In reply: We thank Morton and Morton for summarising the international evidence for the safety of ivermectin in children and pregnancy. We agree that there is accumulating evidence that ivermectin is likely to be safe in small children and pregnancy.1,2,3 However, currently in Australia, ivermectin is only licensed for use in children aged over 5 years and weighing more than 15 kg and when treatment with first line scabicides has failed or is contraindicated. Mass drug administration with ivermectin for scabies has been trialled in the Northern Territory,4 which showed modest benefit. Globally, mass drug administration with ivermectin has been more promising and offered a sustained reduction in scabies and impetigo.5 Further safety data from mass drug administration trials using ivermectin in childhood and pregnancy will help progress access to this effective scabicide.3
- 1. Levy M, Martin L, Bursztejn AC, et al. Ivermectin safety in infants and children under 15 kg treated for scabies: a multicentric observational study. Br J Dermatol 2020; 182: 1003–1006.
- 2. Wilkins AL, Steer AC, Cranswick N, et al. Question 1: is it safe to use ivermectin in children less than five years of age and weighing less than 15 kg? Arch Dis Child 2018; 103: 514–519.
- 3. Chosidow O, Giraudeau B, Cottrell J, et al. Oral Ivermectin versus Malathion Lotion for Difficult‐to-Treat Head Lice. N Engl J Med 2010; 362: 896–905.
- 4. Kearns TM, Speare R, Cheng AC, et al. Impact of an ivermectin mass drug administration on scabies prevalence in a remote Australian Aboriginal community. PLoS Negl Trop Dis 2015; 9: e0004151.
- 5. Romani L, Marks M, Sokana O, et al. Efficacy of mass drug administration with ivermectin for control of scabies and impetigo, with coadministration of azithromycin: a single‐arm community intervention trial. Lancet Infect Dis 2019; 19: 510–518.
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