Oral ivermectin to treat head lice

January 01, 0001

Oral ivermectin to treat head lice

Resistance of lice to insecticides, particularly pyrethroids, results in treatment failure. The efficacy of alternative agents is controversial. These European authors from multiple countries conducted a multicenter, cluster-randomized, double-blind, double-dummy, controlled trial comparing oral ivermectin (at a dose of 400 µg per kilogram of body weight) with 0.5% malathion lotion, each given on days 1 and 8, for patients with live lice not eradicated by topical insecticide used 2 to 6 weeks before enrollment. The cluster was defined as the household.

They found: "A total of 812 patients from 376 households were randomly assigned to receive either ivermectin or malathion. In the intention- to-treat population, 95.2% of patients receiving ivermectin were lice-free on day 15, as compared with 85.0% of those receiving malathion. In the per- protocol population, 97.1% of patients in the ivermectin group were lice-free on day 15, as compared with 89.8% of those in the malathion group. There were no significant differences in the frequencies of adverse events between the two treatment groups."

The authors concluded: "For difficult-to-treat head-lice infestation, oral ivermectin, given twice at a 7-day interval, had superior efficacy as compared with topical 0.5% malathion lotion, a finding that suggests that it could be an alternative treatment."

Oral ivermectin should be considered a proven alternative treatment for head lice.

For the full abstract, click here.

N Engl J Med 362(10):896-905, 11 March 2010
© 2010 to the Massachusetts Medical Society
Oral Ivermectin versus Malathion Lotion for Difficult-to-Treat Head Lice. Olivier Chosidow, Bruno Giraudeau, Jeremy Cottrell, et al. Correspondence to Dr. Chosidow: [email protected]

Category: S. Skin. Keywords: lice, ivermectin, malathion, children, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 23 March 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.