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Comparative Effectiveness of Traditional Head Lice Lotion and Bug-Busting Method in Children

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This study evaluates the effectiveness of traditional head lice lotion (phenothrin) versus the bug-busting method (BBP) for managing head lice infestation in children aged 4-16. Conducted in two semi-rural general practices in East Devon, 30 participants were randomly assigned to either intervention group. Results showed that by Day 14, the BBP method resulted in significantly fewer living lice compared to the lotion, emphasizing its potential as a more effective alternative for treating head lice infestations.

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Comparative Effectiveness of Traditional Head Lice Lotion and Bug-Busting Method in Children

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  1. 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

  2. Aim To compare the effectiveness of traditional head lice lotion (phenothrin) with the bug-busting method of managing head lice infestation

  3. Intervention versus control Control Group Phenothrin: Smell Tolerability Application

  4. Intervention versus control Intervention Group Bug-busting Pack: C.H.C. Combs Conditioner

  5. 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

  6. Rationale • Incidence • Reluctance by parents to use traditional lotions • Trust policy- no evidence base • Cost • Changing role of school nurse

  7. Participants 1. Recruitment – school, G.P., Pharmacy 2. Randomisation-children chose sealed envelopes 3. Parents and siblings – data included only if criteria met

  8. 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

  9. Characteristics Treatment GroupBBP Control Group (Lotion) Mean Age 8.1, SD 2.56 9.27, SD 3.95 Sex: Male 4 3 Sex: Female 11 12 No of single child families 4 1 6 5 No with non-infested siblings 5 9 Hair length short 3 4 Hair length to collar 3 5 Hair length below collar 9 6 Baseline Characteristics No with infested siblings in the same household

  10. Main Outcome Measure • Absence of live lice at Day 14

  11. 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

  12. 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

  13. 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

  14. 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).

  15. 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)

  16. 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)

  17. Results

  18. Key Findings Intervention Group • Cumulative body count on days 1,7, 14 = 466 • Reducing body count as a result of effective BB Intervention

  19. 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

  20. 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)

  21. 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)

  22. 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

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