Head Lice
AMERICAN ACADEMY OF PEDIATRICS CLINICAL REPORT
American Academy of Pediatrics Clinical Report. Head Lice. Pediatrics 2002 110: 638-643.
A clinical report from the AAP that 'attempts to clarify issues of diagnosis and treatment of head lice and makes recommendations for dealing with head lice in the school setting.'It recommends that 'permethrin 1% (Nix) is currently the recommended treatment for head lice, with retreatment in 7 to 10 days if live lice are seen' and that 'treatment failure does not equate with resistance, and most instances of such failure represent misdiagnosis/misidentification or noncompliance with the treatment regimen.'
Overdiagnosis and consequent mismanagement of head louse infestations in North America
Pollack RJ - Pediatr Infect Dis J - 01-AUG-2000; 19(8): 689-93; discussion 694
In this study, health care providers and parents submitted samples of what they thought were nits and eggs. Interestingly, 35% of specimens contained simple debris, such as 'dandruff, fibers, dirt, scabs, epidermal matter' and did not contain lice or nits. 59% of specimens did contain 'louse-derived specimens,' but only about 1/2 of them 'included a louse or an egg containing an apparently viable embryo.' So only 31% of the specimens indicated a real lice infestation that required treatment and the other kids were misdiagnosed and overtreated. Supringly, doctors were more likely than parents or teachers to misdiagnose lice infestations.
Lice , Nits, and School Policy
Williams LK - Pediatrics - 01-MAY-2001; 107(5): 1011-5
Found that 'most children with nits alone did not become infested. Policies requiring exclusion from school and treatment for all children with nits alone are likely excessive. Instead, these children may benefit from repeated examination to exclude the presence of crawling lice.'
This was a good study because if found that only 18% of kids with nits actually developed an active lice infestation. So just because you have nits, either before or after treatment, doesn't mean that your child is still infested with lice.
Head Lice Infestation: Single Drug Versus Combination Therapy With One Percent Permethrin and Trimethoprim/Sulfamethoxazole
Hipolito RB - Pediatrics - 01-MAR-2001; 107(3): E30
This study found that 'a combination of 1% PER {Nix} and TMP/SMX {Bactrim} is an effective alternative therapy for HLI. We recommend that the dual therapy with 1 %PER and oral TMP/SMX be used and reserved in cases of multiple treatment failures or suspected cases of lice-related resistance to therapy. '
Bactrim is thought to kill the intestinal bacteria inside the lice, which they need to survive.
