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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 (does 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."

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

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

End Note

[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

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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."

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