BMJ

Permethrin outperforms oral ivermectin in large cluster randomized scabies trial

March 12, 2026

This multicentre, assessor‑blinded, cluster‑randomized SCRATCH trial included 507 ivermectin‑treated participants across 142 households and 568 permethrin‑treated participants across 147 households. Cluster‑level cure at day 28 reached 71.8% with ivermectin vs. 88.5% with permethrin (–16.7 percentage‑point difference; 95% confidence interval [CI], –26.3 to –7.1). Index‑case cure rates were likewise higher with permethrin (91.5%) than ivermectin (76.6%) (–14.9 percentage‑point difference; 95% CI, –23.6 to –6.2). Individual‑level cure rates also favored permethrin (94.2% vs. 85.3%; –9.2 percentage‑point difference; 95% CI, –14.9 to –3.5). Cutaneous adverse events occurred in 11.9% of ivermectin recipients and 15.6% of permethrin recipients.

Clinical takeaway: For classic scabies, 5% permethrin remains the more effective option, and clinicians should consider it first line—especially when maximizing household‑level cure is essential.

Source:

Boralevi F, et al. (2026, January 6). BMJ. Oral ivermectin versus 5% permethrin cream to treat children and adults with classic scabies: multicentre, assessor blinded, cluster randomised clinical trial. https://pubmed.ncbi.nlm.nih.gov/41494769/