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Oral Ivermectin Compared with Ivermectin–Metronidazole Combined Therapy


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"In each group 15 patients received combined therapy with metronidazole (dose 250 mg three times per day for 2 weeks) and ivermectin (two doses of 200 μg/kg, 1 week apart), and 15 patients received ivermectin alone (two doses of 200 μg/kg, 1 week apart). All patients were then followed-up weekly for four visits."

"There was a difference in the mite count between the subgroups taking ivermectin and combined therapy during all follow-up visits. At the last visit, in the combined therapy subgroup, 1.7% of patients showed no clinical improvement, 26.7% showed a marked clinical improvement, and 71.6% showed complete remission. In those on the ivermectin regimen, 27 patients had a mite count >5 mites/cm2, 21.7% showed no clinical improvement, 33.3% showed a marked improvement, and 45% showed complete remission."

"In conclusion, the combined therapy was superior in decreasing the D. folliculorum count in all groups and in reducing the mite count to the normal level in rosacea and in blepharitis lesions, while the two regimens were comparable in reducing the mite count to the normal level in acne and peri-oral dermatitis lesions." [1]

ElaineA at RF reports she tried this regimen and reports the following: 

"Your dose of Ivermectin should be based on your body weight. For me that was 12 mg of Ivermectin per dose based on my body weight. Two doses of 12 mg. Ivermectin one week apart. Plus Oral Metronidazole 250 mg, 3 times a day for the two week time period. You will take both drugs on the start of the first and second weeks. On the other days you will take the Oral Metronidazole.

Here's the details. 

The treatment with Oral Ivermectin and Oral Metronidazole was based on an article published in the International Journal of Infectious disease in 2013. Treatment takes 2 weeks. Oral Ivermectin and Oral Metronidazole. Insurance copay for me was just $13.03 USD (Uninsured retail about $52 USD).

Paper can be found here: [1]

Treatment (from paper) based on body weight for the oral Ivernectin:
1. Two doses of oral Ivermectin one week apart, 200 micrograms Ivermectin per kilogram of body weight. Worked out to 12 mg for me - I am a relatively small adult. Take on an empty stomach with a large glass of water.
2. Oral Metronidazole, 250 mg. three times a day for two weeks.

As always, it is best to discuss this treatment with your doctor. These are prescription drugs. My family doctor was most helpful.

Converting 1 lb to kilograms and working out 0.2mg/kilogram

1 Pound = 0.453592 Kilograms => 0.453592 Kilograms/lb * 0.2 mg/Kilogram = 0.0907184 mg Ivermectin /lb of body weight.

So take your body weight in pounds and multiply by 0.0907184 mg Ivermectin /lb. As always its best to check with your doctor on the proper dosage!

Results from the paper on 120 people with confirmed Demodex mites for 4 different skin conditions including rosacea, acne, and blepharitis demodex (occular rosacea):

Remision: 71.6% of people in the study with the oral Ivermectin+ oral Metronidazole treatement went into remission vs. 45% on just oral Ivermectin. 
Marked improvement: 26.7% (Oral Iver+ Oral Metro) vs. 33% (Oral Iver. only). 
No Improvement: 1.7% (Oral Iver+ Oral Metro) vs. 21.7% (Oral Iver. only)

Another article I read said that liquid Metronidazole will not kill demodex mites. Based on my own experience, Metrogel did not work for me topically. The Oral Metronidazole in combination with the Oral Ivermectin worked extremely well. I'm nearly at 7 weeks post treatment and skin and eyes are still clear."

ElaineA, The Rosacea Forum, post no 10

ElaineA has a post worth reading on this subject, Oral Ivermectin, getting diagnosed and a prescription.

Oral Ivermectin Alone
One paper showed an effective treatment of demodex folliculitis using oral ivermectin without oral metronidazole, and concluded, "Substantial improvement was observed after two doses of oral ivermectin (200 μg/kg per dose, 2 weeks apart) with no relapse after one year. [2]

"Oral ivermectin (200 micrograms/kg/day) is also a treatment alternative for PPR although it is supported with level D evidence. In patients with treatment resistant rosacea, combination of oral ivermectin and permethrin 5% cream can be considered since this combination was found to be effective in decreasing demodex density in immunocompromised patients as well." [3]

Etcetera
More Information on Oral Ivermectin

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End Note

1-s2.0-S1201971213X00050-cov150h.gif.376
[1] International Journal of Infectious Diseases
Volume 17, Issue 5, May 2013, Pages e343-e347
Evaluation of the efficacy of oral ivermectin in comparison with ivermectin–metronidazole combined therapy in the treatment of ocular and skin lesions of Demodex folliculorum
Doaa Abdel-BadieSalema, Atef El-shazlya, Nairmen Nabiha, Youssef El-Bayoumy, Sameh Salehc

[2] CMAJ. 2017 Jun 26; 189(25): E865.doi: 10.1503/cmaj.161323
Demodex folliculitis
Claude Bachmeyer, MD and Alicia Moreno-Sabater, PharmD PhD

[3] Clin Cosmet Investig Dermatol. 2020; 13: 179–186.
Published online 2020 Feb 20. doi: 10.2147/CCID.S194074
PMCID: PMC7039055
PMID: 32110082
Conventional and Novel Treatment Modalities in Rosacea
Burhan Engin, Defne Özkoca, Zekayi Kutlubay, and Server Serdaroğlu

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ElaineA [post no 3] reports trying this treatment and posts on September 14, 2018, "I am still clear at 7 months post oral treatment."

ElaineA [post no 5] reports, "I'm still clear at 1 year! This 2 drug combined oral treatment worked extremely well for me. I had no side effects from the oral drugs. Treatment with the drugs took 2 weeks. I also continued to use the Cliradex wipes on face and eye lids during the 2 week treatment and for 2 weeks after treatment as an additional precaution."

ElaineA [post no 1339] reports, "I took the 2 drug oral ivermectin + oral metronidazole treatment early last year. It worked. 15+ months later my eyes and skin are still clear. I didn't have any problems with taking the 2 oral drugs.

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1-s2.0-S1201971213X00050-cov150h.gif

So, we suggest that the combined therapy works better than ivermectin alone on cases with different skin lesions and anterior blepharitis.

In conclusion, the combined therapy was superior in decreasing the D. folliculorum count in all groups and in reducing the mite count to the normal level in rosacea and in blepharitis lesions, while the two regimens were comparable in reducing the mite count to the normal level in acne and peri-oral dermatitis lesions.

International Journal of Infectious Diseases
Volume 17, Issue 5, May 2013, Pages e343-e347
Evaluation of the efficacy of oral ivermectin in comparison with ivermectin–metronidazole combined therapy in the treatment of ocular and skin lesions of Demodex folliculorum
Doaa Abdel-Badie Salema, Atef El-shazly, Nairmen Nabih, Youssef El-Bayoumy, Sameh Salehc

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