title: An observer-blinded study of 1% permethrin creme rinse with and without adjunctive combing in patients with head lice.
abstract: OBJECTIVE
  To determine if NIX (Warner Lambert Healthcare, Morris Plains, NJ) 1% Permethrin Creme Rinse Lice Treatment (1% PLT) without combing will effectively treat >/=95% of patients on day 2 or on day 15; to determine whether combing influences efficacy.
  
  
  METHODS
  A randomized, observer-blinded study enrolled 95 infested adults and children. All patients were treated with 1% PLT on day 1 and, if still infested, on day 8. One third of households were randomized to the combing group and two thirds to the no-combing group. Efficacy was assessed by: (1) visual inspection on days 1, 2, 8, 9, and 15 and, (2) shampooing/straining on days 2, 9, and 15. The target efficacy was 95%.
  
  
  RESULTS
  In the no-combing group, the lice-free rate was 83.1% on day 2 (95% CI, 71.0-91.6), 45.8% on day 8 (before second treatment) (95% CI, 32.7-59.2), 77.6% on day 9 (95% CI, 64.7-87.5), and 78.3% on day 15 (95% CI, 65.8-87.9). Adjunctive combing did not improve efficacy on any day.
  
  
  CONCLUSIONS
  In this population, 1% PLT was significantly less than 95% effective and suggests resistance to 1% PLT. The failure of nit removal combing by nonprofessional caregivers to improve efficacy demonstrates the unreliability of combing as adjunctive treatment in this setting.
authors.affiliation: Department of Dermatology, University of Miami School of Medicine, Florida 33101, USA.
authors.forename: Terri L
authors.initials: TL
authors.lastname: Meinking
authors.forename: Coleen M
authors.initials: CM
authors.lastname: Clineschmidt
authors.forename: Cong
authors.initials: C
authors.lastname: Chen
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kolber
authors.forename: Robert W
authors.initials: RW
authors.lastname: Tipping
authors.forename: Christine I
authors.initials: CI
authors.lastname: Furtek
authors.forename: Maria Elena
authors.initials: ME
authors.lastname: Villar
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Guzzo
mesh_terms: D000293:Adolescent; D000818:Animals; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006920:Hygiene; D007306:Insecticides / Q000008:administration & dosage*; D010373:Lice Infestations / Q000188:drug therapy* / Q000628:therapy; D008297:Male; D010374:Pediculus; D026023:Permethrin / Q000008:administration & dosage*; D012536:Scalp Dermatoses / Q000188:drug therapy*; D016037:Single-Blind Method; D017211:Treatment Failure
chemical_list: D007306:Insecticides; D026023:Permethrin