Medifox Super remedy for body lice, head lice, pubic lice, scabies mites, bedbugs, cockroaches, 500 ml

Every year, about 300 million people worldwide suffer from scabies [1, 2]. According to foreign authors [3-8], the incidence of scabies in various regions of the globe is increasing, including in European countries: France, Poland, Belgium, England. Scabies is a global health problem in third world countries [9]. It is an endemic disease in tropical and subtropical regions such as Africa, central and South America, northern and central Australia, and Southeast Asia [10–13]. Scabies is also relevant for the countries of the Middle East. During a mass survey of the population of one of the cities of Iraq (2007–2008), this parasitosis was detected in 11.1% of cases [14, 15].

In Russia, over the past two and a half decades, the intensive incidence rate of scabies has decreased from year to year [16–21]. Compared to 2005, by 2012 its value decreased by 3.5 times - from 132.0 to 38.2 [22-24]. A similar situation is typical for Uzbekistan and Tajikistan [25, 26].

At the same time, by decree of the Government of R.F. No. 715 of December 1, 2004 “On approval of the list of socially significant diseases and the list of diseases that pose a danger to others,” scabies is included in this list [27]. The report of the Moscow Minister of Health noted that in the structure of infectious morbidity in the capital's population, the largest share falls on pediculosis and scabies (54.3%), which is 2.8 times more than the incidence of airborne infections (19.3%) and 3.6 times more than intestinal infections (15.1%) [28]. In official documents of the Ministry of Health of the Russian Federation. It was noted that only cases of scabies are registered when patients visit government medical organizations [29].

Using an anonymous survey of 319 dermatovenerologists in 6 federal districts (FD) of the Russian Federation, significant shortcomings in the registration of scabies were identified. More than 2/3 of dermatovenereologists practice treatment of diseases under other diagnoses. The reasons for deliberate concealment of information are uncertainty in the diagnosis (59.2%), personal request of the patient (19.3%) and reluctance to carry out anti-epidemic measures in the outbreak (18.4%). Trial treatment for scabies is practiced by 86.2% of doctors, and more than half (50.6%) with a positive effect are not interested in registering it [30].

It has been mathematically proven that the real incidence of scabies in the Russian Federation is significantly higher than the official one. Several indicators were used for the calculation: the volume of sold scabicides (benzyl benzoate, spregal, medifox, sulfur ointment) for 2010-2012. (according to Рharmexpert); the absolute number of patients with scabies registered in the ministries of health, defense, internal affairs, and the federal penitentiary service over these years; the use of scabicides for the treatment of other dermatoses and prophylactic treatment of contact persons; course consumption of each scabicide. The real number of patients with scabies in the Russian Federation turned out to be 11.8 times (2010), 12.7 (2011) and 16.1 (2012) higher than officially registered [31]. The data obtained indicate the relevance of the problem of scabies for healthcare in the Russian Federation.

In the Order of M.Z. RF No. 162 dated April 24, 2003 “On approval of the industry standard “Protocol for the management of patients. Scabies" (hereinafter Order No. 162) only two treatment models are given - therapy for typical scabies and post-scabiosis itching. Experience in the system of postgraduate professional education shows that doctors often ask questions about the management of patients with complicated scabies (pyoderma, dermatitis, microbial eczema) and scabies with scabious lymphoplasia of the skin [31].

It is well known that the clinical picture of scabies is determined by several factors: the activity of the mite, the body’s allergic reaction to the pathogen and its metabolic products (feces; oral secretion secreted by the female when making a burrow; secretion of the oviduct glands, which serves to glue eggs to the bottom of the burrow), pyogenic microflora [32 ]. In accordance with the parasitism characteristics of the scabies mite Sarcoptes scabiei

(L.) in humans, several clinical variants of scabies are distinguished: typical, Norwegian, complicated, without burrows, “clean” or “incognito” scabies, with scabious skin lymphoplasia (SCL) and pseudosarcoptosis [33-35]. This classification is officially approved by Order No. 162. In addition, a new clinical type of scabies has been described - scabious erythroderma, the treatment model of which is already included in the “Federal Clinical Guidelines for the Management of Patients with Scabies” [36, 37]. Examination and treatment of a large number of patients with scabies made it possible to establish that the occurrence of microbial eczema in scabies is often confined to the localization of the scabies (buttocks, abdomen, axillary folds) [32, 38, 39]. After resolution of infiltration in foci of microbial eczema, lenticular papules with a diameter of 5-7 mm often become visible, which can persist for several months. In the hot climate of the Republic of Tajikistan, during the examination and treatment of 217 patients with scabies, it was clearly demonstrated that MLS is often the cause of the development of secondary pyoderma [40].

Monitoring the implementation of Order No. 162 in 50 cities of six federal districts of the Russian Federation made it possible to determine the occurrence of clinical variants of scabies in the practice of doctors (Fig. 1) and to determine the need to develop treatment models that are missing in this document [41]. Almost all dermatologists deal with scabies complicated by secondary pyoderma (97.8%), scabies without burrows (92.5%), scabies complicated by allergic dermatitis (89.5%), microbial eczema (74.5%) and scabies with SLK (85.9%). Norwegian scabies was observed less frequently (37.9%). The need to develop models/standards for the treatment of complicated scabies was indicated by 85% of respondents, scabies with LS - 73.4%, scabies without burrows - 66.1%, Norwegian scabies - 46.7% [42].

Rice. 1. The occurrence of various variants of the course of scabies in the practice of dermatovenerologists according to anonymous survey data ().

Complicated scabies occurs quite often, which often masks the true clinical picture of the disease and leads to diagnostic errors. The most common complications are pyoderma and dermatitis, microbial eczema is less common. The incidence of complicated scabies depends on the patient population and is characterized by a wide range of fluctuations - from 2.6 to 83.6% [39, 43-47]. For example, during an active examination of 1094 conscript military personnel, scabies was detected in 119 (10.9%) people [48]. Complicated scabies was registered in 35% of cases. The structure of complications was dominated by pyoderma (86%), allergic dermatitis (14%) and microbial eczema (14%) were less frequently recorded. A combination of complications was registered in 11% of cases. Pyoderma was represented by staphylococcal impetigo (61%), ostiofolliculitis (50%), ecthyma (19%) and boils (11%), combined in 1/3 of patients.

In 76% of military personnel with scabies, limited allergic dermatitis on the buttocks was identified, which is conventionally designated as “gluteal dermatitis.” Clinically, it manifested itself as symmetrical bright red erythema with peeling on the surface the size of a palm. It always occurred with LSK (50%) and in 20% with its absence. The presence in the latter case of many follicular papules indicates infection with larvae, the penetration of which causes severe itching and scratching. Allergic dermatitis occurs, the cause of which is a biological factor [44].

Among patients with scabies treated in a hospital, a complicated process was registered in 33.9% of cases [41]. In the structure of complications, secondary pyoderma sharply predominated (73.8%), characterized by multiple rashes and more severe clinical forms. In the structure of secondary pyoderma, the leaders were ostiofolliculitis (74%), staphylococcal impetigo (54.8%) and ecthyma vulgaris (51.6%). Less common were deep folliculitis (35.5%) and boils (22.6%). Only a third (31.7%) of patients had one nosological form of pyoderma, 2/3 (68.3%) had two or more, and on average 2.4±0.5 per patient. Staphylococcal impetigo was more often combined with ostiofolliculitis and/or ecthyma vulgaris. Almost half of the patients (42.9%) had allergic dermatitis, every fifth had microbial eczema (21.4%). The listed complications were combined in every fourth patient.

The purpose of the study is to analyze the mistakes of dermatovenerologists in choosing treatment tactics for patients with complicated scabies and scabies occurring with LS.

Currently, four drugs are used to treat scabies in the Russian Federation and CIS countries: benzyl benzoate emulsion/ointment, Medifox, Spregal and sulfur ointment. When choosing a drug to treat patients with scabies, the doctor must take into account the positive aspects and disadvantages of each remedy.

Benzyl benzoate.

Approved for use in children over 3 years of age due to the possibility of developing Gasping syndrome (sudden death syndrome), , , . Not recommended for use in pregnant women. Patients note a burning sensation when the drug is first applied. It is not the drug of choice for the treatment of complicated scabies, especially in hot climates. Relatively high cost of emulsion.

Sulfuric ointment.

A 5% concentration is allowed from 5 years of age. Not for use in pregnant women. Often contributes to the development of dermatitis, especially when using a 33% concentration. It has an unpleasant odor and stains laundry. The course of treatment is long (5-7 days). Poorly tolerated in the hot season.

Spregal

. It is allowed to be used in children from the neonatal period. May be used with caution in pregnant women. It is the drug of choice for the treatment of complicated scabies, including in hot climates. However, the high price of the drug limits its use in large families with low incomes.

Medifox.

It is allowed to be used in children starting from one year of age. Can be used with caution in pregnant women. It is the drug of choice for the treatment of complicated scabies, including in hot climates. The main disadvantage is the short shelf life of the working solution (8 hours). However, in conditions of large irradiating foci, the prepared solution can be used both for the treatment of patients and for the preventive treatment of contact persons. The cost of the drug allows it to be used even in economically disadvantaged families.

The active ingredient in Medifox is permethrin. The mechanism of its action is based on disruption of the microcirculation of sodium channels in ticks, which leads to a delay in repolarization, causing paralysis and death of the parasite at all stages of development. Permethrin belongs to the group of low-toxic scabicides. It is widely used both in our country and abroad. According to Russian specialists, the effectiveness of treatment with Medifox reaches 100%, , . Considering that the drug does not have a 100% ovicidal effect, a treatment regimen has been developed taking into account the effect on females and eggs of scabies mites. It is recommended to rub the drug on the 1st and 4th days of the course. Medifox is widely used for the treatment of scabies in the Armed Forces of the Russian Federation.

It should be noted that abroad permethrin is used in the form of a cream of 5% concentration. Permethrin cream is often used to treat scabies in the US, UK and Australia. In the first two countries, 5% permethrin cream is included in national protocols for the treatment of patients with scabies as a first-line drug. More often, permethrin is used once at night, , , , , , , , , , less often - twice with an interval of one week, , , , . The effectiveness of therapy ranges from 89 to 98%, , ,, , . Exposure of 5% permethrin cream to the skin is usually 8-14 hours. It is then washed off with soap and water.

A comparative analysis of the effectiveness of four scabicides approved for use in the Russian Federation in terms of the dynamics of clinical manifestations and the effect on the pathogen in a hospital setting, where patients with complicated scabies were mainly hospitalized, showed that recovery when using 0.4% Medifox emulsion was 80.7%. American dermatologists believe that 5% permethrin cream is superior in effectiveness and safety to lindane and crotamiton, and ivermectin. It has been established that the toxicity of 5% permethrin cream is 40-400 times less than 1% lindane lotion. In 1996, side effects from permethrin use were only 2.5 per 1,000 scabies patients treated with the drug.

In the United States, permethrin has no age restrictions. The American Academy of Pediatrics considers permethrin 5% cream to be a safe and effective scabicide. It can be used to treat even infants. In Canada it is used in children older than 2 months. It is applied overnight (from 8 to 12 hours), then washed off and the course is repeated a week later. In infants, the entire skin, including the head, is treated.

An interesting study examined the effectiveness and safety of 4% permethrin cream in 196 pregnant women. The majority of women were in the second (42.2%) and third trimesters (46.9%) of pregnancy and only 10.9% were in the first. It has been proven that 4% permethrin, even when rubbed in twice, does not cause intrauterine abnormalities in fetal development and can be recommended for treatment during pregnancy.

In the literature of the last two decades, publications have appeared on the formation of resistance of scabies mites to permethrin, , , , . However, all studies involved people living in settlements where scabies persisted, for example, in Australia and El Salvador. Permethrin has been used for the treatment of patients and prophylactic treatment of contact persons for several years. There are no officially confirmed data on tick resistance to permethrin in vivo in the literature.

Purpose

This study was a comparative study of the effectiveness of treating scabies with 0.4% and 0.8% Medifox emulsion.

Materials and methods of research.

The work was carried out in the Republic of Tajikistan on the basis of city clinical hospital No. 1 in 2011-2012. 42 family centers of scabies, totaling 252 people, were examined. The diagnosis of scabies was confirmed in the laboratory by scraping the epidermis using 40% lactic acid and by dermatoscopy. The incidence of scabies in foci was 75.4%. 194 patients with scabies were treated with Medifox.

The control group (CG) consisted of 92 patients who received treatment with a 0.4% Medifox emulsion. In the experimental group (OG), there were 102 patients, and the drug concentration was 2 times higher (0.8%). Rubbing in the freshly prepared emulsion was carried out in the evening on days 1 and 4 of the course. To treat complications of scabies, days 2, 3, 5 and subsequent days were used until the clinical manifestations completely resolved. Treatment of secondary superficial pyoderma was carried out with topical antibacterial agents (fucorcin, potassium permanganate, canadex, celestoderm with garamycin). To treat allergic dermatitis, as a complication of scabies, creams/ointments with topical corticosteroids (celestoderm, dermovate) were used. Creams/ointments with topical corticosteroids (celestoderm, sinaflan) were rubbed into lenticular papules with scabious lymphoplasia of the skin (SLK) twice a day. Treatment of scabies complicated by dermatitis, pyoderma, as well as when they were combined with SLC in the CG and OG was carried out in the same way. The effectiveness of treatment was assessed after 5 days (at the end of the course of therapy) and after 2 weeks (during follow-up). In the presence of LSK, the observation period was extended until the rashes completely resolved. Efficacy was assessed according to the following criteria: recovery, significant improvement, reinvasion. No drug complications were recorded during therapy.

The distribution of patients with scabies in the CG and MG by gender and age is presented in Fig. 1 and 2.

Data in Fig. 1 and 2 indicate that the distribution of patients by gender and age in the CG and MG was representative.

An analysis of numerous literary sources shows that when assessing the effectiveness of treatment for scabies, there is no differentiated approach to the duration of resolution of specific clinical manifestations of the disease and its complications, which regress much later. In this case, the effectiveness of a particular drug is assessed based on the dynamics of clinical manifestations without taking into account the effect on the pathogen. A distinctive feature of this study was a differentiated approach to assessing the rate of resolution of clinical manifestations of scabies (disappearance of scabies ducts, vesicles and follicular papules), its complications and LS. If after a course of specific therapy the patient still had clinical manifestations of scabies, then they were given an additional single application of 0.8% Medifox emulsion. To prevent possible reinvasion in family foci of scabies, all healthy family members (81 people) received 100% preventive treatment with 0.8% Medifox. No cases of illness among contact persons were registered in these cases.

Results of our own research.

The distribution of patients with scabies in the CG and OG, taking into account the clinical form of the disease, is presented in Table. 1.

Table 1

Distribution of patients with scabies treated with Medifox, taking into account the clinical type of scabies

In the CG and OG, patients with typical scabies without complications and LS were predominant. In both groups they were recorded almost equally often (35.9% and 41.2%) (p>0.05). Scabies in combination with LSK was observed in 21.7% and 27.5% of patients, respectively (p>0.05). A fifth of the sample from the CG (20.6%) and OG (21.5%) consisted of patients with scabies complicated by secondary pyoderma in the presence of LS (p>0.05). Scabies complicated by allergic dermatitis was recorded in both groups equally often (10.9% and 9.8%), but always in combination with secondary pyoderma and LS. In other words, the distribution of patients taking into account the clinical form of scabies in the CG and OG was also representative.

A comparative assessment of the effectiveness of 0.4% and 0.8% Medifox emulsion was carried out for the entire sample and for the treatment of each type of scabies noted in Table 1. Data in Fig. 3 indicate that recovery of patients with typical scabies without complications and LSK, when using a 0.8% concentration of Medifox after 2 weeks, was achieved significantly 1.3 times more often than with a 0.4% concentration of the drug (95.2% versus 75 .7%) (p<0.05). It should be borne in mind that the effectiveness of a scabicide is considered good if, after a course of specific therapy according to the chosen regimen, recovery occurs in 80% of patients or more. In the CG this figure was slightly lower (75.7%). Reinvasion was observed in 1 (2.4%) patient with OG and 2 (6.1%) patients with CG. The sources of reinfestation were family members infected with scabies who were absent from the outbreaks during the period of treatment of patients and preventive treatment of contact persons. The data obtained clearly demonstrate the higher effectiveness of 0.8% medifox emulsion in the treatment of typical scabies, which predominated in both the CG and OG.

There were 30 patients with typical manifestations of scabies in combination with scabies in the control group and 28 in the group. It is important to note that after 2 weeks there were significant differences in the resolution of typical clinical manifestations of scabies (initial variants of scabies burrows, follicular papules on the trunk and non-inflammatory vesicles on the hands and feet) was not detected when using different concentrations of Medifox (p>0.05) (Fig. 4). Recovery of 83.3% (CG) and 96.4% (OG) of patients indicates the effectiveness of the drug. At the same time, it was noted that when using a 0.8% concentration of Medifox, typical manifestations of scabies disappeared after 5 days in a larger number of patients (by 13.1%). The itching that accompanies SLS was the cause of the appearance of fresh scratches and small papules, which is often regarded by dermatologists as the persistence of typical scabies.

There were 41 patients with typical scabies complicated by superficial pyoderma in combination with LSK, including 19 in the CG and 22 in the OG. It was found that when using a higher concentration of Medifox (0.8%), the percentage of resolution of typical clinical manifestations of scabies was 1 .3 higher (90.9% vs. 68.4%) (p<0.05). This is quite natural, because secondary pyoderma is often associated with scabies. In this case, staphylococcal impetigo appears on the hands, wrists and feet in place of scabies, and in place of follicular papules - ostiofolliculitis and folliculitis. Opening of pustules during itching is accompanied by the formation of purulent crusts, limiting the access of the drug to the pathogen. It is well known that in the presence of pyoderma, the itching is less intense. T.V. Sokolova (1989) experimentally proved that in passages with pustules, mites are often absent and, therefore, the production of allergens is sharply reduced. Due to this, the intensity of itching is also reduced in the area of ​​the LM, which is essentially a marker of the immunoallergic process in the patient’s body.

Scabies complicated by allergic dermatitis, secondary pyoderma in combination with LSK was registered in 20 patients, 10 in the CG and MG. In this case, the rate of resolution of typical manifestations of the disease did not significantly depend on the concentration of the drug (p>0.05). With such a clinical picture of the disease, it was impossible to distinguish a specific process from a nonspecific one. The recovery rate in the control group was 80%, in the experimental group – 90%, i.e. only 10% higher (p>0.05) (Fig. 6). However, it should be taken into account that the sample of patients in these groups was minimal and, perhaps, therefore no significant differences were identified.

Generalized data on the rate of resolution of typical manifestations of scabies in all its clinical variants for patients with CG (92) and OG (102) are presented in Fig. 7. The effectiveness of treatment when using 0.8% medifox emulsion was 17.4% higher than 0.4% (94.1% versus 77.2%). At the same time, a differentiated approach to assessing the resolution of typical manifestations of scabies showed that a 0.8% concentration of Medifox was 1.3 times more effective in the treatment of patients with typical scabies without complications and LSK, as well as with typical scabies complicated by secondary pyoderma in combination with SLC. These patients made up 2/3 (116 people) of the sample. The results obtained clearly indicate that the effectiveness of treatment directly depends on the clinical form of the disease.

The dynamics of resolution of superficial pyoderma in patients with scabies was monitored (Fig. 8). In 2/3 (67.2%) of cases, superficial pyoderma (single ostiofolliculitis, impetigo) resolved after 5 days. In a third (32.8%) of cases, pyoderma (folliculitis, multiple impetigo, tourniol) resolved by the end of the second week.

The dynamics of resolution of SLK were monitored in 194 patients treated with 0.4% and 0.8% Medifox emulsion (Fig. 9). After 5 days, SLK regressed in 15.1% of patients, after 2 weeks – in another 22.7%, after 3 weeks – in another 27.7%, after a month – in another 31.1%. Thus, in 96.6% of cases, LSK resolved within a month.

No side effects or drug complications were registered.

Discussion of the results obtained.

Evaluation of the effectiveness of scabies treatment should be carried out taking into account the clinical form of the disease (typical, complicated by pyoderma, dermatitis, in combination with LS), which allows obtaining reliable information. Using the example of 0.4% and 0.8% concentrations of Medifox, it was shown that in the whole sample, when using twice the concentration of the drug, there were no significant differences (94.6% versus 77.2%, p>0.05). They were identified taking into account the clinical form of the disease for patients with typical scabies, as well as when it is combined with scabies against the background of complications of secondary pyoderma. This group of patients made up 2/3 of the sample. An increase in the concentration of Medifox led to the recovery of a significantly larger number of patients: 90.9% versus 68.4% (p<0.05), and LSK resolved in 96.6% of patients within a month. A single treatment of healthy family members with a 0.8% Medifox emulsion prevented intrafamilial reinvasion and the possibility of a “ping-pong” infection. At the same time, an increase in the effectiveness of treating scabies with a 2-fold increase in the concentration of Medifox indicates the absence of resistance of the scabies mite to this scabicide. A promising direction is the development by domestic enterprises of stable dosage forms of Medifox (gel, cream) with a higher concentration of the drug (2-5%).

Persistence of SLC is often regarded by doctors as ineffective treatment of scabies, although there is no live pathogen in scrapings of the epidermis. However, laboratory confirmation of the effectiveness of therapy is not used in medical institutions. We have shown that in the whole group, LSK resolved in 96.6% of patients within a month.

Thus, assessing the effectiveness of scabies treatment with one or another scabicide without taking into account the clinical form of the disease (typical, complicated by pyoderma, dermatitis, in combination with LSK) does not allow obtaining reliable results.

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Product description

You can treat wall and floor surfaces, clothing, bed linen, door handles, chairs and other objects with this disinfectant. The product is suitable for disinfestation at different times of the year. It can be used to treat absorbent and non-absorbent surfaces.

Medifox Super can be used to irrigate areas where small insects accumulate and cause harm to humans. The special product is effective regardless of the type of surface being treated. The working emulsion is valid for 8 hours after its preparation, so it is necessary to start treating the room immediately.

Mode of application

Depending on which surface needs to be treated, the special product is diluted with clean boiled water. The concentration is prepared taking into account the purposes for which it will be used. During the treatment of the room, you need to remove or carefully hide dishes, food, and animals. It is required to wear gloves when carrying out disinfestation work, and it is also advisable to use other protective equipment. After all the required areas have been treated, the perimeter must be left to ventilate for at least 30 minutes. The drug has a residual acaricidal effect, so even with its single use, the area after treatment should be well ventilated.

The amount of Medifox Super required for the preparation of working emulsions:

Safety

The insecticide contains several components of different nature, so when using it you should definitely follow safety precautions. The main active ingredients are insecticide derivatives that allow you to fight different types of parasites. To avoid negative effects, you should adhere to the correct procedure for using the disinfectant and follow the dosage. The toxic composition, when used correctly, does not cause side effects, but it is recommended to treat surrounding objects with it without the presence of people. Avoid contact with mucous membranes and the digestive tract.

This product requires special preparation when used. You must carefully read the instructions for use and follow safety precautions.