Clinical Review Evidence based case report

Treatment for head lice

BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7180.385 (Published 06 February 1999) Cite this as: BMJ 1999;318:385
  1. M Dawes, general practitioner (martin.dawes@dphpc.ox.ac.uk),
  2. N R Hicks, general practitioner,
  3. M Fleminger, general practitioner,
  4. D Goldman, general practitioner,
  5. J Hamling, general practitioner,
  6. L J Hicks, general practitioner
  1. Hollow Way Medical Centre, Oxford OX4 2NJ
  1. Correspondence to: Dr Dawes
  • Accepted 2 September 1998

Christopher, my son, has been lost in many places. One of his local adventures was in Sainsbury's. On losing sight of my wife he went to a member of staff and stated that he was lost. He was asked what his mummy looked like. “She's the one with a scarf on her head because she's got nits.” We frequently face the problem of head lice in practice, but our practice team felt uncertain about the most effective treatment.

The question

The first step was to design an answerable question. This is the three step question described by Scott Richardson.1 It should contain the problem, the intervention, and the outcome. Our final question was “In children attending primary care with nits what is the most effective treatment for eradication?”

The search

I gathered evidence from several sources hoping to gain a consensus. I was looking mainly for well designed clinical trials. A good source of evidence of a therapeutic effect is a meta-analysis of randomised controlled trials. The Cochrane Library is one source of high quality meta-analyses. However, I do not have this in my surgery so I looked up head lice in the Oxford Textbook of Medicine.2 The section on head lice began by giving me quotes from Robert Burns. There was a description of the biology and clinical features of head lice. It said that head lice are resistant to chlorinated hydrocarbons and suggested the use of malathion. “More recently Permethrin has been shown to be equally effective without the potentially toxic side effects (CNS) of Malathion.” It suggested that all these treatments achieve 100% cure rates but gave …

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