Scabies - Management of Infection Guidance for Primary Care

Publication: 30/09/2010  
Next review: 21/10/2023  
Clinical Guideline
ID: 2260 
Approved By: LAPC 
Copyright© Leeds Teaching Hospitals NHS Trust 2020  


This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.




Preferred option



Treat all home & sexual contacts within 24 hours 1C
Treat whole body from ear/chin downwards and under nails.
If under 2 years/elderly, also face/scalp 2

Permethrin 3A+
5% cream
2 applications, 1 week apart 1C

Malathion 3 D
0.5% aqueous liquid
2 applications, 1 week apart 1C

Principles of Treatment

  1. This guidance is based on the best available evidence but its application must be modified by professional judgement.
  2. A dose and duration of treatment is suggested. In severe or recurrent cases consider a larger dose or longer course
  3. Choices are given as Preferred option or Alternative for patients intolerant of the preferred option and 2nd Line for when an alternative is required because of treatment failure
  4. Only send microbiology specimens if there is a clinical suspicion of infection. Inappropriate specimens (e.g. routine ulcer swab or routine catheter specimen of urine) lead to inappropriate antibiotic prescribing.
  5. Prescribe an antibiotic only when there is likely to be a clear clinical benefit.
  6. Limit prescribing over the telephone to exceptional cases.
  7. Where a ‘best guess’ therapy has failed or special circumstances exist, microbiological advice can be obtained from LTHT Microbiology (Mon-Fri 9am-5pm and Sat and Sun 9am-1pm: 0113 39 23962/28580; Otherwise via LTHT switchboard - ask for the On call Microbiology Registrar)

Note: Doses are oral and for adults unless otherwise stated. Please refer to BNF for further information.


Record: 2260
  • to provide a simple, empirical approach to the treatment of common infections
  • to promote the safe, effective and economic use of antibiotics
  • to minimise the emergence of bacterial resistance and reduce the incidence of Healthcare Associated Infections in the community
Clinical condition:


Target patient group:
Target professional group(s): Primary Care Doctors
Adapted from:

This guidance was initially developed in 1999 by practitioners in South Devon, as part of the S&W Devon Joint Formulary Initiative, and Cheltenham & Tewkesbury Prescribing Group and modified by the PHLS South West Antibiotic Guidelines Project Team, PHLS Primary Care Co-ordinators and members of the Clinical Prescribing Sub-group of the Standing Medical Advisory Committee on Antibiotic Resistance. It was further modified following comments from Internet users. The guidance has been updated annually as significant research papers, systematic reviews and guidance have been published. The Health Protection Agency works closely with the authors of the Clinical Knowledge Summaries.

Evidence base

Grading of guidance recommendations
The strength of each recommendation is qualified by a letter in parenthesis.

Study design


Good recent systematic review of studies


One or more rigorous studies, not combined


One or more prospective studies


One or more retrospective studies


Formal combination of expert opinion


Informal opinion, other information


Letters indicate strength of evidence:
A+ = systematic review: D = informal opinion


  1. HPA. The management of scabies in the community. Health Protection Agency North West. 2005. Accessed 22.09.14. RATIONALE: Treatment of all contacts: expert opinion is that the index case and all members of the household and sexual contacts should be treated within 24 hours of one another, even in the absence of symptoms, to reduce the risk of re-infestation. Two treatments, 7 days apart: expert opinion is that two treatment sessions are needed to treat scabies effectively.#
  2. ABPI Medicines Compendium. Lyclear Dermal Cream. Datapharm Communications Ltd. 2008. Accessed 23.09.14.
  3. Strong M, Johnstone P. Interventions for treating scabies. Cochrane Database of Systematic Reviews. 2007. Issue 3 Accessed 23.09.14. RATIONALE: Permethrin: topical permethrin appeared more effective than oral ivermectin, topical crotamiton, and topical lindane. The greatest body of evidence is for topical permethrin compared with lindane (n=735, five RCTs: RR 0.32, 95% CI 0.13 to 0.75). Malathion: no RCTs were found that evaluated the efficacy of malathion for the treatment of scabies. Malathion has only been evaluated in uncontrolled studies.

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Document history

LHP version 1.0

Related information

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