Springboard message from Dr. Bachman

I've just returned from Honduras after spending time with 12 medical students and 10 other students on a selective.  We saw patients, did education, pulled teeth, and provided an experience which was very good. If you are interested in this selective, we are going again next February. The Selective time was Feb 14-28 and included the 8 day trip in Honduras.
Along the way we saw plenty of scabies  The NEJM had a nice article on this here
The Cochrane review also concluded that oral ivermectin appeared to be more effective than both lindane and topical benzyl benzoate (relative risk of treatment failure with ivermectin as compared with lindane, 0.36 in two trials involving 193 subjects, and relative risk with ivermectin as compared with benzyl benzoate, 0.50 in three trials involving 192 subjects). However, a recent study showed that there was a higher rate of treatment failure with single-dose ivermectin than with topical benzyl benzoate.¹⁹ This finding may reflect the fact that ivermectin does not sterilize scabies eggs. Therefore, a second dose of ivermectin is usually administered at least 1 week after the first dose to kill the newly hatched mites. Further support for this concept comes from a trial that compared ivermectin with topical permethrin in 85 patients.  In that trial, a single dose of ivermectin was less effective than topical permethrin (cure rate of 70% vs. 98%), but if a second dose of ivermectin was administered to patients who did not have a response after the first dose, the cure rate with ivermectin rose to 95%
In the United States, the average wholesale price of a 60-g tube of 5% permethrin cream is approximately $30.  The cost of a 3-mg tablet of ivermectin is approximately $6, which translates into a cost of about $30 for a single dose for a patient weighing 70 kg.
Meetings:
http://www.stfm.org/conferences/practiceimprovement/pi/index.cfm  Has Conference for Practice Improvement. You have 12 days before the deadline fro submission.  It is in San Antonio, Dec 2-5.
Unfortunately the Institute for Healthcare Improvement is meeting is close to the same time, Dec 5-8 in Orlando.
http://www.ihi.org/IHI/Programs/ConferencesAndSeminars/22ndAnnualNationalForumonQualityImprovementinHealthCare.htm
Both are excellent.
Have a good day