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What are standard ivermectin dosing guidelines for common human indications (scabies, strongyloidiasis) in mg/kg?
Executive summary
Standard, commonly cited ivermectin doses for human parasitic indications cluster around 150–200 micrograms per kilogram (mcg/kg or 0.15–0.2 mg/kg) as a single oral dose; many references say a single dose can be repeated (e.g., for scabies) after 7–14 days or at intervals of months for mass‐drug administration [1] [2] [3]. Larger, experimental or research regimens (hundreds to thousands mcg/kg or multi‑day courses) have been studied or modeled for other purposes and are distinct from routine dosing for scabies and strongyloidiasis [4] [5].
1. What major references say the dose is: 150–200 mcg/kg
Clinical and reference sites commonly present ivermectin dosing for parasitic infections in the 150–200 mcg/kg range. Mayo Clinic’s patient/drug summary notes the dose is usually 150 mcg/kg as a single dose and also lists 200 mcg/kg in other passages, reflecting that authoritative sources use that band for typical single‑dose therapy [1]. Several clinical guides and dermatology cheat sheets likewise recommend roughly 150–250 mcg/kg with repeat dosing for scabies or strongyloidiasis when needed [3] [2].
2. How scabies dosing is usually applied in practice
For scabies, many authorities recommend a weight‑based single oral dose of about 200 mcg/kg with a repeat dose after 7–14 days when necessary because ivermectin has limited activity against eggs and newly hatched mites; clinical guides explicitly state repeats at 7–14 days or additional doses for crusted scabies [3] [2]. Drugs.com guidance for scabies and related uses also notes that crusted scabies may require two or more doses spaced one to two weeks apart [6].
3. Strongyloidiasis — single dose versus repeat/verification
For strongyloidiasis, routine regimens often use a single weight‑based dose in the same 150–200 mcg/kg range, with some protocols repeating dosing or confirming eradication by stool testing; dermatology and general dosing summaries group strongyloidiasis with other parasitic infections treated by single‑dose ivermectin in that mcg/kg range [2] [3] [7]. The literature also emphasizes checking for parasitologic cure rather than assuming a single dose is always sufficient [7].
4. Mass‑administration and other dosing patterns (annual, filariasis)
Public health programs use different schedules and doses: mass treatment regimens for filariasis or onchocerciasis can use higher or repeated annual doses such as 0.4 mg/kg in combination programs or single annual doses of ~0.15 mg/kg in other settings, depending on the parasite and program design [6]. Drugs.com summarizes programmatic doses and the need for retreatment intervals because ivermectin does not reliably kill adult Onchocerca volvulus [6].
5. Higher and experimental dosing — what research shows
Research and trials have tested much higher or multi‑day regimens for other goals (e.g., mosquitocidal activity or experimental antiviral use). Modeling and trials have explored multi‑day regimens of 300–600 mcg/kg/day and even single doses up to 800 mcg/kg in research contexts; these are explicitly experimental and not the routine doses for scabies or strongyloidiasis [4] [5]. Systematic reviews note that usual doses (0.2–0.4 mg/kg) are considered very safe and that higher doses have been evaluated for safety in trials [8].
6. Where sources disagree or vary and why that matters
Documents differ in wording and numeric emphasis: Mayo Clinic lists 150 mcg/kg in some lines and 200 mcg/kg in others [1]; other guides present a range (150–250 mcg/kg) or round to 0.15 mg/kg for programmatic use [3] [2] [6]. These variations reflect different clinical contexts (single clinical treatment vs. mass administration), different parasite biology (egg vs. adult stages), and differing expert guidance, not necessarily outright contradiction. Clinicians choose within this band based on indication, severity (e.g., crusted scabies), local guidelines, and need for repeat dosing [3] [6].
7. Practical takeaways and limitations of the sources
Practical takeaway: for typical scabies or strongyloidiasis treatment, expect a single oral ivermectin dose around 150–200 mcg/kg (0.15–0.2 mg/kg), with repeat dosing for scabies often at 7–14 days and programmatic variations for mass treatment [1] [3] [6]. Limitations: the provided sources cover guidance and research up to different dates and contexts; they include clinical summaries, programmatic notes, and experimental trial reports but do not provide a single unified professional society guideline in this selection — clinicians should follow local, up‑to‑date institutional or national guidance when treating patients [1] [4] [8].
If you want, I can extract exact tablet counts for common body weights from a chosen source (e.g., Drugs.com weight bands) or compile specific repeat‑dose schedules for crusted scabies and strongyloidiasis from the sources above.