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

Publication Type:Journal Article
Year of Publication:2000
Authors:R. J. Roberts, Casey, D., Morgan, D. A., Petrovic, M.
Journal:Lancet
Volume:356
Issue:9229
Pagination:540 - 544
Date Published:2000
ISBN Number:0140-6736
Keywords: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.

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Scratchpads developed and conceived by (alphabetical): Ed Baker, Katherine Bouton Alice Heaton Dimitris Koureas, Laurence Livermore, Dave Roberts, Simon Rycroft, Ben Scott, Vince Smith