How to advise a patient when over the counter products have failed

doi:10.1136/bmj.326.7401.1257

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Ian Burgess1, director (ian@insectresearch.com)

Insect Research and Development Limited, Cambridge CB1 5EL

First it is important to know whether treatment really has failed, so it is important that you or a nurse know how to reliably identify live lice at all developmental stages, and that you can differentiate hatched eggshells (nits) from potentially viable eggs. Nobody can reliably identify viable eggs, even with the aid of a microscope, unless the young louse can be seen moving inside the shell.

Failure with over the counter products may have two causes: improper use and insecticide resistance.