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A review of the current evidence on primary treatment modalities of head lice demonstrates increasing resistance to current regimens. New and alternative therapies are now available. A treatment algorithm was created to address safety and efficacy of treatments, as well as to guide clinicians through navigation of the regimens. Through an online journal search, 59 articles were selected for the review. Literature searches were performed through PubMed, Medline, Ebsco Host, and CINAHL, with key search words of "Pediculosis capitis" and "head lice" in the title, abstract, and index. Meta-analyses and controlled clinical trials were viewed with greater weight if they had a large sample size, were statistically significant, and did not allude to bias. When resistant infestations are well-documented in a locality, changes to the treatment regimen are indicated, and alternative treatments should be considered. Recent studies and U.S. Food and Drug Administration (FDA) approvals have changed the available treatment options for Pediculosis capitis, including benzyl alcohol, topical ivermectin, spinosad, and the LouseBuster(TM). Further, environmental management and prevention measures should be taken to avoid reinfestation and to prevent the spread of head lice. Continued study is recommended to establish long-term safety of new and alternative agents.
Pediculosis capitis infestations are a common health problem, with cases ranging in the hundreds of millions worldwide. In the United States, infestations are most prevalent among preschool-aged children attending childcare, elementary school students, and the household members of infested children (Bowden, 2012). Incidence is rising, largely related to increased resistance to treatment with current first-line therapies (Connolly, 2011; Durand et al., 2012). Resistance is also growing due to inadequate and unnecessary treatments. The convenience and availability of over-thecounter pediculicide products to consumers make clinician management by moderation and selectivity very difficult. This review is intended to provide an updated source of information on new products, as well as changes in the efficacy of known treatments. Further, adequate diagnosis, consideration of alternative therapies, environmental recommendations, and general education are cornerstones of Pediculosis capitis management in primary care.
Description of the Parasite
The parasitic louse, Pediculosis capitis, is 1 to 3 mm long (Gunning, Pippitt, Kiraly, & Sayler, 2012). Its color varies based on hair color of the host and ranges from grayish-white to darker shades. Pediculosis capitis only infests...