疥癬患者におけるイベルメクチンの安全性および投与回数についての検討 Ivermectin for the Treatment of Scabies-Review of the Safety and Number of Administration Times

2008年4月から同10月までの当院入院症例のうち，疥癬40例に対してイベルメクチン投与と安息香酸ベンジルオイラックス外用を行った。全例が65歳以上であった。イベルメクチン投与中および投与後に有害事象を認めた症例は臨床検査値異常が5例，基礎疾患によると考えられる死亡例が2例あった。このうち臨床検査値異常の5例はいずれも無治療で正常化した。軽度の肝障害を認めた2例に対してもイベルメクチンの内服治療を行ったが，投与後に臨床検査値の悪化は認めなかった。投与回数については疥癬のライフサイクルからは少なくとも2回の投与が望ましいと考えられた。しかし，2回で治癒した例は71%に過ぎず，12例で3回以上の投与を必要とした。疥癬の集団発生では，当院のような高齢者症例の多い場合でも積極的な内服加療が有効であり，比較的安全に使用できることが確認された。

From April through October 2008, 40 patients hospitalized at Rakuwakai Otowa Hospital were treated for scabies using oral ivermectin and external benzyl benzoate eurax. All patients were over 65 years of age. <BR>During or after their treatment, five of these patients showed abnormal blood chemistry ; however, the blood chemistry of all five patients returned to normal without any additional medicines. Two patients died of causes relating to pre-existing critical diseases. Two patients treated with ivermectin had previous minor liver disorders but showed no abnormal effects in their blood test data. Due to <I>Sarcoptes scabiei's</I> life cycle, it was believed that at least two administrations would be needed ; however, only 71% of scabies were cured after two administrations and twelve patients required more than three administrations. <BR>Based on this experience, during an outbreak of scabies in a closed community, such as a hospital, including groups of elderly individuals, we suggest ivermectin as a safe and effective treatment.