All the RCTs were too small to provide adequate safety data for use of ivermectin against scabies, particularly in children. Ivermectin has been used extensively in community control programmes for onchocerciasis and filariasis and there have been few reports of serious adverse events.51,52 There has been one report of a significant increase in mortality rate in a psychogeriatric unit (15/42 (36%); P = 0-001) within 6 months of ivermectin use compared with controls in the same care facility over a 3-year period.53 However, each resident in the unit had previously received several applications of other scabies treatments, including lindane and permethrin. Use of ivermectin in the elderly in other countries has not resulted in any similar increase in mortality.54

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