著者

日本皮膚科学会疥癬診療ガイドライン策定委員会 石井 則久 浅井 俊弥 朝比奈 昭彦 石河 晃 今村 英一 加藤 豊範 金澤 伸雄 久保田 由美子 黒須 一見 幸野 健 小茂田 昌代 関根 万里 田中 勝 谷口 裕子 常深 祐一郎 夏秋 優 廣田 孝司 牧上 久仁子 松田 知子 吉住 順子 四津 里英 和田 康夫

出版者

公益社団法人 日本皮膚科学会

雑誌

日本皮膚科学会雑誌 (ISSN:0021499X)

巻号頁・発行日

vol.125, no.11, pp.2023-2048, 2015-10-20 (Released:2015-10-22)

参考文献数

185

---

Here, we present our new guideline for the diagnosis and treatment of scabies which we, the executive committee convened by the Japanese Dermatological Association, developed to ensure proper diagnosis and treatment of scabies in Japan. Approval of phenothrin topical use under the National Health Insurance in August 2014 has contributed to this action. Permethrin, a topical anti-scabietic medication belonging to the same pyrethroid group as phenothrin, is already in use worldwide. For making proper diagnosis of scabies, following three points should be taken into consideration: clinical findings, detection of the mite(s) (Sarcoptes scabiei var. hominis), and epidemiological findings. The diagnosis is confirmed when the mites or their eggs are identified by microscopy or by dermoscopy. As we now have a choice of phenothrin, the first line therapy for classical scabies is either topical phenothrin lotion or oral ivermectin. Second line for topical treatment is sulfur-containing ointments, crotamiton cream, or benzyl benzoate lotion. Gamma-BHC ointment is no more provided for clinical use. If the patient is immunosuppressed, the treatment option is still the same, but he or she should be followed up closely. If the symptoms persist, diagnosis and treatment must be reassessed. For hyperkeratotic (crusted) scabies and nail scabies, removal of thick scabs, cutting of nails, and occlusive dressing are required along with topical and/or oral treatments. It is important to apply topical anti-scabietic lotion/cream/ointment below the neck for classical scabies or to the whole body for hyperkeratotic scabies, including the hands, fingers and genitals. For children and elderlies, it is recommended to apply treatment to the whole body even in classical scabies. The dosage for ivermectin is a single oral administration of approximately 200 μg/kg body weight. It should be taken on an empty stomach with water. Administration of a second dose should be considered at one-week with new lesions and/or with detection of mites. Safety and effectiveness of combined treatment with topical and oral medications are not yet confirmed. Further assessment is needed. Taking preventative measures is as important as treating those infected. It is essential to educate patients and healthcare workers and conduct epidemiological studies to prevent further spread of the disease through effectively utilizing available resources including manpower, finance, logistics, and time. (Jpn J Dermatol 125: 2023-, 2015)

著者

加藤 豊範

出版者

一般社団法人 日本環境感染学会

雑誌

日本環境感染学会誌 (ISSN:1882532X)

巻号頁・発行日

vol.30, no.4, pp.274-280, 2015 (Released:2015-10-05)

参考文献数

15

被引用文献数

6 4

---

手洗いや手指衛生は院内感染防止対策の基本である.しかし,医療関係者の多くは手指衛生を遵守しているとは言い難く,手指衛生遵守率の向上は院内感染対策の永遠のテーマでもある.本研究では,感染委員会及びICTが中心となり,組織的に手指衛生遵守率向上に取り組んだ結果,取り組み当初(2011年)3.2%であった手指衛生遵守率は,2年後(2013年)には21.9%と飛躍的に上昇した.さらに,MRSAの検出率は31.5%から13.1%に減少し,MRSAの新規分離率も11.5%から2.6%まで減少した.手指衛生に対する組織的な取り組みは,その遵守率を向上させ,MRSA分離率への低下につながり,さらにはMRSAの新規検出菌数の減少へとつながったと考えられる.本研究の結果から,組織的に手指衛生遵守率向上の取り組みを行う事は,院内感染防止に有用であると考えられる.