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Ivermectin More Effective Than Metronidazole


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  • Root Admin

"The role of ivermectin in the treatment of rosacea may be as an anti-inflammatory and anti-parasitic agent targeting Demodex mites. In comparing topical ivermectin and metronidazole, ivermectin was more effective; this treatment modality boasted more improved quality of life, reduced lesion counts, and more favorable participant and physician assessment of disease severity. Patients who received ivermectin 1% cream had an acceptable safety profile. Ivermectin is efficacious in decreasing inflammatory lesion counts and erythema." [1]

"Head-to-head trials show that azelaic acid and ivermectin might be slightly better than metronidazole." [2]

[1] Dovepress
New developments in the treatment of rosacea – role of once-daily ivermectin cream
Leah A Cardwell, Hossein Alinia, Sara Moradi Tuchayi, Steven R Feldman
Accepted for publication 11 January 2016
Published 18 March 2016 Volume 2016:9 Pages 71—77
DOI https://doi.org/10.2147/CCID.S98091

[2] Topical treatments for rosacea.
Can Fam Physician. 2019 11;65(11):803
Authors: Fritsch P, Kolber MR, Korownyk C

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  • Root Admin

Another study showing the superiority of ivermectin over metronidazole has been published by NEJH Journal Watch. 399 rosacea patients enrolled in a study who were judged clear after receiving 16 weeks of ivermectin treatment and stopped the ivermectin treatment. Those that had a greater IGA score of ≤2 (which means some pimples/redness returned) "resumed their original topical treatment until remission was again obtained" whether it was ivermectin or metronidazole. The study showed that the relapse rate of rosacea was more days than those using the metronidazole treatment, in other words, the number of days to the relapse of rosacea was higher in the ivermectin group than the metronidazole group. The study concluded, "The relapse rate by study end at 36 weeks was lower for IVER recipients (62.7%) than MET recipients (68.4%)."

Metronidazole vs. Ivermectin
Mark V. Dahl, MD reviewing Taieb A et al. J Eur Acad Dermatol Venereol 2015 Dec 21
Which drug for remission of rosacea?


"The results of this relapse study showed that an initial successful treatment with ivermectin 1% cream QD significantly extended remission of rosacea compared with initial treatment with metronidazole 0.75% cream BID following treatment cessation."

J Eur Acad Dermatol Venereol. 2016 May;30(5):829-36. doi: 10.1111/jdv.13537. Epub 2015 Dec 21.
Maintenance of remission following successful treatment of papulopustular rosacea with ivermectin 1% cream vs. metronidazole 0.75% cream: 36-week extension of the ATTRACT randomized study.
Taieb A, Khemis A, Ruzicka T, Barańska-Rybak W, Berth-Jones J, Schauber J, Briantais P, Jacovella J, Passeron T; Ivermectin Phase III Study Group


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"Better efficacy with IVM 1% cream (QD) compared to MTZ 0.75% cream (BID) contributes to an improved quality of life with significantly more patients achieving an MCID in DLQI score at week 16 and higher mean EQ-5D score. IVM 1% cream is thus a better alternative than MTZ 0.75% cream for severe papulopustular rosacea patients."

Dermatol Ther (Heidelb). 2016 Sep; 6(3): 427–436.
Superior Efficacy with Ivermectin 1% Cream Compared to Metronidazole 0.75% Cream Contributes to a Better Quality of Life in Patients with Severe Papulopustular Rosacea: A Subanalysis of the Randomized, Investigator-Blinded ATTRACT Study
Martin Schaller, Thomas Dirschka, Lajos Kemény, Philippe Briantais, and Jean Jacovella


"Ivermectin 1% cream was significantly superior to MTZ 0·75% cream and achieved high patient satisfaction."

Br J Dermatol. 2015 Apr;172(4):1103-10. doi: 10.1111/bjd.13408. Epub 2015 Feb 11.
Superiority of ivermectin 1% cream over metronidazole 0·75% cream in treating inflammatory lesions of rosacea: a randomized, investigator-blinded trial.
Taieb A, Ortonne JP, Ruzicka T, Roszkiewicz J, Berth-Jones J, Peirone MH, Jacovella J; Ivermectin Phase III study group.


"Topical ivermectin is an effective option in the treatment of papulopustular rosacea. Although ivermectin seems to be more effective than topical metronidazole, with both treatment options about two-thirds of patient relapsed within 36 weeks after discontinuation of treatment."

Dermatol Ther (Heidelb). 2018 Sep;8(3):379-387. doi: 10.1007/s13555-018-0249-y. Epub 2018 Jun 25.
Topical Ivermectin in the Treatment of Papulopustular Rosacea: A Systematic Review of Evidence and Clinical Guideline Recommendations.
Ebbelaar CCF, Venema AW, Van Dijk MR.


"Ivermectin 1% cream QD appears to be a more effective topical treatment than other current options for the inflammatory lesions of rosacea, with at least an equivalent safety and tolerability profile, and could provide physicians and dermatologists with an alternative first-line treatment option."

Springerplus. 2016 Jul 22;5(1):1151. doi: 10.1186/s40064-016-2819-8. eCollection 2016.
The efficacy, safety, and tolerability of ivermectin compared with current topical treatments for the inflammatory lesions of rosacea: a network meta-analysis.
Siddiqui K, Stein Gold L, Gill J.


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