Antiparasitic activity of ivermectin: Four decades of research into a "wonder drug"

Parasitic diseases still pose a serious threat to human and animal health, particularly for millions of people and their livelihoods in low-income countries. Therefore, research into the development of effective antiparasitic drugs remains a priority. Ivermectin, a sixteen-membered macrocyclic lactone, exhibits a broad spectrum of antiparasitic activities, which, combined with its low toxicity, has allowed the drug to be widely used in the treatment of parasitic diseases affecting humans and animals. In addition to its licensed use against river blindness and strongyloidiasis in humans, and against roundworm and arthropod infestations in animals, ivermectin is also used "off-label" to treat many other worm-related parasitic diseases, particularly in domestic animals. In addition, several experimental studies indicate that ivermectin displays also potent activity against viruses, bacteria, protozoans, trematodes, and insects. This review article summarizes the last 40 years of research on the antiparasitic effects of ivermectin, and the use of the drug in the treatment of parasitic diseases in humans and animals.

In Vivo Evaluation of an Ivermectin and Allicin Combination Treatment for Eradicating Poultry Red Mite

A safe and effective method for eradicating poultry red mite (PRM; Dermanyssus gallinae) is urgently needed, as existing treatments show a low efficacy or hazardous effects on chickens. We evaluated the efficacy of a combined treatment with ivermectin and allicin (IA) against PRMs in chickens and drug residues in non-target samples. The efficiency of PRM eradication by IA was compared with those of natural acaricides in vitro. Ivermectin (0.25 mg/mL) + allicin (1 mg/mL) (IA compound) was sprayed on isolator housing hens with PRMs. The PRM mortality rate, clinical symptoms, and ivermectin residue in hens were analyzed. IA showed the highest PRM-eradication efficacy among all tested compounds in vitro. The insecticidal rates of IA were 98.7%, 98.4%, 99.4%, and 99.9% at 7, 14, 21, and 28 days of treatment, respectively. After inoculating PRMs, hypersensitivity, itching, and a pale-colored comb were observed in control animals, which were absent in treated hens. No clinical symptoms from IA and ivermectin residues were found in hens. IA effectively exterminated PRMs, demonstrating its potential for industrial use to treat PRMs.

Head Lice

Head lice infestation is associated with limited morbidity but causes a high level of anxiety among caregivers of school-aged children and adolescents. Since the 2015 clinical report on head lice was published by the American Academy of Pediatrics, new medications have been approved, and an algorithm for management of affected patients is included. This revised clinical report clarifies current diagnosis and treatment protocols.

Human pediculosis, a global public health problem

Background

Human pediculosis is caused by hematophagous lice, which are transmitted between individuals via direct and/or indirect contact. Despite the public health importance of louse infestation, information concerning the global burden of pediculosis and the epidemiological landscape of louse-borne diseases is limited. The aim of this review was to summarize the biology, epidemiology, diagnosis, and control of lice infestation in humans. We also discussed the latest advances in molecular taxonomy and molecular genetics of lice.

Methods

We searched five electronic bibliographic databases (PubMed, ScienceDirect, CNKI, VIP Chinese Journal Database, and Wanfang Data) and followed a standard approach for conducting scoping reviews to identify studies on various aspects of human lice. Relevant information reported in the identified studies were collated, categorized, and summarized.

Results

A total of 282 studies were eligible for the final review. Human pediculosis remains a public health issue affecting millions of people worldwide. Emerging evidence suggests that head lice and body lice should be considered conspecific, with different genotypes and ecotypes. Phylogenetic analysis based on mitochondrial (mt) cytb gene sequences identified six distinct clades of lice worldwide. In addition to the direct effect on human health, lice can serve as vectors of disease-causing pathogens. The use of insecticides plays a crucial role in the treatment and prevention of louse infestation. Genome sequencing has advanced our knowledge of the genetic structure and evolutionary biology of human lice.

Conclusions

Human pediculosis is a public health problem affecting millions of people worldwide, particularly in developing countries. More progress can be made if emphasis is placed on the use of emerging omics technologies to elucidate the mechanisms that underpin the physiological, ecological, and evolutionary aspects of lice.

Graphic Abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s40249-022-00986-w.

Effectiveness of topical 0.5% ivermectin shampoo in the treatment of pediculosis capitis among school-going female children

Background:

Pediculosis is a common ectoparasitic infestation in children. There are different treatment modalities that have been used in the treatment of pediculosis capitis from time immemorial, each with their own shortcomings. Increasing emergence of resistance to permethrin has led to the lookout for newer alternatives.

Aims and Objectives:

The role of topical ivermectin in the management of pediculosis in people with culturally different hair grooming practices is analyzed in this study.

Materials and Methods:

This observational open-label clinical study was conducted in September–November 2019 in the schools that were under the rural health center at South India among school-going female children aged between 13 and 16 years of age and diagnosed with pediculosis.

Results:

This study demonstrated that a single application of ivermectin shampoo was able to kill head lice in 86.2% of the participants. In participants with persistent infection (13.8%), a repeat application killed the entire louse and 100% efficacy was demonstrated. Topical ivermectin is devoid of systemic side effects of oral ivermectin. Topical ivermectin has found to be more effective than contemporary recommended agents such as malathion and permethrin.

Effective treatments for head lice

Head lice is a parasitic infestation common in children. Proper management is essential to treat lice in a safe, convenient, cost-effective, and efficacious manner. School lice policies are often antiquated and can stigmatize the child and family. Evidence-based care guidelines may significantly help families minimize the stress of lice.

Design of a Topically Applied Gel Spray Formulation with Ivermectin Using a Novel Low Molecular Weight Gelling Agent, Palmitoyl-Glycine-Histidine, to Treat Scabies

Palmitoyl-glycine-histidine (Pal-GH) is a new low molecular weight gelling agent. It exhibits thixotropic behavior, low viscosity, and high dissolving properties for a wide range of hydrophilic to lipophilic drugs. Orally administered ivermectin (IVM) is used to treat scabies. However, this treatment is associated with well-known side effects, thus a study is awaited to search for alternative routes of administration. Although a topical formulation of IVM could be a candidate, it requires whole body application except the head and face for several hours on a daily basis. Therefore, in this study, we prepared a gel spray formulation containing IVM as an approach for application to large skin areas with a single spray application without further contact with the applied formulation. Pal-GH gel spray formulations were prepared from its aqueous solution by a heating and cooling method. Rheological behavior and physical appearance (spraying, spreading ability, volume of spraying, and homogeneity) of the prepared formulations were evaluated. Pal-GH gel with propylene glycol demonstrated impressive rheological properties (typical thixotropic behavior) with high hysteresis area among all the tested Pal-GH gels and spreading ability. The obtained IVM concentration in the skin after topical application of 0.1% IVM-containing Pal-GH formulation onto hairless rats was much higher than the reported therapeutic concentration obtained from oral administration in humans. These results suggested that topical application of IVM using a Pal-GH gel spray formulation could be an alternative to the conventional oral forms for the scabies treatment.

Head lice

Head lice infestation is associated with limited morbidity but causes a high level of anxiety among parents of school-aged children. Since the 2010 clinical report on head lice was published by the American Academy of Pediatrics, newer medications have been approved for the treatment of head lice. This revised clinical report clarifies current diagnosis and treatment protocols and provides guidance for the management of children with head lice in the school setting.

Treatment of pediculosis capitis: a critical appraisal of the current literature

Pediculosis capitis is the most common ectoparasitic disease in children in industrialized countries and extremely common in resource-poor communities of the developing world. The extensive use of pediculicides with a neurotoxic mode of action has led to the development and spread of resistant head lice populations all over the world. This triggered the development of compounds with other modes of action. The current literature on treatment approaches of head lice infestation was searched, and published randomized controlled trials were critically analyzed. The following compounds/family of compounds were identified: spinosad, a novel compound with a new neurotoxic mode of action, isopropyl myristate, 1,2-octanediol, ivermectin, plant-based products, and dimeticones. The efficacy and safety of these compounds are reviewed and recommendations for the treatment of pediculosis capitis in individuals as well as the interruption of ongoing epidemics are provided.