Episode 414: 421. Scabies and DUKE criteria

Stavropoulou E, et al. Reassessing the 2023 International Society for Cardiovascular Infectious Diseases Duke clinical criteria for infective endocarditis: Impact of excluding fever and updating diagnostic definitions. Clin Infect Dis 2025 Dec 31; [e-pub]. DOI: 10.1093/cid/ciaf737 . Big takeaways About 35% of patients truly had IE. Fever showed up in 80% of patients both with and without IE, so it did not help distinguish them. Dropping fever from the criteria actually made them better: Sensitivity improved: 77% (no-fever) vs 74% (standard). Specificity improved a lot: 80% vs 49%. "Possible IE" shrank from 39% to 17%, meaning fewer gray-zone cases. Only 0.4% of patients without IE were incorrectly labeled as having IE. Both are widely used and both can work for regular (non-crusted) scabies. The SCRATCH trial: who won? In the SCRATCH trial from France, researchers treated about 1000 people in 300 households with confirmed scabies. Each household was randomized to: Whole-body 5% permethrin cream on days 0 and 10, or Oral ivermectin (weight-based) on days 0 and 10. They then checked who was cured at day 28. Here's what they found: Household cure rates Permethrin: 88% cured Ivermectin: 72% cured Translation: For every 6 households treated with permethrin instead of ivermectin, one extra household was fully cured (NNT 6). Index (main) patient cure rates Permethrin: 92% Ivermectin: 77% That's one extra person cured for about every 7 treated with permethrin instead of ivermectin (NNT 7). Side effect Skin irritation-type reactions: 14% with permethrin vs 10% with ivermectin. So permethrin wins on cure, with a small trade-off in local skin reactions.

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Episode 414: 421. Scabies and DUKE criteria is an episode from Questioning Medicine by Questioning Medicine.

This episode is 11:42 long.

This episode was published on Feb 25, 2026.

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