Drug-resistant head lice in Georgia

Now that school has started again, it is time to discuss that topic that parents of children often have to address: head lice.  Like everything in nature, these little beasties can develop drug resistance with enough time and exposure, and they have done just that in 25 of 30 States sampled in a recent study.  

Despite effective identification and treatment, cases of head lice have continued to rise since the 1990s.  Some surmise this may be due to the increased use of pyrethroids in the last few decades as a pesticide as part of a broader effort to shift away from harsher chemicals like DDT. Pyrethroids resistance has been found, for example, in house flies.  

Head lice affect somewhere between 6 million and 12 million children between the ages of 3 and 11 every year, according to the U.S. Centers for Disease Control and Prevention. Over-the-counter medications that contain pyrethroids include Pronto, R&C, Rid, and Triple X.  Even in a resistant State like Georgia, these are still considered first-line therapies.  Make sure your patients understand the instructions and leave the medication on long enough, along with eliminating fomites and treating all affected household members at the same time.  However, if they do not respond to treatment, you may have to prescribe something.  Prescription medicines that are recommended for head or pubic lice include:

Benzyl alcohol 5% (Ulesfia), which is used to treat head lice. It is applied to the hair on the head, left on for 10 minutes, and then rinsed off.

Malathion lotion (Ovide), which is used to treat head lice. It is applied to hair on the head, left on for 8 to 12 hours, then rinsed off. If lice are still present 7 to 9 days later, a second treatment must be done.  

Luckily lice do not serve as vectors for disease, but they are certainly a distraction.  If you have had any experience with resistant lice, feel free to post in the comments,

Julie Hannah, FNP-C