[Permethrin-resistant pediculosis].
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Numerous therapies are available in both over-the-counter and prescription formulations for the treatment of head lice infestation. We summarize treatment recommendations from published literature and from a recent meta-analysis from the Cochrane Database of Systematic Reviews that describe the efficacy, safety, and resistance patterns of monotherapies available in the United States. If treatment with pyrethrin or permethrin fails to eradicate the infestation, the treatment of choice is malathion. However, because of malathion's flammability, it should be a second-line therapy. Orally administered ivermectin has been reported to be efficacious, but it is not currently a US Food and Drug Administration-approved pediculicide. Alternative therapies are also discussed, in addition to indications for prophylaxis, resistance reporting, and the social impact of infestation.
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A clinical trial of the pyrethroid permethrin in 1% lotion was performed on 20 children. Ten were treated for 10 minutes and 10 for 2 hours. All lice washed off the heads of children treated for 2 hours were dead immediately after treatment. Twenty-four percent of the lice removed from one child treated for 10 minutes were still alive 2 hours later. The ovicidal effect was similar in both groups, with egg mortality 88% and 90% following 10-minute and 2-hour treatment, respectively. The mortality of untreated control eggs was 14% and 11%, respectively.
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