Question

A patient comes to the clinic following being treated for scabies with permethrin 5% (Elimite). She states that she completed the therapy as ordered but it has been 2 weeks since finished treatment and she is still very itchy. What does the nurse practitioner do?

a. Order a second treatment with permetrin 5% (Elimite)
b. Order Cefalexin (Keflex)
c. Wet mount to check for lie mites
d. Advise patient to use oatmeal soaks to minimize itching

Answer 1

In the case of continued itching after scabies treatment, a practitioner can advise oatmeal soaks for relief or consider another treatment with permethrin if reinfection is suspected. Systemic antibiotics or lice diagnostics are generally not appropriate.

Step-by-step explanation:

A patient who has completed therapy with permethrin 5% (Elimite) for scabies and continues to experience itching two weeks after treatment may be experiencing post-scabies pruritus, which can continue for some weeks after the mites have been eradicated. In such cases, the practitioner may not immediately prescribe another round of permethrin but can consider several options. These include advising the patient to use soothing measures such as oatmeal soaks to minimize itching or prescribing a topical steroid if the itching is severe and causing discomfort. However, if there is a suspicion of treatment failure or reinfection, the practitioner might consider examining the patient or ordering a second treatment with permethrin. Without signs of active infection, systemic antibiotics like Cefalexin (Keflex) or diagnostic procedures for lice, such as a wet mount, would not be appropriate.