Comparison of wet combing with malathion for treatment of head lice in the UK: a pragmatic randomised controlled trial | Vince Smith

Comparison of wet combing with malathion for treatment of head lice in the UK: a pragmatic randomised controlled trial

Fri, 2007-02-02 15:01 — Vince Smith

Publication Type		Journal Article
Year of Publication		2000
Authors		Roberts, R. J.; Casey, D.; Morgan, D. A.; Petrovic, M.
Journal Title		Lancet
Volume		356
Issue		9229
Pages		540-544
Journal Date		Aug 12
Accession Number		44988
Key Words		adolescent; Animals ; Child ; Child; Preschool ; Comparative Study ; Humans ; insecticide ; Lice Infestations/drug therapy/therapy ; malathion ; Pediculus ; Research Support; Non-U.S. Gov't ; scalp dermatoses
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.
Notes		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; ppublish0140-6736 Journal
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