Ivermectin Shows Advantage Over Malathion for Head Lice

Oral drug more effective in eradicating hard-to-treat lice than topical malathion lotion
By Eric Metcalf
HealthDay Reporter

WEDNESDAY, March 10 (HealthDay News) -- Oral ivermectin has better efficacy than topical malathion lotion for eradicating hard-to-treat cases of head lice, according to research published in the March 11 New England Journal of Medicine.

Olivier Chosidow, M.D., of the Hôpitaux de Paris, and colleagues analyzed data from 812 participants from 376 households. Subjects were at least 2 years old with head-lice infestation confirmed with a fine-toothed comb. Patients or a household member had failed to eradicate their infestation with a topical insecticide several weeks earlier. Subjects were randomized to receive two treatments of oral ivermectin or 0.5 percent malathion lotion. The primary end point was freedom from head lice at day 15.

In the intention-to-treat population, the researchers found that the proportions of patients receiving ivermectin or malathion who were lice-free at 15 days were 95.2 and 85 percent, respectively. In the per-protocol population, 97.1 and 89.8 percent were lice-free, respectively. The frequency of adverse events was similar for the groups.

"Ivermectin may be a good alternative to malathion when topical insecticide resistance is suspected," the authors write. "Restricting the use of ivermectin for head-lice infestation to the target population in our study (i.e., patients with infestation in whom a topical insecticide failed) should limit the risk of the emergence of resistance, but long-term surveillance will be mandatory."

The study was supported by Johnson & Johnson-Merck Sharp & Dohme-Chibret. Several authors reported financial relationships with these and other pharmaceutical companies.

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