ismellcapitalism | 4 points
Any info on how effective ivermectin is with vulnerable populations?I am interested if anyone has found info on the effects of ivermectin on the most vulnerable specifically: over 60, underlying conditions? We seem to know it works for most people--but that is also true for doing nothing. That is, most people are asymptomatic. Any info on this would be powerful to share.
[-] TrumpLyftAlles | 2 points
On the positive side, ivermectin is recommended for treatment of scabies for people in long-term care facilities.
SHEA/APIC Guideline: Infection Prevention and Control in the Long-Term Care Facility (2012):
Ivermectin, an oral antihelminthic agent, is an effective, safe, and inexpensive option for treatment of scabies. However, it has not been approved by the FDA for this indication.
Not FDA yet CDC-recommended:
Ivermectin Brand name product: Stromectol* Ivermectin is an oral antiparasitic agent approved for the treatment of worm infestations. Evidence suggests that oral ivermectin may be a safe and effective treatment for scabies; however, ivermectin is not FDA-approved for this use. Oral ivermectin should be considered for patients who have failed treatment with or who cannot tolerate FDA-approved topical medications for the treatment of scabies. If used for classic scabies, two doses of oral ivermectin (200µg/kg/dose) should be taken with food, each approximately one week apart. The safety of ivermectin in children weighing less than 15 kg and in pregnant women has not been established.
Note that although ivermectin guidelines recommend taking on an empty stomach, scabies experts recommend taking with a meal to increase bioavailability (CITE NEJM Currie article).
That 200mgc/hg dose is kind of the standard recommended dose -- very possibly because of this CDC page.
The note is funny: take it on an empty stomach because bioavailability is greater if taken with a meal. Does the CDC want the treatment to be less effective? Nah, it's just the public health / medical communities perpetual bias for safey. A good thing.
[-] TrumpLyftAlles | 1 points
Whoops, came across this negative report:
Ivermectin and Death in Elderly Patients (1997)
During an outbreak of scabies in a 47-bed closed unit of the nursing home, all patients were treated with topical therapy, but scabies was not eradicated. Each patient was then given a single oral dose of ivermectin (150 to 200 μg/kg body weight). Within five days, rashes and symptoms cleared. Over the next six months, there was a pattern of excess deaths among the treated population. A comparison of deaths among the 47 ivermectin-treated patients and 47 age- and sex-matched controls from the rest of the nursing home showed a significant difference in death rates and a relative risk of 3. There were 28 deaths in the unit during the three years before the scabies outbreak and 15 deaths in the six months after ivermectin treatment, a significant change. No pattern in the cause of death was noted, but the treated patients who died had sudden behavioral changes, with lethargy, anorexia, and listlessness before death.
That's pretty damning. Regardless, 15 years later ivermectin was still recommended. This may have been a one-shot event: super-scabies, bad batch of ivermectin, a nasty bug that randomly killed more ivermectin-eaters?
\ There were 28 deaths in the unit during the three years before the scabies outbreak and 15 deaths in the six months after ivermectin treatment
How old were they though, what were the causes of their deaths in autopsy? It really isn't damning, although interesting, this doesn't at all confirm or even hint that ivermectin caused any deaths.
[-] ismellcapitalism | 1 points
Thanks for these replies. I am really interested in why the popular press is not picking up the success. Danger for older patients certainly could matter--though again, this is not clear, below, and the remarkable recoveries of people around the globe from this virus--I would have my 83 year old vulnerable father take it in a minute if he got sick.
[-] TrumpLyftAlles | 3 points | May 24 2020 23:20:38
I'm sorry, I looked pretty hard at PubMed and googled a bit and didn't find anything about ivermectin and the covid19-related comorbidities. The closest I got was on a list of ivermectin side-effects, which said that old people's livers are not as efficient so ivermectin wouldn't be cleared as quickly from the system. IMO that presents zero risk. It's just the kind of thing they can put in there for all old people for all things liver-related. No data.
I'm a fanboy -- but IMO opinion, in the context of COVID-19 the null hypothesis should be that ivermectin is safe until proven guilty. IMO it has the strongest safety record of any drug: 7+ billion doses to a billion+ people over three decades, very few deaths, like 3 and those are arguable. AFAIK. I haven't done the exhaustive "How many people has ivermectin killed" search. Aspirin and penicillin are much more dangerous than ivermectin.
On twitter I posted that I might risk taking the horse paste version someday. Someone responded with "Let's nominate this guy for the Darwin award." My reply:
COVID-19 vs ivermectin: How much more dangerous is the virus to me (my long list of comorbidities)? 1000 times? 10,000 times? 100,000 times?
It might be more than 100,000 times.
Given the rate at which nursing home residents are dying, IMO the comparative risk of taking ivermectin is 10,000 times less than NOT taking it. It's a very safe drug.
IMO, as a non-scientist non-physician who just follows the news and half-comprehendingly reads some studies -- what do I know?
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