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Supplements Definitive Management of Head Lice in the Era of Pediculicide Resistance
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Clinical Update on Resistance and Treatment of Pediculosis capitis
Terri L. Meinking, BA
Overview: The State of Head Lice Management and Control
Ronald C. Hansen, MD
American Academy of Pediatrics Guidelines for the Prevention and Treatment of Head Lice Infestation
Barbara L. Frankowski, MD, MPH
Faculty Discussion: Definitive Management of Head Lice in the Era of Pediculicide Resistance
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Clinical Update on Resistance and Treatment of Pediculosis capitis
Terri L. Meinking, BA
Treating and Managing Head Lice: The School Nurse Perspective
Sally Z. Schoessler, BSN, RN, SNT
Faculty Discussion: Definitive Management of Head Lice in the Era of Pediculicide Resistance
American Academy of Pediatrics Guidelines for the Prevention and Treatment of Head Lice Infestation
Barbara L. Frankowski, MD, MPH
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Head Lice Treatment Costs and the Impact on Managed Care
Dennis P. West, PhD, FCCP
Overview: The State of Head Lice Management and Control
Ronald C. Hansen, MD
Treating and Managing Head Lice: The School Nurse Perspective
Sally Z. Schoessler, BSN, RN, SNT

Clinical Update on Resistance and Treatment of Pediculosis capitis

Terri L. Meinking, BA

Head lice are extremely host-specific, feeding only on humans, and have demonstrated increased resistance to pediculicides. Current clinical data demonstrate that most pediculicides do not meet advertising claims of "killing lice on contact." Slow pediculicidal action, ineffective formulations, and sublethal residue on the hair and scalp have contributed to resistance over time. Malathion 0.5% is the only pediculicide that has retained its efficacy, killing both lice and nits.2,3 Other commonly used products have demonstrated resistance in the United States. Although malathion resistance has been documented in the United Kingdom, the formulations there are very different from OVIDE that is sold in the United States. The US formulation includes synergistic components to deter the development of resistance. When US-manufactured OVIDE was tested on malathion-resistant lice from the United Kingdom, it maintained its efficacy.7 Recent data suggest that a decreased application time for OVIDE is effective without producing residual effects.5 The reduced application time is beneficial for the pediatric population, particularly in terms of limiting the risk for potential adverse events, such as itching or burning of the scalp.

Of particular interest is the failure of nit combing to produce better outcomes, even when used as an adjunct to pediculicide therapy.4 Schools and organizations often advocate nit combing as a safe and effective way to eradicate lice and nits. Study results suggest that nit combing is not effective.

The clinical history of pediculicides and the increase in resistance over time strongly suggest the need for better management of therapies that remain efficacious, such as malathion 0.5%. Currently, it is the only pediculicide to demonstrate no resistance and no change in efficacy; however, overuse of malathion 0.5% may lead to resistance in the United States as it has in other countries. Since malathion 0.5% is a prescription product, physicians are urged to regulate its use and to educate patients and others, such as school administrators and public health policy developers, about the proper use of pediculicides.




 

1. Meinking T, Taplin D. Infestations. In: Pediatric Dermatology. 3rd ed. Schachner LA, Hansen RC, eds. Edinburgh: Mosby; 2003:1141-1180.

2. Meinking TL, Entzel P, Villar ME, Vicaria M, Lemard GA, Porcelain SL. Comparative efficacy of treatments for pediculosis capitis infestations: update 2000. Arch Dermatol. 2001;137:287-292.

3. Meinking TL, Serrano L, Hard B, et al. Comparative in vitro pediculicidal efficacy of treatments in a resistant head lice population in the United States. Arch Dermatol. 2002;138:220-224.

4. Meinking TL, Clineschmidt CM, Chen C, et al. An observer-blinded study of 1% permethrin creme rinse with and without adjunctive combing in patients with head lice. J Pediatr. 2002;141:665-670.

5. Meinking TL, Vicaria M, Eyerdam DH, et al. Efficacy of a reduced application time of OVIDE® Lotion (0.5% malathion) compared to Nix® Crème Rinse (1% permethrin) for the treatment of head lice. In press: Ped. Dermatol.

6. Taplin D, Meinking TL, Castillero PM, Sanchez R. Permethrin 1% Crème Rinse for the treatment of Pediculus humanus var caputis infestation. Pediatr Dermatol. 1986;3:344-348.

7. Downs AM, Stafford KA, Harvey II, Coles GC. Evidence for double resistance to permethrin and malathion in head lice: reply from authors. Br J Dermatol. 2000;142:1067.

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