Systematic review of clinical efficacy of topical treatments for head lice

BMJ 1995;311:604-608 (2 September)

General practice

Systematic review of clinical efficacy of topical treatments for head lice

Robert H Vander Stichele, general practitioner,^a Els M Dezeure, school health services physician,^a Marc G Bogaert, clinical pharmacologist ^a

^a Heymans Institute of Pharmacology, University of Ghent, De Pintelaan, 185, B-9000 Ghent, Belgium

Correspondence to: Dr Vander Stichele.

Abstract

Objectives: To collect and evaluate all trials on clinical efficacyof topical treatments for head lice.
Design: Systematic review of randomised trials identified fromfollowing data sources: Medline, International PharmaceuticalAbstracts, Science Citation Index, letters to key authors andcompanies, and hand search of journals.
Setting: Trials in schools or communities.
Subjects: Patients infested with lice.
Main outcome measure: Cure rate (absence of live lice and viablenits) on day 14 after treatment.
Results: Total of 28 trials were identified and evaluated accordingto eight general and 18 lice specific criteria. Of the 14 trialsrated as having low to moderate risk of bias, seven were selectedas they used the main outcome measure. These seven trials described21 evaluations of eight different compounds and placebo (allbut two evaluations were of single applications). Only permethrin1% creme rinse showed efficacy in more than two studies withthe lower 95% confidence limit of cure rate above 90%.
Conclusions: Only for permethrin has sufficient evidence beenpublished to show efficacy. Less expensive treatments such asmalathion and carbaryl need more evidence of efficacy. Lindaneand the natural pyrethrines are not sufficiently effective tojustify their use.

Key messages

Key messages
In this systematic review we found only 28 randomised trials on clinical efficacy of topical treatments for head lice
Of these trials, only seven were of acceptable methodological quality and measured outcome at 14 days after treatment (the optimum time to assess clinical efficacy)
Of the eight different compounds evaluated, only permethrin 1% creme rinse showed efficacy in more than two studies with a lower 95% confidence limit of cure rate above 90%
Only for permethrin has sufficient evidence been published to show efficacy: less expensive treatments such as malathion and carbaryl need more evidence of efficacy, while lindane and the natural pyrethrines are not sufficiently effective to justify their use

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