Efficacy of 5% permethrin-2% fusidic acid cream compared to 5% permethrin-placebo in the treatment of impetiginized scabies

Introduction: Scabies is caused by Sarcoptes scabiei var hominis, often causing secondary bacterial infections, especially by Streptococcus pyogenes and Staphylococcus aureus. Permethrin 5% cream is the first-line of treatment that is recommended, combined with Fusidic acid 2% cream as the first-line topical antibiotic. We investigated the efficacy of a combination of permethrin 5% cream and fusidic acid 2% cream for the treatment of impetiginized scabies. Methodology: A double-blind, randomized clinical trial was organized at two Islamic boarding schools in Bogor, West Java, Indonesia. Forty subjects were randomly allocated into the intervention group (permethrin 5% and fusidic acid 2%; n = 20), and the control group (permethrin 5% and placebo; n = 20). Treatment efficacy was determined through the visual analogue scale (VAS) for pruritus and pain, and by examining bacterial cultures. Results: Treatment efficacy in the intervention group was higher than in the control group on day 7 (80% vs. 35%) and day 14 (95% vs 35%, p ≤ 0.001, RR 2.714) with decreasing VAS for pruritus (p = 0.04) and pain (p = 0.035). The most common bacterium was Staphylococcus aureus. Some minor adverse effects such as itch and heat occurred temporarily. Conclusions: Treating impetiginized scabies with permethrin 5% and fusidic acid 2% cream is more effective than treating with only 5% premethrin. The most common bacterium causing secondary infection in impetiginized scabies is Staphylococcus aureus.