Clinical Question: In children with...

Clinical Question: In children with head lice, is fine-tooth combing of the hair as effective as treatment with an insecticide?

Setting: Outpatient (primary care)

meditation Design: Randomized controlled trial (single-blinded)

Allocation: Unconcealed

Synopsis: Resistance to pediculicides can be high in a areas, often topping 80 percent This application of mind evaluated the effectiveness of using a specific fine-tooth toilet-comb (Bug Buster, not available in the United States) upon conditioned hair compared with sum of two units pediculicides in 133 children, pair to 15 years of age, with head lice. The investigators recruited children from the offices of family physicians and via advertisements in pharmacies and seminarys The children were randomized, with allocation unconcealed, to be treated using combing or the pediculicides malathion 05 percent or permethrin (Nix), depending in succession the availability in local pharmacies. Combing was done in succession wet, conditioned hair to transfer lice and nits, and was performed each three days for a total of four combings. The pediculicides were used one time following the directions on the label, still are more commonly used twice, individual week apart. Children were examined for the port of lice five days after treatment with a pediculicide and 15 days after the start of the combing regimen according to a study nurse unaware of their treatment, with failure determined as the personality of one or more live lice. Using intention-to-treat analysis, 14 percent of the children were licefree at follow-up after a single treatment with the pediculicides, whereas 52 percent were lice-free with the combing regimen (number stand in want ofed to treat = 2.6; 95% confidence interval, 12 to 71) therapy rates might be affected by way of the type of comb; rates in a previous investigation were lower when an earlier version of the card was used (Roberts RJ, et al. Comparison of wet combing with malathion for treatment of head lice in the UK: a pragmatic randomised controll trial. Lancet 2000;356:540-4)

Bottom Line: Approximately the same half of children using a specific lice dressing-comb every three days for nine days will be lice independent at a two-week follow-up. This rate was higher than that with either of sum of two units commonly used pediculicides, although they were single used once instead of twice, as commonly commended Combing is not technically difficult as lengthy as conditioner has been used in succession the hair, although it is a les desirable option to the parent. Although this staggered assessment of consequences might make sense given the risk of reinfestation, this reflection would have been much stronger if the one and the other groups had been evaluated after 15 days and if the children in the pediculicide assign places to had received two treatments. (Level of Evidence: 1b-)

ALLEN F SHAUGHNESSY, PHARM.D.

reflection Reference: Hill N, et al. Single blind, randomised, comparative meditation of the Bug Buster kit and above the counter pediculocide treatment against head lice in the United Kingdom. BMJ August 13 2005;331:384-7 Used with permission from Shaughnessy AF. Combing for lice effective. Accessed online October 20 2005 at: http://www.InfoPOEMs.com.

COPYRIGHT 2006 American Academy of Family Physicians

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