Head lice A Randomised Controlled Trial

Head lice A Randomised Controlled Trial

Comparing the effectiveness of traditional head lice lotion with the bug-busting method of managing

head lice infestation.L Plastow, M Luthra, M Marshall,

D Russell, J Wright.Mt. Pleasant Health Centre, Exeter. R Powell, Exeter & N.Devon RDSU

AimTo compare the

effectiveness oftraditional head lice

lotion(phenothrin) with the

bug-bustingmethod of managing head

liceinfestation

Intervention versus control

Control Group

Phenothrin:SmellTolerabilityApplication

Intervention versus control

Intervention Group

Bug-busting Pack:C.H.C.CombsConditioner

Context Setting: Two semi-rural

General Practices in East Devon

Participants: 30 children aged 4-16 years randomly assigned to the two intervention groups phenothrin and bug-busting

Ethical approval: granted by Exeter Ethics Committee

Funding: Northcott Foundation

Rationale

Incidence Reluctance by parents

to use traditional lotions

Trust policy- no evidence base

Cost Changing role of school

nurse

Participants

1. Recruitment – school, G.P., Pharmacy

2. Randomisation-children chose sealed envelopes

3. Parents and siblings – data included only if criteria met

Exclusion Criteria Active symptomatic asthma Persistent skin disorder of

scalp Treated with head lice lotion

within previous 4 weeks Hair: bleached, permed,

coloured Sensitivity to pyrethroid,

organophosphate and or carbon insecticides

Sensitivity to chrysanthemums

Baseline Characteristics

69Hair length below collar

53Hair length to collar

43Hair length short

95No with non-infested siblings

56

14No of single child families

1211Sex: Female

34Sex: Male

9.27, SD 3.958.1, SD 2.56Mean Age

Control Group (Lotion)Treatment Group BBPCharacteristics

No with infested siblings in the same household

Main Outcome Measure

Absence of live lice at Day 14

Intervention

Control Group Day 1- Combed dry. Lice found stuck on CRF.

Lotion applied Day 4- no intervention Day 7 – as Day 1 Day 10- no intervention Day14 Combed dry. Lice removed stuck on CRF

Intervention

Intervention Group Day 1- Combed dry. Lice

found stuck on CRF. Conditioner applied. Combed using BBP

Day 4- Conditioner applied. Combed using BBP

Day 7 – as Day 1 Day 10- as Day 4 Day 14 Combed dry. Lice

removed stuck on CRF

Statistical Analysis

Intention to treat analysis was conducted using Mann Whitney U test (Non-parametric) for continuous data.

Where there was no evidence of skewness, Chi-squared was conducted for categorical data

Results

Day 1 Children in BBP infested

with median of 8 lice at any stage in development compared with a median of 10 in the lotion group.

This difference was not significant (p>.05).

Day Seven Results

Children in BBP were infested with a median of 3 lice at any stage in development compared with a median of 15 in the lotion group.

This difference was significant (p=0.041)

Day Fourteen Results

Children in BBP were infested with a median of 0 lice at any stage in development compared with a median of 5 in the lotion group.

This difference was significant (p=0.008)

Results

1515 1515 1515 1515 1515 1515N =

trial group - wet-combing or lotion

lotionwet-combing

160

140

120

100

80

60

40

20

0

-20

Day 1 instars

Day 1 adults

Day 7 instars

Day 7 adults

Day 14 instars

Day 14 adults

1927

538

19

27

853

1918

8

18

5

43

18

4

185

Key Findings

Intervention Group

Cumulative body count on days 1,7, 14 = 466

Reducing body count as a result of effective BB Intervention

Key Findings

Control Group

Cumulative body count on days 1,7, 14 = 1028

Increasing body count as a result of egg hatching and reproduction of lice not killed by lotion application

Key Findings

Intervention Group At Day 7 the number of

living nymphs was 218 (47%)

At day 14 the number of living nymphs was 29 (6%) (p<0.001)

Key Findings

Control Group At Day 7 the number

of living nymphs was 462 (45%)

At day 14 the number of living nymphs was 280 (27%) (p<0.001)

Summary

NNT 2.5 (95% CI: 2.19 to 2.81)

A minimum of two applications of lotion required for clinical effectiveness

The BBP method is likely to be more effective than traditional methods