We read with interest the article by Lluch-Galcerá et al.1 on the current scabies epidemic. First, we would like to commend the authors on their excellent review of this topic. We would also like to add a small point and clarify a controversial issue regarding the use of oral ivermectin, which we think stems from a section of the summary of product characteristics that currently states “the influence of food on absorption is unknown”.2

The bioavailability of ivermectin is increased by the intake of food, particularly fatty food.3 What differs in the studies published to date is the intensity of the effect, which ranges from zero to a 2.6-fold increase.4 The discrepancies could be linked to the different doses of ivermectin used in the respective studies.4

In their article, Lluch-Galcerá et al.1 indicate that ivermectin should be taken after fasting, and this is indeed stipulated in several guidelines, including the German guidelines on the diagnosis and treatment of scabies.5 Most authors, however, believe that ivermectin should be taken with fatty foods to increase its absorption and potential effectiveness.6,7 The Centers for Disease Control and Prevention8 and the European Academy of Dermatology and Venereology both specifically recommend taking ivermectin with food.9