Abstract：
BACKGROUND: Treatment failure is considered to be an important factor in relation to the increase in scabies incidence over the last decade. However, the regional and temporal differences, in addition to the predictors of therapy failure, are unclear.
OBJECTIVE: We aimed to conduct a systematic review of the prevalence of treatment failure in patients with scabies and investigation of associated factors.
METHODS: We searched MEDLINE, EMBASE, CINAHL, Web of Science, Scopus, Global Health and the Cochrane Central Register of Controlled Trials from inception to August 2021 for randomized and quasi-randomized trials, in addition to observational studies that enrolled children or adults diagnosed with confirmed or clinical scabies treated with permethrin, ivermectin, crotamiton, benzyl benzoate, malathion, sulfur or lindane, and measured treatment failure or factors associated with treatment failure. We performed a random effects meta-analysis for all outcomes reported by at least two studies.
RESULTS: A total of 147 studies were eligible for inclusion in the systematic review. The overall prevalence of treatment failure was 15.2% [95% confidence interval (CI) 12.9-17.6; I2 = 95.3%, moderate-certainty evidence] with regional differences between World Health Organization regions (P = 0.003) being highest in the Western Pacific region (26.9%, 95% CI 14.5-41.2). Oral ivermectin (11.8%, 95% CI 8.4-15.4), topical ivermectin (9.3%, 95% CI 5.1-14.3) and permethrin (10.8%, 95% CI 7.5-14.5) had relatively lower failure prevalence compared with the overall prevalence. Failure prevalence was lower in patients treated with two doses of oral ivermectin (7.1%, 95% CI 3.1-12.3) compared with those treated with one dose (15.2%, 95% CI 10.8-20.2; P = 0.021). Overall and permethrin treatment failure prevalence in the included studies (1983-2021) increased by 0.27% and 0.58% per year, respectively. Only three studies conducted a multivariable risk factor analysis; no studies assessed resistance.
CONCLUSIONS: A second dose of ivermectin showed lower failure prevalence than single-dose ivermectin, which should be considered in all guidelines. The increase in treatment failure over time hints at decreasing mite susceptibility for several drugs, but reasons for failure are rarely assessed. Ideally, scabicide susceptibility testing should be implemented in future studies.
OBJECTIVE: We aimed to conduct a systematic review of the prevalence of treatment failure in patients with scabies and investigation of associated factors.
METHODS: We searched MEDLINE, EMBASE, CINAHL, Web of Science, Scopus, Global Health and the Cochrane Central Register of Controlled Trials from inception to August 2021 for randomized and quasi-randomized trials, in addition to observational studies that enrolled children or adults diagnosed with confirmed or clinical scabies treated with permethrin, ivermectin, crotamiton, benzyl benzoate, malathion, sulfur or lindane, and measured treatment failure or factors associated with treatment failure. We performed a random effects meta-analysis for all outcomes reported by at least two studies.
RESULTS: A total of 147 studies were eligible for inclusion in the systematic review. The overall prevalence of treatment failure was 15.2% [95% confidence interval (CI) 12.9-17.6; I2 = 95.3%, moderate-certainty evidence] with regional differences between World Health Organization regions (P = 0.003) being highest in the Western Pacific region (26.9%, 95% CI 14.5-41.2). Oral ivermectin (11.8%, 95% CI 8.4-15.4), topical ivermectin (9.3%, 95% CI 5.1-14.3) and permethrin (10.8%, 95% CI 7.5-14.5) had relatively lower failure prevalence compared with the overall prevalence. Failure prevalence was lower in patients treated with two doses of oral ivermectin (7.1%, 95% CI 3.1-12.3) compared with those treated with one dose (15.2%, 95% CI 10.8-20.2; P = 0.021). Overall and permethrin treatment failure prevalence in the included studies (1983-2021) increased by 0.27% and 0.58% per year, respectively. Only three studies conducted a multivariable risk factor analysis; no studies assessed resistance.
CONCLUSIONS: A second dose of ivermectin showed lower failure prevalence than single-dose ivermectin, which should be considered in all guidelines. The increase in treatment failure over time hints at decreasing mite susceptibility for several drugs, but reasons for failure are rarely assessed. Ideally, scabicide susceptibility testing should be implemented in future studies.
摘要：
背景：治疗失败被认为是过去十年中sc疮发病率增加的重要因素。然而,治疗失败的区域和时间差异以及预测因素尚不清楚.
目的：系统评价sc疮患者治疗失败的发生率及相关因素。
方法：我们搜索了MEDLINE，EMBASE,CINAHL,WebofScience,Scopus,全球卫生和CochraneCentral从成立到2021年8月进行随机和准随机试验，以及纳入儿童或成人诊断为使用氯菊酯治疗的确诊或临床sc疮的观察性研究，伊维菌素,Crotamiton,苯甲酸苄酯，马拉硫磷,硫磺,或者林丹,和测量治疗失败或与治疗失败相关的因素。我们对至少两项研究报告的所有结果进行了随机效应荟萃分析。
结果：147项研究合格。治疗失败的总患病率为15.2%(95%CI:12.9~17.6;I2=95.3%,中度确定性证据），世卫组织区域之间的差异（P=0.003）在西太平洋区域最高（26.9％[95％CI：14.5至41.2]）。口服伊维菌素（11.8%[95%CI：8.4至15.4]），与总体患病率相比,局部用伊维菌素(9.3%[95%CI:5.1~14.3])和氯菊酯(10.8%[95%CI:7.5~14.5])的失败患病率相对较低.与接受单剂量治疗的患者(15.2%[95%CI:10.8至20.2];P=0.021)相比，接受两种剂量口服伊维菌素治疗的患者的失败发生率较低(7.1%[95%CI:3.1至12.3]。纳入研究（1983-2021年）的总体和氯菊酯治疗失败的患病率每年增加0.27％和0.58％，分别。只有三项研究进行了多变量危险因素分析，没有人评估阻力。
结论：第二剂量伊维菌素的失败发生率低于单剂量伊维菌素，应在所有指南中加以考虑。随着时间的推移，治疗失败的增加暗示了螨对几种药物的易感性降低，但很少评估失败的原因。理想情况下,在未来的研究中,应实施杀螨药敏试验.
目的：系统评价sc疮患者治疗失败的发生率及相关因素。
方法：我们搜索了MEDLINE，EMBASE,CINAHL,WebofScience,Scopus,全球卫生和CochraneCentral从成立到2021年8月进行随机和准随机试验，以及纳入儿童或成人诊断为使用氯菊酯治疗的确诊或临床sc疮的观察性研究，伊维菌素,Crotamiton,苯甲酸苄酯，马拉硫磷,硫磺,或者林丹,和测量治疗失败或与治疗失败相关的因素。我们对至少两项研究报告的所有结果进行了随机效应荟萃分析。
结果：147项研究合格。治疗失败的总患病率为15.2%(95%CI:12.9~17.6;I2=95.3%,中度确定性证据），世卫组织区域之间的差异（P=0.003）在西太平洋区域最高（26.9％[95％CI：14.5至41.2]）。口服伊维菌素（11.8%[95%CI：8.4至15.4]），与总体患病率相比,局部用伊维菌素(9.3%[95%CI:5.1~14.3])和氯菊酯(10.8%[95%CI:7.5~14.5])的失败患病率相对较低.与接受单剂量治疗的患者(15.2%[95%CI:10.8至20.2];P=0.021)相比，接受两种剂量口服伊维菌素治疗的患者的失败发生率较低(7.1%[95%CI:3.1至12.3]。纳入研究（1983-2021年）的总体和氯菊酯治疗失败的患病率每年增加0.27％和0.58％，分别。只有三项研究进行了多变量危险因素分析，没有人评估阻力。
结论：第二剂量伊维菌素的失败发生率低于单剂量伊维菌素，应在所有指南中加以考虑。随着时间的推移，治疗失败的增加暗示了螨对几种药物的易感性降低，但很少评估失败的原因。理想情况下,在未来的研究中,应实施杀螨药敏试验.
