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

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 c...

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Published in:Lancet Vol. 356; no. 9229; pp. 540 - 545
Main Authors: Roberts RJ, Casey D, Morgan DA, Petrovic M, Roberts, R J, Casey, D, Morgan, D A, Petrovic, M
Format: research tables/charts randomized controlled trial Journal Article
Published: Lancet 08/12/2000
Online Access:View this record in EBSCOhost
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      dt: 08/12/2000
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      pub: Lancet
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        atl: Comparison of wet combing with malathion for treatment of head lice in the UK: a pragmatic randomised controlled trial.
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          Roberts RJ
          Casey D
          Morgan DA
          Petrovic M
          Roberts, R J
          Casey, D
          Morgan, D A
          Petrovic, M
        affil: Department of Public Health, North Wales Health Authority, Mold, UK
      sug:
        subj:
          Lice Infestations Therapy
          Malathion Therapeutic Use
          Grooming Methods
          Treatment Outcomes
          Clinical Trials
          Lice Infestations Drug Therapy
          Adolescence
          Funding Source
          Child, Preschool
          Patient Compliance
          Child
          Comparative Studies
          Confidence Intervals
          Chi Square Test
          Fisher's Exact Test
          Human
          Adolescent: 13-18 years
          Child, Preschool: 2-5 years
          Child: 6-12 years
      ab: 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.
      pubtype: Academic Journal
      doctype:
        research
        tables/charts
        randomized controlled trial
        Journal Article
      ougenre: Article
    language: English
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