02630nas a2200325 4500008004100000020001400041245012300055210006900178260000900247300001400256490000800270520164200278653001501920653001201935653001001947653002101957653002201978653001102000653001602011653004302027653001402070653001402084653003702098653002102135100002502156700001402181700001902195700001702214856007302231 2000 eng d a0140-673600aComparison of wet combing with malathion for treatment of head lice in the UK: a pragmatic randomised controlled trial0 aComparison of wet combing with malathion for treatment of head l c2000 a540 - 5440 v3563 a

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.

10aadolescent10aanimals10achild10aChild, Preschool10aComparative Study10ahumans10ainsecticide10aLice Infestations/drug therapy/therapy10aMalathion10aPediculus10aResearch Support, Non-U.S. Gov't10ascalp dermatoses1 aRoberts, Richard, J.1 aCasey, D.1 aMorgan, D., A.1 aPetrovic, M. uhttp://www.phthiraptera.info/sites/phthiraptera.info/files/44988.pdf02549nas a2200181 4500008004100000245003500041210003300076260000900109300000900118490000800127520206900135653001602204100002502220700001402245700001902259700001702278856007202295 2000 eng d00aTreatment of head lice - Reply0 aTreatment of head lice Reply c2000 a20080 v3563 a

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.

10aPediculosis1 aRoberts, Richard, J.1 aCasey, D.1 aMorgan, D., A.1 aPetrovic, M. uhttp://www.phthiraptera.info/sites/phthiraptera.info/files/38006pdf