title: Comparison of wet combing with malathion for treatment of head lice in the UK: a pragmatic randomised controlled trial.
abstract: 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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Public Health, North Wales Health Authority, Mold, UK. richard.roberts@nwales-ha.wales.nhs.uk
authors.forename: R J
authors.initials: RJ
authors.lastname: Roberts
authors.forename: D
authors.initials: D
authors.lastname: Casey
authors.forename: D A
authors.initials: DA
authors.lastname: Morgan
authors.forename: M
authors.initials: M
authors.lastname: Petrovic
mesh_terms: D000293:Adolescent; D000818:Animals; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007306:Insecticides / Q000627:therapeutic use*; D010373:Lice Infestations / Q000188:drug therapy / Q000628:therapy*; D008294:Malathion / Q000627:therapeutic use*; D010374:Pediculus; D012536:Scalp Dermatoses / Q000188:drug therapy / Q000628:therapy*
chemical_list: D007306:Insecticides; D008294:Malathion