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12 years 1 month ago #23057 by beedee
Another Ivomec use was created by beedee
Oral Ivermectin Versus Malathion Lotion for Difficult-to-Treat Head Lice

Chosidow O, Giraudeau B, Cottrell J, et al
N Engl J Med. 2010;362:896-905
Background

The worldwide resistance of head lice to pyrethrins is increasing and has stimulated greater interest in identifying alternative therapeutic regimens. One preparation that is increasingly being used is topical malathion 0.5%. This randomized trial compared an oral drug, ivermectin, with topical malathion in households with resistant infestations of head lice. Participants were enrolled as households, and all members of the household had to be infected and had to have had a previous attempt to topically treat at least 1 member for head lice in the 2-6 weeks before enrollment.
Study Summary

Households were enrolled at 7 study centers in 4 countries in 2004. At the initial visit, each member of the household was examined via a standard hair-combing technique to determine the presence of live lice. Households were then equally randomly assigned to the 2 regimens, and the primary outcome was measured at 15 days. If treatment failed at 15 days, the household was switched to the alternate regimen. Participants were not allowed to use combing as a therapy, to chemically treat or color their hair, or to cut it short during the trial. Success was defined as no live lice on day 15, determined by investigator examination and combing.
More than 800 participants in 376 households were enrolled. Initially, 398 participants were treated with ivermectin and 414 were treated with malathion. The median age of the participants was 10 years, and more than 80% of participants were female. Both treatments were administered on days 1 and 8 of the trial. Ivermectin was administered at a dose of 400 µg/kg, given as 3-mg tablets. Research staff applied the malathion preparation to the participants during visits, completely moisturizing each participant's hair and scalp. Once dry, the participant was allowed to leave the study center with instructions to leave the malathion preparation in for 10-12 hours before shampooing. All participants took pills and received lotion application at each visit, but only 1 treatment was active and the other was placebo.
Ivermectin performed better on the primary outcome -- 95.2% of participants were free of live lice at day 15 compared with 85% of the malathion participants (absolute difference, 10.2 percentage points; 95% CI, 4.6-15.7). Primary treatment with ivermectin failed in 8 participants, and malathion failed in 31 participants. All but 1 participant was successfully treated with the alternate regimen after failure of the initial therapy. The participants overwhelmingly preferred oral treatment (78.3% vs 13%; 8.7% indicated no preference). Fewer than 2% of participants in both groups had adverse effects. The investigators concluded that, compared with topical malathion, oral ivermectin had superior efficacy in treating resistant head lice infestation.
Viewpoint

Over the past 5 years, I have reviewed several studies that evaluated treatment of resistant head lice, a condition that continues to vex clinicians and patients. Most of the alternative preparations involved topical application of an agent that smothered the lice, and all of these generally low-potential toxicity products tended to perform reasonably well. However, these investigators note the difficulties with patient adherence to topical approaches. With treatment on days 1 and 8 and without the long hours spent combing, oral ivermectin appears to be a huge benefit to parents and children alike and may prove to be a useful alternative.
Abstract

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12 years 1 month ago #329878 by Stikkibeek
Replied by Stikkibeek on topic Another Ivomec use
I've read somewhere that Ivermectin has been used in some of the African countries for quite a while, to treat human parasites.

Did you know, that what you thought I said, was not what I meant :S

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12 years 1 month ago #329887 by beedee
Replied by beedee on topic Another Ivomec use
Its used in NZ for scabies.. but very expensive

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12 years 1 month ago #329958 by Anne
Replied by Anne on topic Another Ivomec use
The main problem with the treatment of head lice (and scabies too for that matter) is not the treatment per se, but (a) getting people to treat kids in the first place and then (b) getting them to treat properly.

I wonder if schools could be allowed to administer ivermectin to kids with lice? Not on your nelly, that would be against their individual rights and might go against their parents' wishes for them to grow up "chemical free", never mind all the "chemicals" in their lunch boxes.

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12 years 1 month ago #330162 by Mummamac
Replied by Mummamac on topic Another Ivomec use

Anne;316585 wrote: The main problem with the treatment of head lice (and scabies too for that matter) is not the treatment per se, but (a) getting people to treat kids in the first place and then (b) getting them to treat properly.

I wonder if schools could be allowed to administer ivermectin to kids with lice? Not on your nelly, that would be against their individual rights and might go against their parents' wishes for them to grow up "chemical free", never mind all the "chemicals" in their lunch boxes.


Your dam right. I would be most peed off if some vigilante decided my children needed treatment with an ivermectin. For Goshs sake, there only nits, not a deadly disease...get over yourself!
And for what its worth my kids have NEVER had them, but I find your comment quite weird...who did nits ever kill?:eek:

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12 years 1 month ago #330259 by Anne
Replied by Anne on topic Another Ivomec use
Mummamac, I said that kids with nits should be treated. At no time did I indicate that kids without nits should be treated - that would be a complete waste of time and money.

I have seen children with head sores that have become infected following untreated lice infestation. Hair matted into lumps with blood and pus. Kids end up with hair having to be shaved off, usually with a scalpel because the lumps are so close to the scalp. It is not nice to see kids suffering in this way because the adults in their lives are unable to follow a course of treatment.

I have spoken with parents of children with the above sores and they have said that they didn't want to treat the lice with "chemicals". In my book, that is fine, as long as they are then willing to comb out all the nits, usually on a daily basis until they are no longer present, but many parents are unwilling to do this either. These same children have lunch boxes with twisties, cheezles, muesli bars, lollies and other processed food - but these "chemicals" are fine.

Giving an ivomec tablet would prevent all of this - and them passing the lice onto other people.

So, I am happy that your kids have never had lice. Well done. If you had been in situations where your kids were continually re-infected by untreated kids, you may think differently about suitable treatment.

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12 years 1 month ago #330271 by LongRidge
Replied by LongRidge on topic Another Ivomec use
Of the cattle and sheep worm drenches that I have accidently tasted, most of them taste strongly of garlic. I guess that an active part of drenches is the sulphydryl (I think it is) compound that gives the alliums their distinctive flavour and very powerful chemical antibiotic properties. Because I know that man-made poisons are hugely LESS poisonous than natural poisons, I have no problem with the administration of beneficial drugs. But ....
In animals the -ectins used to kill off external parasites really well. But over the years the lice etc have got resistant, so giving them orally is now much less effective. If given orally to humans, care would be needed to ensure that all the lice died so that no resistance develops.

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12 years 1 month ago #330298 by Simkin
Replied by Simkin on topic Another Ivomec use
Mummamac - my kids have had head lice and it is a HUGE job to get rid of them. They usually got them just before Christmas after the swimming pool opened. At the chemist they sold me 3 different products that didn't work and a cheap plastic nit comb that didn't work either.

Applying these treatments requires quite a lot of discipline and they have to be re-done to kill off the newly hatched lice, too.

There are kids out there who don't have a shower or a bath at home, who are filthy and unkempt. Their parents haven't got the skills or the focus to treat their kids so swallowing a pill would be good for them.

We finally got a steel nit comb which is brilliant. They were gone within a couple of weeks and the good thing is - you can use it once a week to make sure that no new infestation gets established.

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12 years 1 month ago #330301 by Mummamac
Replied by Mummamac on topic Another Ivomec use
Exactly. A nit comb is the best way of dealing with them so I've heard.

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