Skin Problems & Treatments Health Center

Combined Drug Treatment May Be Best Way

March 19, 2001 -- Head lice are a problem no one wants to think or talk about.

But head lice are very common in the U.S. today. They're found among every social group, and good hygiene habits are no protection. Children pass them from head to head in day care centers and schools, and every year an estimated $100 million is spent on head lice treatments.

Unfortunately, none of the available lice treatments works perfectly, and there is increasing evidence that lice are becoming resistant to many drugs designed to kill them. But a recent paper in the March issue of Pediatrics suggests that a treatment combining a topical creme and an oral antibiotic may be more effective than the topical cream alone.

In their study, the researchers randomly assigned over 100 children with lice to a combination therapy of the commonly used 1% permethrin cream rinse, called Nix or the less common Rid, and the oral antibiotic trimethoprim/sulfamethoxazole, the most commonly used brand called Bactrim. They compared this group of children to groups of children receiving only the cream rinse or only the antibiotic.

At both the two- and four-week follow-up, more than 90% of the children receiving the combination therapy were lice-free, compared with only 80% or less in the other two treatment groups. There were no major side effects in any of the treatment groups.

"This is an alternative method we can use for treating head lice," study author Ronaldo B. Hipolito, MD, tells WebMD. "This is not a first-line treatment, but if you have treatment failures and need to try something else, this will work. It is much better than dangerous alternatives people are trying such as kerosene, alcohol, or insecticides." Hipolito is a senior neonatology fellow at the University of California, Davis, School of Medicine.

"This [combination] treatment has been known for some time, but most physicians don't think of it immediately," Alan Meyers, MD, MPH, tells WebMD. Meyers is an associate professor of pediatrics at Boston University School of Medicine.

Usually, the first treatment for lice is just Nix, says Meyers.

Sarah Chamlin, MD, agrees, and she routinely has the whole family treat themselves. "So often it's impossible to get everyone into the office to be tested. I have them repeat the treatment seven or eight days later to kill any eggs that may have hatched." Chamlin is assistant professor of pediatrics and dermatology at Northwestern University School of Medicine in Chicago and attending physician at Children's Memorial Hospital.

Other tips offered by Chamlin: The infested person should put on clean clothes after treatment. Comb the hair carefully with a special "nit comb" to remove nits and lice from the hair. The nits are yellowish-white, oval eggs, firmly attached to the hair shaft. Continue to check the hair and use a nit comb every two to three days, until you're sure all lice and nits are gone.