mono%&!.i'e 67 %oa) /Tetmo%o!A Ga+a! P(arma Lt',A I4e9aA Ni+eria5, To)ica! treatment con%i%te' o. a t(oro&+( at( $it( t(e mono%&!.iram %oa) .o!!o$e' * a))!ication o. enz*! enzoate !otion to t(e entire o'* e!o$ t(e nec4A re)eate' 'ai!* .or > con%ec&tive 'a*%, S& 9ect% in ot( +ro&)% $ere in%tr&cte' to $a%( t(eir c!ot(in+ an' e' !inen% in (ot $aterA 'r* t(em in t(e %&nA an' )re%% t(em $it( a (ot iron, -(ere )o%%i !eA c!o%e contact% o. %& 9ect% $it( %ca ie% $ere eHamine'A an' t(o%e c!inica!!* con.irme' to (ave %ca ie% $ere invite' to enro!! in t(e %t&'*, S& *e4 *an+ memen&(i %*arat 'i eri4an ivermectin )erora! /MectizanA Merc4 L CoA Ra($a*A NG5 'en+an 'o%i% 011B+ 3 4+ erat a'an ata& )en+o atan to)i4a! 'en+an )em erian !otion enz*! enzoate /Sca care BB 067 3 A Vita iotic%A Ni+eria Lt'A I4e9aA Ni+eria5 'an %a &n tetraet(*t(i&ram mono%&!.i'e 67 /Tetmo%o!A Ga+a! P(arma Lt'A I4e9aA Ni+eria5, Pen+o atan to)i4a! ter'iri 'ari man'i 'en+an men++&na4an %a &n mono%&!.iram 'an 'ii4&ti 'en+an )en++&naan !otion enz*! enzoat 4e %e!&r&( t& &( *ait& 'i a$a( !e(er 'an 'i&!an+ %etia) (ari %e!ama > (ari ert&r&tEt&r&t , S& 9e4 )a'a 4e'&aE'&a 4e!om)o4 'i%&r&( &nt&4 menc&ci )a4aian 'an %e)rai mere4a 'en+an air )ana% 'an 'i4erin+4an 'i a$a( %inar mata(ariA 'an 'i%eteri4a, Bi!a mem&n+4in4anA 4onta4 *an+ 'e4at 'en+an %& *e4 *an+ %4a ie% 'i)eri4%aA 'an mere4a 'en+an 4!ini% men'erita %4a ie%t&r&t 'i&n'an+ &nt&4 i4&t %erta 'a!am )ene!itian ini , A%*m)tomatic contact% $ere a!%o treate' &t not enro!!e', A!! %& 9ect% an' c!o%e contact% $ere treate' %im&!taneo&%!*, #onta4 *an+ a%imtomati4 9&+a 'ite!iti teta)i ti'a4 ter'a.tar, Sem&a %& *e4 'an 4onta4 'e4at 'ite!iti %ecara er%amaan,

S& 9ect% $ere .o!!o$e' &) at 0 $ee4% to a%%e%% com)!iance an' eHamine t(e )atient, A %in+!e inve%ti+ator /FMS5A $(o $a% not !in'e' to t(e treatment receive'A recor'e' t(e n&m er o. !e%ion% )re%ent, On!* t(o%e $it( ne$ or )er%i%tent !e%ion% an' )r&rit&% $ere treate' $it( a %econ' co&r%e o. t(eir a%%i+ne' treatmentA an' t(e* $ere eva!&ate' a+ain 0 $ee4% !ater, Criteria .or c&re $ere a %ence o. )r&rit&% an' a %ence o. ne$ !e%ion%, S& *e4 'i follow-up %e!ama '&a min++& &nt&4 meni!ai 4e)at&(an 'an memeri4%a )a%ien, Seoran+ )emeri4%a /FMS5A memeri4%a !e%i *an+ a'a, Fan*a mere4a 'en+an !e%i ar& ata& )er%i%ten 'an )r&rit&% 'io ati 'en+an )en+o atan 4e'&a 'an mere4a 'ieva!&a%i !a+i '&a min++& 4em&'ian, #riteria &nt&4 )en*em &(an a'a!a( ti'a4 a'an*a )r&rit&% 'an ti'a4 a'an*a !e%i ar&, Stati%tica! ana!*%i% $a% 'one &%in+ E)i In.o 0111 /CDCA At!antaA GA5, Di..erence% in )ro)ortion% $ere com)are' $it( t(e 20 %tati%tic, Severit* %core% $ere com)are' &%in+ t(e MannE -(itne* te%tA eca&%e t(e* $ere or'ina! an' $it(o&t a norma! 'i%tri &tion, M&!ti)!e !inear re+re%%ion /ana!*%i% o. covariance5 $a% &%e' to a'9&%t .or a%e!ine %everit* in com)arin+ %& %eI&ent %everit* %core% et$een treatment +ro&)%, Lo+i%tic re+re%%ion $a% &%e' to 'etermine t(e a'9&%te' o''% o. treatment %&cce%% $(i!e contro!!in+ .or con.o&n'in+ .actor%, P va!&e% ? 1,16 $ere con%i'ere' %i+ni.icant, In ca!c&!atin+ t(e %am)!e %izeA $e a%%&me' c&re rate% o. <67 an' ;67 $it( ivermectin an' enz*! enzoateA re%)ective!*, A %am)!e %ize o. => in eac( treatment +ro&) $o&!' )rovi'e <67 )o$er to 'etect t(i% 'i..erence $it( <67 con.i'ence, -e %o&+(t to enro!! 811 in eac( treatment +ro&) to a!!o$ .or incom)!ete .o!!o$E&), Ana!i%i% %tati%ti4 'i!a4&4an 'en+an men++&na4an E)i In.o 0111 /CDCA At!antaA GA5, Per e'aan 'a!am )ro)or%i 'i an'in+4an %ecara c(iE%I&are, S4or 4e)ara(an 'i an'in+4an 'en+an men++&na4an te% MannE-(itne* A 4arena %4a!a or'ina! 'an tan)a 'i%tri &%i norma!, Re+re%i !inier er+an'a /ana!i%i% 4ovarian%5 'i+&na4an &nt&4 men*e%&ai4an tin+4at 4e)ara(an 'a%ar 'a!am mem an'in+4an %4or 4e)ara(an eri4&tn*a antara 4e!om)o4, Re+re%i !o+i%ti4 'i+&na4an &nt&4 menent&4an o''% 4e er(a%i!an )en+o atan %ementara men+en'a!i4an .a4tor cofounding, Ni!ai P ?1A16 'ian++a) %i+ni.i4an, Da!am men+(it&n+ &4&ran %am)e!A 4ami men)re'i4%i tin+4at 4e%em &(an <67 'an ;67 'en+an ivermectin 'an enz*! enzoat, Sam)e! %e an*a4 => )a'a %etia) 4e!om)o4 a4an mem eri4an <67 &nt&4 men'ete4%i )er e'aan ini 'en+an ni!ai 4e*a4inan %e an*a4 <67, #ami er&%a(a &nt&4 men'a)at4an %& *e4 %e an*a4 811 )a'a %etia) 4e!om)o4 %&)a*a ti'a4 ter9a'i 4etin++a!an 'a!am follow up, RES"LTS A tota! o. 081 %& 9ect% $ere recr&ite' /Ta !e 85, T(eir mean /M SD5 a+e $a% 8:,0 /80,<5 *ear% /ran+eA 6D:6 *ear%5K << /@;,875 $ere ma!eA an' 888 /60,<75 $ere .ema!e, O. t(e%eA 81 $ere !o%t to .o!!o$E&) a.ter t(e initia! treatment /; receive' ivermectinA an' > receive' to)ica! treatment5, T$o t(ir'% /::75 o. t(e %& 9ect% $ere c(i!'ren 6D8@ *ear% o. a+e FASIL Se an*a4 081 %& *e4 'i9a'i4an %am)e! /Ta e! 85, Mean &%ia mere4a 8:A0 /80A< M SD5 /4i%aranA 6E:6 ta(&n5K <</@;A875 a'a!a( !a4iE!a4iA 'an 888 /60A<75 a'a!a( )erem)&an, Dari 9&m!a( ter%e &tA 81 (i!an+ &nt&4 'i follow up %ete!a( )en+o atan a$a! /; menerima ivermectinA 'an > menerima )en+o atan to)i4a!5, D&a )erti+a /::75 'ari %& 9e4 a'a!a( ana4 6E8@ ta(&n,

O. t(e 011 %& 9ect% $(o com)!ete' t(e %t&'*A <= receive' ivermectin an' 810 receive' to)ica! treatment, O. t(e <= %& 9ect% $(o receive' ivermectinA 6> /6@,875 (a' mo'erate !e%ion%A @0 /@0,=75 (a' %evere !e%ion%A an' > />,875 (a' cr&%te' !e%ion%, O. t(e 810 %& 9ect% $(o receive' to)ica! treatmentA ;6 %& 9ect% /;>,675 (a' mo'erate !e%ion%A 0; /0:,675 (a' %evere !e%ion%A an' none (a' cr&%te' !e%ion%, None o. t(e %& 9ect% in eit(er +ro&) (a' mi!' !e%ion% at )re%entation, Prior to treatmentA t(e %everit* %core o. t(e ivermectin +ro&) /0,6 M 1,:K me'ianA 0,15 $a% %i+ni.icant!* +reater t(an t(at o. t(e to)ica! treatment +ro&) /0,> M 1,@K me'ianA 0,1K P C 1,11@5, Dari 011 %& *e4 *an+ men*e!e%ai4an %t&'iA <= menerima ivermectin 'an 810 menerima )en+o atan to)i4a!, Dari <= %& *e4 *an+ menerima ivermectinA 6> /6@A875 memi!i4i !e%i mo'eratA @0 /@0A=75 memi!i4i !e%i eratA 'an > />A875 memi!i4i !e%i 4r&%ta, Dari 810 %& *e4 *an+ menerima to)i4a! )en+o atanA ;6 %& *e4 /;>A675 memi!i4i !e%i mo'eratA 0; /0:A675 memi!i4i !e%i *an+ )ara(A 'an ti'a4 a'a *an+ !e%i 4r&%ta, Ta4 %at& )&n 'ari %& *e4 )a'a 4e'&a 4e!om)o4 memi!i4i !e%i rin+an )a'a )re%enta%i, Se e!&m )en+o atanA %4or 4e)ara(an )a'a 4e!om)o4 *an+ men++&na4an ivermectin /0A6 M 1A:A me'ianA 0,15 %ecara %i+ni.i4an !e i( e%ar 'i an'in+4an 'en+an 4e!om)o4 *an+ men++&na4an o at %ecara to)i4a! /0A> M 1A@K me'ianA 0A1K PC1A11@5, %& 9ect% /0875 in t(e ivermectin +ro&) an' in @0 %& 9ect% /@875 in t(e to)ica! treatment +ro&) /P 2 1,11>5, In t(e ivermectin +ro&)A 86 /8675 (a' mi!' !e%ion%A : /:75 (a' mo'erate !e%ion%A an' none (a' %evere or cr&%te' !e%ion%, In t(e to)ica! treatment +ro&)A 0: /0675 (a' mi!' !e%ion%A 8: /8:75 (a' mo'erate !e%ion%A an' none (a' %evere or cr&%te' !e%ion% /Fi+&re 85, T(e im)rovement /re'&ction5 in %everit* %core $a% %i+ni.icant!* +reater in t(e ivermectin +ro&) /N0,0 M1,:K me'ianA N0,15 t(an in t(e to)ica! treatment +ro&) /N8,; M 1,=K me'ianA N0,1K P ? 1,118A a'9&%tin+ .or a%e!ine %everit*5, O. t(o%e $it( )er%i%tent !e%ion%A 6 %& 9ect% /0@75 in t(e ivermectin +ro&) (a' )o%itive micro%co)* com)are' $it( 8< /@675 in t(e to)ica! treatment +ro&) /P 2 1,815, A!! %& 9ect% $it( )er%i%tent !e%ion% receive' a %econ' co&r%e o. t(eir a%%i+ne' treatment, T$o $ee4% a.ter t(e %econ' treatmentA 6 o. 08 /0@75 in t(e ivermectin +ro&) (a' !e%ion% /a!! mi!'5 com)are' $it( 8@ o. @0 />>75 in t(e to)ica! treatment +ro&) /88 (a' mi!' !e%ion%A an' > (a' mo'erate !e%ion%5A &t t(i% 'i..erence $a% not %i+ni.icant /P 2 1,@@5A an' t(e mean re'&ction in %everit* %core $a% t(e %ame in ot( +ro&)% /N8,15, O. t(e > %& 9ect% $it( cr&%te' !e%ion%A 0 $ere com)!ete!* c&re' a.ter 0 'o%e% o. ivermectin, S& *e4 / 08 7 5 )a'a 4e!om)o4 ivermectin 'an @0 %& *e4 / @8 7 5 )a'a 4e!om)o4 )en+o atan to)i4a! / P C1A11> 5 , Da!am 4e!om)o4 )em erian ivermectin A 86 / 86 7 5 memi!i4i !e%i rin+an A : / : 7 5 memi!i4i !e%i mo'erat A 'an ti'a4 memi!i4i !e%i )ara( ata& er4&!it , Pa'a 4e!om)o4 )en+o atan to)i4a! A 0: / 06 7 5 memi!i4i !e%i rin+an A 8: / 8: 7 5 memi!i4i !e%i mo'erat A 'an ti'a4 a'a *an+ )ara( ata& er4&!it !e%i / Gam ar 8 5 , Penin+4atan / )en&r&nan 5 'a!am %4or 4e)ara(an %ecara %i+ni.i4an !e i( e%ar )a'a 4e!om)o4 ivermectin / E0,0 M 1A: A me'ian A E0,1 5 'ari)a'a 4e!om)o4 )en+o atan to)i4a! / E8,; M 1,= A me'ian A E0,1 A P ? 1,118 A 'i%e%&ai4an &nt&4

tin+4at 4e)ara(an a%e!ine5 , Dari mere4a 'en+an !e%i )er%i%ten A 6 / 0@ 7 5 )a'a 4e!om)o4 ivermectin 'i an'in+4an 'en+an 8< / @6 7 5 )a'a 4e!om)o4 'en+an )en+o atan to)i4a! / P C 1A81 5 , Sem&a %& *e4 'en+an !e%i )er%i%ten menerima )en+o atan 4e'&a *an+ , D&a min++& %ete!a( )era$atan 4e'&a A 6 'ari 08 / 0@ 7 5 )a'a 4e!om)o4 ivermectin memi!i4i !e%i /%em&a rin+an5 'i an'in+4an 'en+an 8@ 'ari @0 / >> 7 5 )a'a 4e!om)o4 )en+o atan to)i4a! / 88 memi!i4i !e%i rin+an A 'an > memi!i4i !e%i mo'erate 5 A nam&n )er e'aan ini ti'a4 %i+ni.i4an /P C 1,@@5 A 'an )en&r&nan erarti 'a!am %4or 4e)ara(an a'a!a( %ama )a'a 4e'&a 4e!om)o4 /)C8,1 5 , Dari > %& *e4 'en+an !e%i 4r&%ta A '&a enarE enar %em &( %ete!a( 0 'o%i% ivermectin , T(e overa!! c&re rate a.ter @ $ee4% $a% <67 in t(e ivermectin +ro&) an' =:7 in t(e to)ica! treatment +ro&) /P 2 1,1@5, A %trati.ie' ana!*%i% 'i' not %&++e%t an* 'i..erence in re%)on%e et$een c(i!'ren an' a'&!t% /P 2 1,::5, T(e re%&!t% $ere a!%o ana!*ze' on an intention to treat a%i% $it( t(e 81 'ro)o&t% inc!&'e' a% treatment .ai!&re%, B* t(i% ana!*%i%A =<7 o. t(e ivermectin +ro&) an' =@7 o. t(e to)ica! treatment +ro&) ac(ieve' c&reA &t t(i% 'i..erence $a% not %i+ni.icant /P 2 1,>05, An+4a 4e%em &(an 4e%e!&r&(an %ete!a( @ min++& a'a!a( <67 )a'a 4e!om)o4 ivermectin 'an =:7 )a'a 4e!om)o4 )en+o atan to)i4a! /P C 1A1@5, Se &a( ana!i%i% *an+ 'i4e!om)o44an ti'a4 men*aran4an a'an*a )er e'aan re%)on% antara ana4Eana4 'an oran+ 'e$a%a /P C 1A::5, Fa%i! 9&+a 'iana!i%i% )a'a )en+o atan 'a%ar 'en+an 81 drop-out 'ima%&44an %e a+ai 4e+a+a!an )en+o atan, Den+an ana!i%i% iniA =<7 'ari 4e!om)o4 ivermectin 'an =@7 'ari 4e!om)o4 )en+o atan to)i4a! menca)ai )en*em &(anA teta)i )er e'aan ini ti'a4 %i+ni.i4an /P C 1A>05, In a !o+i%tic re+re%%ion ana!*%i% $it( c&re rate a.ter @ $ee4% a% t(e 'e)en'ent varia !e an' treatment +ro&)A a+eA %eHA )o%itive micro%co)*A an' initia! %everit* a% in'e)en'ent varia !e%A on!* treatment +ro&) /P 2 1,11;5 an' initia! %everit* /P 2 1,11>5 $ere %i+ni.icant )re'ictor% o. c&re, Com)are' $it( to)ica! treatmentA ivermectin $a% %i+ni.icant!* more !i4e!* to re%&!t in c&re /a'9&%te' o''% ratio 6,0K <67 CIJ 8,: to 8;5, Da!am ana!i%i% re+re%i !o+i%ti4 'en+an an+4a 4e%em &(an %ete!a( @ min++& %e a+ai varia e! 'e)en'en 'an 4e!om)o4A &m&rA 9eni% 4e!aminA )o%iti. mi4ro%4o)A 'an tin+4at 4e)ara(an a$a! %e a+ai varia e! in'e)en'enA(an*a 4e!om)o4 )en+o atan /PC 1A11;5 'an tin+4at 4e)ara(an a$a! /PC 1A11>5 a'a!a( )re'i4tor %i+ni.i4an )en*em &(an, 'i an'in+4an 'en+an )en+o atan to)i4a!A ivermectin %ecara %i+ni.i4an !e i( m&n+4in &nt&4 men+(a%i!4an o at /ra%io o''% *an+ 'i%e%&ai4an 6A0A <67 CIJ 8A:E8;5

DISC"SSION

-e .o&n' t(at ivermectin (a% %imi!ar or etter e..icac* com)are' $it( t(e common!* &%e' to)ica! treatment o. 067 enz*! enzoate !otion an' mono%&!.iram %oa), T(e%e re%&!t% are %imi!ar to t(o%e o. ot(er $or4er%, A %in+!e 'o%e o. ivermectin re%&!te' in re%o!&tion o. )r&rit&% a.ter @ $ee4% in <>7 o. )atient% in %o&t(ern Ni+eriaA com)are' $it( @=7 $(o receive' enz*! enzoate,0@ A !o$er 'o%e o. ivermectin /811 2+34+5 ac(ieve' a ;17 re%)on%e rate in Frenc( Po!*ne%ia com)are' $it( a @=7 re%)on%e rate in t(o%e treate' $it( 817 enz*! enzoateA &t t(e%e 'i..erence% $ere not %i+ni.icant,06 In contra%tA com)!ete re%o!&tion o. %4in !e%ion% $a% o %erve' in on!* 6:7 o. )atient% $it( %ca ie% $(o receive' a %in+!e 'o%e o. ivermectin com)are' $it( 687 o. t(o%e $(o $ere treate' $it( 817 enz*! enzoate in Van&at&,0: T(e a&t(or% attri &te' t(e re!ative!* !o$ re%)on%e rate to t(e )o%%i !e )er%i%tence o. )a)&!e% an' no'&!e% $it(o&t %ca ie% mite% at t(e .ina! a%%e%%mentA > $ee4% )o%tEtreatment, In a %t&'* o. FIVa%%ociate' %ca ie%A :>7 o. )atient% re%)on'e' to a %in+!e 'o%e o. ivermectinA )rimari!* t(o%e c!a%%i.ie' $it( mi!' or mo'erate %everit*A com)are' $it( @;7 o. )atient% $(o receive' enz*! enzoate,08 T(e com ination o. ivermectin $it( enz*! enzoate $a% e..ective in a!! 8; ca%e% in $(ic( it $a% &%e'A inc!&'in+ in %evere an' cr&%te' .orm%, PEMBAFASAN #ami menem&4an a($a ivermectin memi!i4i 4(a%iat *an+ %ama ata& !e i( ai4 'i an'in+4an 'en+an )en+o atan to)i4a! *an+ &m&m 'i+&na4an *ait& !otion enzi! enzoat 067 'an %a &n mono%&!.iram , Do%i% t&n++a!)em erian ivermectin men+(a%i!4an re%o!&%i )r&rit&% %ete!a( @ min++& )a'a <>7 )a%ien 'i Ni+eria %e!atan A 'i an'in+4an 'en+an @= 7 *an+ menerima enz*! enzoate,0@ Do%i% ren'a( ivermectin / 811 B+ 3 4+ 5 menca)ai tin+4at tan++a)an ;1 7 'i Po!ine%ia Pranci% 'i an'in+4an 'en+an tin+4at re%)on @= 7 )a'a mere4a *an+ 'ira$at 'en+an !otion enzi! enzoat 817A nam&n )er e'aan ter%e &t ti'a4 %i+ni.icant,06 Se a!i4n*a A re%o!&%i !en+4a) !e%i 4&!it 'iamati (an*a 6: 7 )a%ien 'en+an %4a ie% *an+ menerima %at& 'o%i% ivermectin 'i an'in+4an 'en+an 68 7 'ari mere4a *an+ 'io ati 'en+an 81 7 enzi! enzoat 'a!am Van&at& ,0: Da!am %e &a( %t&'i FIVE %4a ie% A :> 7 'ari )a%ien menan++a)i 'o%i% t&n++a! 'ari ivermectin A ter&tama *an+ 'i4!a%i.i4a%i4an 'en+an rin+an ata& %e'an+ 4e)ara(an A 'i an'in+4an 'en+an @; 7 'ari )a%ien *an+ menerima enzi! enzoate,08 #om ina%i ivermectin 'en+an enz*! enzoat e.e4ti. 'a!am %em&a 8; 4a%&% 'i mana it& 'i+&na4an A terma%&4 'a!am ent&4 )ara( 'an er4&!it ,

O&r %t&'* (a' a !ar+er n&m er o. )atient% t(an ot(er %t&'ie% com)arin+ ivermectin $it( enz*! enzoate an' t(&% (a' +reater )o$er to 'etect a 'i..erence et$een t(e%e t$o treatment%, Fo$everA $(en 'ro)o&t% $ere inc!&'e' in t(e ana!*%i% a% treatment .ai!&re%A t(e 'i..erence et$een t(e t$o treatment +ro&)% $a% not %tati%tica!!* %i+ni.icant, Beca&%e t(e n&m er o. 'ro)o&t% in t(e ivermectin +ro&) $a% +reater t(an in t(e to)ica! treatment +ro&)A com)ari%on o. t(e t$o +ro&)% * an intention to treat ana!*%i% 'emon%trate' no %i+ni.icant 'i..erence in treatment re%)on%e, Fo$everA it i% &n!i4e!* t(at a!! o. t(e 'ro)o&t% re)re%ente' treatment .ai!&re%A eca&%e t(o%e $(o re%)on' to treatment no !on+er (ave incentive to ret&rn .or .o!!o$E&),0: In a''itionA 'e%)ite t(e +reater %everit* o. !e%ion% at )re%entation in t(e ivermectin +ro&) t(an in t(e to)ica! treatment +ro&)A t(e ivermectin +ro&) (a' a etter re%)on%e to treatment in t(o%e $(o com)!ete' t(e %t&'*, Pene!itian 4ami memi!i4i %e9&m!a( e%ar )a%ien 'i an'in+4an )ene!itian !ain *an+ mem an'in+4an ivermectin 'en+an enzi! enzoat 'an 'en+an 'emi4ian memi!i4i 4e4&atan *an+ !e i( e%ar &nt&4 men'ete4%i )er e'aan antara '&a 4e!om)o4 )en+o atan, Nam&nA 4eti4a drop out 'ima%&44an 'a!am ana!i%i% %e a+ai 4e+a+a!an )en+o atanA )er e'aan antara '&a 4e!om)o4 %ecara %tati%ti4 ti'a4 %i+ni.i4an, #arena an+4a drop out )a'a 4e!om)o4 ivermectin !e i( e%ar 'ari )a'a 4e!om)o4 )en+o atan to)i4a!A )er an'in+an 'ari '&a 4e!om)o4 &nt&4 men+o atiA ana!i%i% men&n9&44an ti'a4 a'a *an+ %i+ni.i4an )er e'aan 'a!am re%)on )en+o atan, Nam&nA ti'a4 m&n+4in a($a %em&a drop out 'i$a4i!i 4e+a+a!an )en+o atanA 4arena oran+Eoran+ *an+ mere%)on )en+o atan ti'a4 !a+i memi!i4i in%enti. &nt&4 4em a!i &nt&4 follow up ,0: Se!ain it&A me%4i)&n !e i( e%ar 4e)ara(an !e%i )a'a )re%enta%i )a'a 4e!om)o4 ivermectin 'i an'in+4an 4e!om)o4 )en+o atan to)i4a!A 4e!om)o4 ivermectin memi!i4i re%)on *an+ !e i( ai4 ter(a'a) )en+o atan )a'a mere4a *an+ men*e!e%ai4an %t&'i, At !ea%t t$o !imitation% o. o&r %t&'* co&!' intro'&ce )otentia! ia%, T(e .ir%t i% t(at )atient% $ere a!ternate!* a%%i+ne'A rat(er t(an ran'om!* a%%i+ne'A to treatment +ro&)%, Con%eI&ent!*A $e 'i' not maintain a!!ocation concea!ment, Fo$everA ever* e!i+i !e %& 9ect $a% enro!!e'A an' t(e or'er o. a%%i+ne' treatment $a% not a!tere'A t(&% minimizin+ )otentia! %e!ection ia%, A %econ' !imitation i% t(at t(e inve%ti+ator $(o eva!&ate' t(e re%)on%e to treatment $a% not !in'e' to t(e treatment +ro&) a%%i+nment, Fo$everA $e con%i'er t(e criteria .or eva!&atin+ t(e re%)on%e to treatment /no, o. !e%ion%A)atientO% re)ort o. )r&rit&%5 %&..icient!* o 9ective to )revent a ma9or 'e+ree o. ia%, Seti'a4n*a '&a 4eter ata%an )a'a )ene!itian 4ami a'a!a( 4arena ia%, Yan+ )ertama a'a!a( a($a )a%ien 'i)i!i( A &4an %ecara aca4A &nt&4 4e!om)o4 )en+o atan, Setia) %& 9e4 *an+ memen&(i %*arat te!a( ter'a.tarA 'an &r&tan )en+o atan *an+ 'i eri4an ti'a4 er& a(A %e(in++a meminima!4an )oten%i ia% %e!e4%i, #eter ata%an 4e'&a a'a!a( a($a )en*i'i4 *an+ men+eva!&a%i re%)on ter(a'a) )en+o atan men+eta(&i )en+o atan &n&t4 t&+a% 4e!om)o4, Nam&nA 4ami mem)ertim an+4an 4riteria &nt&4 men+eva!&a%i re%)on ter(a'a) )en+o atan /nomor !e%iA La)oran )a%ien )r&rit&%5 c&4&) o *e4ti. &nt&4 mence+a( ia%,

Ivermectin (a% %evera! c!inica! a'vanta+e% t(at ma4e it %&)erior to to)ica! treatment in 'eve!o)in+ co&ntrie%, It i% %a.eA ineH)en%iveA %im)!e to a'mini%terA ea%i!* %&)ervi%e'A an' treat% t(e entire %4in %&r.ace $it(o&t ne+!ecte' area%,0; Ivermectin i% etter to!erate' t(an to)ica! treatment in t(o%e $it( eHcoriation% or o)en &!ceration%,0: T(e 'r&+ (a% %&cce%%.&!!* een &%e' .or ma%% treatment an' in e)i'emic%,0A6A80 It a!%o (a% t(e a''itiona! ene.it o. re'&cin+ t(e )reva!ence o. ot(er (&man )ara%itic in.ection% common in t(e tro)ic%A inc!&'in+ onc(ocercia%i%A Ascaris in.ectionA !*m)(atic .i!aria%i%A )e'ic&!o%i%A c&taneo&% !arva mi+ran%A an' %tron+*!oi'ia%i%,8;A0>A0; A!t(o&+( ivermectin re'&ce% Loa loa micro.i!aremiaA !i.et(reatenin+ ence)(a!o)at(* can occ&r in (eav* in.ection%A $(ic( $arrant% ca&tion in en'emic area%,0> L. loa in.ection i% in.reI&ent in nort(ern Ni+eriaA $(ere t(i% %t&'* $a% )er.orme', Ivermectin i% a!%o %&)erior to to)ica! a+ent% in treatin+ imm&nocom)romi%e' )er%on% $it( %ca ie%A08A0; $(ic( m&%t e con%i'ere' in A.rican %ettin+% $it( a (i+( )reva!ence o. FIV in.ection /67 )reva!ence in Ni+eria in 011>5, Even $(en eI&iva!ent e..icac* $it( enz*! enzoate i% a%%&me'A t(e%e a''itiona! a'vanta+e% o. ivermectin ma4e it a %&)erior c(oice in 'eve!o)in+ co&ntrie%A !i4e Ni+eriaA $(ere con'ition% .avor ra)i' %)rea' t(at can I&ic4!* reac( e)i'emic )ro)ortion%, Lon+E term eva!&ation o. t(e ri%4 o. reEin.e%tation an' rate% o. 'i%ea%e in c!o%e contact% $arrant% .&rt(er %t&'*, Ivermectin memi!i4i e era)a 4e&nt&n+an 4!ini% *an+ mem &atn*a &n++&! &nt&4 )en+o atan to)i4a! 'i ne+ara er4em an+ , Ini a'a!a( 4arena aman A m&ra(A %e'er(ana &nt&4 men+e!o!a A m&'a( 'ia$a%i A 'an mera$at %e!&r&( )erm&4aan 4&!it,0; Ivermectin 'ito!eran%i !e i( ai4 'ari)a'a )en+o atan to)i4a! )a'a mere4a 'en+an e4%o4ria%i ata& &!%era%i ter &4a,0: O at er(a%i! te!a( 'i+&na4an &nt&4 )en+o atan ma%%a! 'an )a'a e)i'emi%,0 A 6A80 Fa! ini 9&+a memi!i4i man.aat tam a(an 'en+an men+&ran+i )reva!en%i in.e4%i )ara%it man&%ia !ainn*a *an+ &m&m 'i 'aera( tro)i% A terma%&4 onc(ocercia%i% A in.e4%i A%cari% A .i!aria%i% !im.ati4 A )e'ic&!o%i% A !arva mi+ran% c&taneo&% A 'an %tron+*!oi'ia%i%,8; A 0>A0; Me%4i)&n ivermectin men+&ran+i Loa !oa micro.i!aremia , lifethreatening en%e.a!o)ati 'a)at ter9a'i )a'a in.e4%i erat,0> in.e4%i L, !oa a'a!a( 9aran+ 'i a+ian &tara Ni+eria A 'i mana %t&'i ini 'i!a4&4an , Ivermectin 9&+a &n++&! &nt&4 o at to)i4a! 'a!am men+o ati oran+ imm&nocom)romi%e' 'en+an %4a ie%, 08A0; *an+ (ar&% 'i)er(ati4an 'a!am )en+at&ran A.ri4a 'en+an )reva!en%i tin++i in.e4%i FIV / )reva!en%i 67 'i Ni+eria )a'a ta(&n 011> 5 , Ba(4an 4eti4a e.e4tivita%n*a %etara 'en+an enzi! enzoat A 4e&nt&n+an tam a(an ivermectin mem &atn*a &n++&! )i!i(an 'i ne+ara er4em an+ A %e)erti Ni+eria A 'i mana 4on'i%i )en*e aran ce)at *an+ 'a)at menca)ai )ro)or%i e)i'emi , Eva!&a%i 9an+4a )an9an+ ri%i4o re E in.e%ta%i 'an tin+4at )en*a4it 'i 'e4at 4onta4 %t&'i !e i( !an9&t ,