From the Guidelines
Pediatric head lice can be effectively treated with over-the-counter permethrin 1% (Nix) as first-line therapy, applied to damp hair, left on for 10 minutes, then rinsed out, as recommended by the most recent and highest quality study 1. The treatment of pediatric head lice involves several options, including:
- Permethrin 1% (Nix) as the first-line therapy, which has low mammalian toxicity and does not cause allergic reactions in patients with plant allergies 1
- Pyrethrin products (RID) as an alternative, but should be avoided in children allergic to chrysanthemums 1
- Prescription options such as malathion 0.5% (Ovide) for children over 6, spinosad 0.9% (Natroba) for children 4 years and older, or ivermectin 0.5% lotion (Sklice) for children over 6 months for resistant cases 1
- Wet combing with a fine-toothed metal lice comb every 2-3 days for two weeks as an adjunct therapy or alternative for very young children or when medications are contraindicated 1 It is essential to note that treatment failures often occur due to incorrect application, insufficient contact time, or reinfestation rather than resistance, so proper education on application techniques is crucial 1. Additionally, parents should wash bedding and clothing used in the previous 48 hours in hot water and dry on high heat, as head lice cannot survive more than 24-48 hours away from the human scalp, making extensive home cleaning unnecessary 1.
From the FDA Drug Label
For the treatment of Head Lice, Pubic (Crab) Lice and Body Lice A second treatment must be done in 7-10 days to kill any newly hatched lice eggs (nits) Treat apply thoroughly to dry hair or other affected area. if infestation continues, see a doctor for other treatments
The treatment option for pediatric pediculosis (head lice) is to apply the pyrethrin shampoo to dry hair, leave it on for 10 minutes, and then rinse. A second treatment must be done in 7-10 days to kill any newly hatched lice eggs (nits). If infestation continues, consult a doctor for other treatments 2.
From the Research
Treatment Options for Pediatric Pediculosis (Head Lice)
- The American Academy of Pediatrics (AAP) recommends over-the-counter (OTC) pyrethroid products, such as permethrin and pyrethrin, as the first line of treatment for head lice infestations 3.
- Prescription products, including permethrin 5%, lindane, and malathion 0.5%, are also available for treatment 3.
- A combination of 1% permethrin and trimethoprim/sulfamethoxazole has been shown to be an effective alternative therapy for head lice infestations 4.
- Newer topical products, such as spinosad, have been introduced and have demonstrated superior performance compared to permethrin in clinical trials 5.
- Non-pharmacologic measures, such as environmental decontamination and proper application of products, are also important for effective treatment and prevention of reinfestation 6, 7.
Topical Treatments
- Permethrin 1% is still considered a first-line treatment for head lice infestations, despite reported increases in resistance 5.
- Malathion 0.5% is highly effective and has not shown any reported resistance, but should be used with caution due to its flammability and potential for serious adverse effects 3.
- Spinosad 0.9% has been shown to be an effective and well-tolerated agent for the treatment of head lice, with superior performance compared to permethrin 5.
- Benzyl alcohol 5% is also available as a topical treatment, but its efficacy compared to other agents is not well established 5.
Combination Therapies
- A combination of 1% permethrin and trimethoprim/sulfamethoxazole has been shown to be an effective alternative therapy for head lice infestations, with a success rate of 95% at the 2-week follow-up visit 4.
- The use of combination therapies may help to reduce treatment failures and slow the development of resistance to individual agents 4.