Oral ivermectin versus malathion lotion for difficult-to-treat head lice.
BACKGROUND
Head-lice infestation is prevalent worldwide, especially in children 3 to 11 years old. Topical insecticides (i.e., pyrethroids and malathion) used as a lotion, applied twice at an interval of 7 to 11 days, are typically used for treatment. Resistance of lice to insecticides, particularly pyrethroids, results in treatment failure. The efficacy of alternative agents is controversial.


METHODS
We conducted a multicenter, cluster-randomized, double-blind, double-dummy, controlled trial comparing oral ivermectin (at a dose of 400 microg per kilogram of body weight) with 0.5% malathion lotion, each given on days 1 and 8, for patients with live lice not eradicated by topical insecticide used 2 to 6 weeks before enrollment. The cluster was defined as the household. Infestation was confirmed and monitored by means of fine-toothed combing. Patients were at least 2 years of age and weighed at least 15 kg; all were treated at the study sites. The primary end point was the absence of head lice on day 15.


RESULTS
A total of 812 patients from 376 households were randomly assigned to receive either ivermectin or malathion. In the intention-to-treat population, 95.2% of patients receiving ivermectin were lice-free on day 15, as compared with 85.0% of those receiving malathion (absolute difference, 10.2 percentage points; 95% confidence interval [CI], 4.6 to 15.7; P<0.001). In the per-protocol population, 97.1% of patients in the ivermectin group were lice-free on day 15, as compared with 89.8% of those in the malathion group (absolute difference, 7.3 percentage points; 95% CI, 2.8 to 11.8; P=0.002). There were no significant differences in the frequencies of adverse events between the two treatment groups.


CONCLUSIONS
For difficult-to-treat head-lice infestation, oral ivermectin, given twice at a 7-day interval, had superior efficacy as compared with topical 0.5% malathion lotion, a finding that suggests that it could be an alternative treatment. (ClinicalTrials.gov number, NCT00819520.)
Chosidow
Olivier
O
Université Pierre et Marie Curie Paris 6 and Assistance Publique-Hôpitaux de Paris, Paris, France. olivier.chosidow@hmn.aphp.fr
Giraudeau
Bruno
B
Cottrell
Jeremy
J
Izri
Arezki
A
Hofmann
Robert
R
Mann
Stephen G
SG
Burgess
Ian
I
D000284:Administration, Oral; D000287:Administration, Topical; D000293:Adolescent; D000818:Animals; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007306:Insecticides / Q000009:adverse effects / Q000627:therapeutic use*; D057194:Intention to Treat Analysis; D007559:Ivermectin / Q000009:adverse effects / Q000627:therapeutic use*; D010373:Lice Infestations / Q000188:drug therapy*; D008294:Malathion / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D010374:Pediculus; D012536:Scalp Dermatoses / Q000188:drug therapy*; D016896:Treatment Outcome
D007306:Insecticides; D007559:Ivermectin; D008294:Malathion