Head lice A Randomised Controlled Trial Comparing the effectiveness of traditional head lice lotion with the bug-busting method of managing head lice infestation

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  • Head lice A Randomised Controlled TrialComparing 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 controlControl Group

    Phenothrin:SmellTolerabilityApplication

  • Intervention versus controlIntervention Group

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

  • ContextSetting: Two semi-rural General Practices in East DevonParticipants: 30 children aged 4-16 years randomly assigned to the two intervention groups phenothrin and bug-bustingEthical approval: granted by Exeter Ethics CommitteeFunding: Northcott Foundation

  • RationaleIncidence Reluctance by parents to use traditional lotionsTrust policy- no evidence baseCostChanging role of school nurse

  • Participants1. Recruitment school, G.P., Pharmacy2. Randomisation-children chose sealed envelopes3. Parents and siblings data included only if criteria met

  • Exclusion CriteriaActive symptomatic asthmaPersistent skin disorder of scalpTreated with head lice lotion within previous 4 weeksHair: bleached, permed, colouredSensitivity to pyrethroid, organophosphate and or carbon insecticidesSensitivity to chrysanthemums

  • Baseline CharacteristicsNo with infested siblings in the same household

  • Main Outcome MeasureAbsence of live lice at Day 14

  • InterventionControl GroupDay 1- Combed dry. Lice found stuck on CRF. Lotion appliedDay 4- no interventionDay 7 as Day 1Day 10- no interventionDay14 Combed dry. Lice removed stuck on CRF

  • InterventionIntervention GroupDay 1- Combed dry. Lice found stuck on CRF. Conditioner applied. Combed using BBPDay 4- Conditioner applied. Combed using BBPDay 7 as Day 1Day 10- as Day 4Day 14 Combed dry. Lice removed stuck on CRF

  • Statistical AnalysisIntention 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

  • ResultsDay 1Children 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 ResultsChildren 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 ResultsChildren 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

  • Key FindingsIntervention Group

    Cumulative body count on days 1,7, 14 = 466Reducing body count as a result of effective BB Intervention

  • Key FindingsControl Group

    Cumulative body count on days 1,7, 14 = 1028Increasing body count as a result of egg hatching and reproduction of lice not killed by lotion application

  • Key FindingsIntervention GroupAt Day 7 the number of living nymphs was 218 (47%)

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

  • Key FindingsControl GroupAt Day 7 the number of living nymphs was 462 (45%)At day 14 the number of living nymphs was 280 (27%) (p
  • SummaryNNT 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