Methods: Cochrane Search Strategy, military records, traditional medicine databases, unpublished trial. Only randomized controlled trials were considered and assessed for inclusion against pre-set criteria.

Results: 36 trials were identified but 26 were did not meet inclusion criteria. Of the remaining 10 trials, 2 are on-going and will be assessed when further results become available, and 8 including a community intervention, were included. Only one placebo controlled trial was identified which showed that intervention was more effective than no intervention. Newer treatments (permethrin and ivermectin) were generally more effective than older treatments (lindane, crotamiton and benzyl benzoate) assessed for clinical, parasitic and subjective cure rates. No serious neurological side-effects were reported in any of the trials, and cutaneous side effects were reported equally in both intervention and controlled groups. Although some trials assessed the effectiveness of oral versus topical treatment, treatment vehicle and mass community treatment, these studies were not powerful enough to demonstrate an effect.

Discussion: Newer treatments appear more effective than older ones with little difference in adverse side effects. However, many questions remain unanswered, especially concerning the effectiveness of ivermectin as an oral drug for scabies, effective intervention strategies for close family contacts and mass community treatment, the effectiveness of different vehicles for topical treatment and drug safety.