What is the management of pediculosis (Pediculosis, head lice) in pediatric patients?

From the Guidelines

Pediatric lice management should begin with over-the-counter permethrin 1% (Nix) as first-line treatment, applied to damp hair, left on for 10 minutes, then rinsed out, as recommended by the American Academy of Pediatrics 1. The treatment of pediculosis in pediatric patients involves the use of pediculicides, with permethrin 1% being the most studied and recommended option in the United States 1. Key points to consider in the management of pediculosis include:

• The use of permethrin 1% as first-line treatment, with a second application 7-10 days later to kill newly hatched lice 1.
• For resistant cases, prescription options include malathion 0.5% (Ovide) for children over 6 years, spinosad 0.9% (Natroba), or ivermectin 0.5% (Sklice) 1.
• Mechanical removal with a fine-toothed comb is essential after treatment to remove dead lice and nits 1.
• Parents should check all household members and treat those infected simultaneously to prevent reinfestation 1.
• Machine wash all bedding, clothing, and personal items used by the infected child in hot water (130°F) and dry on high heat, and seal items that cannot be washed in plastic bags for two weeks 1.
• Children can return to school after completing the first treatment, and preventive measures include teaching children not to share personal items like combs, hats, or headphones 1. It is also important to note that lice infestation is not related to poor hygiene and spreads primarily through direct head-to-head contact 1. In terms of school policies, no-nit policies for return to school should be abandoned, and school personnel involved in detection of head lice infestation should be appropriately trained 1. Overall, the management of pediculosis in pediatric patients requires a comprehensive approach that includes the use of pediculicides, mechanical removal, and preventive measures, as well as education and training for parents and school personnel 1.

From the FDA Drug Label

Apply malathion lotion on DRY hair in amount just sufficient to thoroughly wet the hair and scalp. Pay particular attention to the back of the head and neck while applying malathion lotion. Wash hands after applying to scalp. Allow hair to dry naturally - use no electric heat source, and allow hair to remain uncovered. After 8 to 12 hours, the hair should be shampooed. Rinse and use a fine - toothed (nit) comb to remove dead lice and eggs. If lice are still present after 7 - 9 days, repeat with a second application of malathion lotion. Malathion lotion is indicated for patients infected with Pediculus humanus capitis (head lice and their ova) of the scalp hair.

The management of pediculosis (head lice) in pediatric patients involves:

• Applying malathion lotion to dry hair, thoroughly wetting the hair and scalp
• Allowing the hair to dry naturally without using electric heat
• Shampooing the hair after 8 to 12 hours and using a fine-toothed comb to remove dead lice and eggs
• Repeating the application after 7 to 9 days if lice are still present 2 Key points:
• Malathion lotion is indicated for the treatment of head lice and their ova in scalp hair 2
• Other family members should be evaluated by a physician to determine if they are infested and receive treatment if necessary 2

From the Research

Diagnosis of Pediculosis

• Diagnosis should be based on the observation of a live louse, as the presence of nits can be misleading and may not always indicate an active infestation 3
• The American Academy of Pediatrics (AAP) guidelines recommend that diagnosis should ideally be based on the observation of a live louse, and the presence of nits should be used with caution to avoid misdiagnosis 3

Treatment Options

• Over-the-counter (OTC) pyrethroid products, such as pyrethrin and permethrin, are commonly used to treat head lice and are generally considered safe for most people 3
• Prescription products, including permethrin 5%, lindane, and malathion 0.5%, are also available, but resistance to some of these products has been documented 3
• A combination of 1% permethrin and trimethoprim/sulfamethoxazole has been shown to be an effective alternative therapy for head lice infestation 4
• Dimeticone 4% lotion has been found to be a very effective and safe pediculicide for pediculosis control, with high cure rates and minimal reinfestation 5

Management in Schools

• The AAP guidelines recommend that no-nit policies in schools are detrimental and can cause lost time in the classroom, as well as an inappropriate allocation of the school nurse's time for lice screening 3
• Accurate diagnosis, safe treatment options, and a common-sense approach to managing infestations in schools are recommended 3

Pediatrician's Attitudes and Practices

• A survey of Italian pediatricians found that the majority believe that parents consult their primary care pediatrician only after the failure of other "remedies" 6
• The same survey found that most pediatricians prescribe malathion as a first-line treatment, and consider creams, foams, and gels to be the most effective formulations 6
• The survey also found that most pediatricians suggest repeating the treatment after one week, and believe that recurrences are often the result of reinfestation in the community 6