@article {46156, title = {Comparison of wet combing with malathion for treatment of head lice in the UK: a pragmatic randomised controlled trial}, journal = {Lancet}, volume = {356}, year = {2000}, note = {LR: 20041117; JID: 2985213R; 0 (Insecticides); 121-75-5 (Malathion); CIN: Lancet. 2000 Aug 12;356(9229):523-4. PMID: 10950223; CIN: Lancet. 2000 Dec 9;356(9246):2007; author reply 2008. PMID: 11130540; CIN: Lancet. 2000 Dec 9;356(9246):2007; author reply 2008. PMID: 11130541; CIN: Lancet. 2000 Dec 9;356(9246):2007; author reply 2008. PMID: 11130542; CIN: Lancet. 2000 Dec 9;356(9246):2008. PMID: 11130543; ppublish}, month = {2000}, pages = {540 - 544}, abstract = {

BACKGROUND: Concern about the effectiveness and toxicity of insecticide lotions has led to promotion of mechanical methods to remove head lice. We compared the effectiveness of \"bug-busting\" (wet combing with a fine-toothed comb) and malathion lotion.METHODS: We screened 4037 schoolchildren in two counties in Wales, UK (intermediate resistance to malathion). Of 167 found to have head lice, 81 (aged 3-14 years) were eligible to participate in a randomised controlled trial that compared mechanical removal of lice by a commercial kit every 3-4 days for 2 weeks with two applications of 0.5\% malathion lotion 7 days apart; parents carried out both treatments. The outcome measure was the presence of live lice 7 days after the end of treatment. Analyses were by intention to treat. FINDINGS: 74 children completed the study and 72 were included in the analysis. The cure rate was 38\% (12 of 32) for bug-busting and 78\% (31 of 40) for malathion. Children assigned bug-busting were 2.8 (95\% CI 1.5-5.2) times more likely than those assigned malathion to have lice at the end of treatment (p=0.0006). INTERPRETATION: Malathion lotion was twice as effective as bug-busting, even in an area with intermediate resistance. Policies advocating bug-busting as first-line treatment for head lice in the general population are inappropriate. Assessment of the outcome of treatment 1-2 weeks after completion is essential for successful management. Only about 50\% of participants complied fully with treatment, so future trials should be pragmatic in design, avoid false incentives, and study representative samples of children.

}, keywords = {adolescent, animals, child, Child, Preschool, Comparative Study, humans, insecticide, Lice Infestations/drug therapy/therapy, Malathion, Pediculus, Research Support, Non-U.S. Gov{\textquoteright}t, scalp dermatoses}, isbn = {0140-6736}, url = {http://www.phthiraptera.info/sites/phthiraptera.info/files/44988.pdf}, author = {Richard J. Roberts and Casey,D. and Morgan,D. A. and Petrovic,M.} } @article {39808, title = {Treatment of head lice - Reply}, journal = {Lancet}, volume = {356}, year = {2000}, month = {2000}, pages = {2008}, abstract = {

Reply to:Hill,N.; Ibarra,J.; Richards,S.; Downs,A. all in same issue, pages 2007-2008 on the paper titled: -\ Comparison of wet combing with malathion for treatment of head lice in the UK: a pragmatic randomised controlled trial.\ Lancet. 2000 Aug 12;356(9229):540-4.

Abstract:

Background: Concern about the effectiveness and toxicity of insecticide lotions has led to promotion of mechanical methods to remove head lice. We compared the effectiveness of \"bug-busting\" (wet combing with a fine-toothed comb) and malathion lotion.
METHODS:\ We screened 4037 schoolchildren in two counties in Wales, UK (intermediate resistance to malathion). Of 167 found to have head lice, 81 (aged 3-14 years) were eligible to participate in a randomised controlled trial that compared mechanical removal of lice by a commercial kit every 3-4 days for 2 weeks with two applications of 0.5\% malathion lotion 7 days apart; parents carried out both treatments. The outcome measure was the presence of live lice 7 days after the end of treatment. Analyses were by intention to treat.
FINDINGS:\ 74 children completed the study and 72 were included in the analysis. The cure rate was 38\% (12 of 32) for bug-busting and 78\% (31 of 40) for malathion. Children assigned bug-busting were 2.8 (95\% CI 1.5-5.2) times more likely than those assigned malathion to have lice at the end of treatment (p=0.0006).
INTERPRETATION:\ Malathion lotion was twice as effective as bug-busting, even in an area with intermediate resistance. Policies advocating bug-busting as first-line treatment for head lice in the general population are inappropriate. Assessment of the outcome of treatment 1-2 weeks after completion is essential for successful management. Only about 50\% of participants complied fully with treatment, so future trials should be pragmatic in design, avoid false incentives, and study representative samples of children.

}, keywords = {Pediculosis}, url = {http://www.phthiraptera.info/sites/phthiraptera.info/files/38006pdf}, author = {Richard J. Roberts and Casey,D. and Morgan,D. A. and Petrovic,M.} }