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Oral Ivermectin versus Malathion Lotion for Difficult-to-Treat Head Lice
Olivier Chosidow, M.D., Ph.D., Bruno Giraudeau, Ph.D., Jeremy Cottrell, M.S.,
Arezki Izri, M.D., Robert Hofmann, M.D., Ph.D., Stephen G. Mann, M.D., and Ian Burgess, Ph.D.

Selon une étude de l'Inserm et de l'AP-HP publiée en mars 2010 dans le New England Journal of Medicine l'ivermectine bien connue dans le traitement de la gale a démontré son efficacité dans l'éridication des poux en deux prises, à 7 jours d'intervalle.
Le traitement serait efficace à 95%, soit davantage que les lotions classiques.
Mais l'ivermectine devra être réservée aux cas difficiles à traiter qui résistent aux lotions afin de ne pas créer de résistance à ce nouveau traitement.

Revoir également : LES POUX - PEDICULOSE [Lire]

Background
Head-lice infestation is prevalent worldwide, especially in children 3 to 11 years old. Topical insecticides (i.e., pyrethroids and malathion) used as a lotion, applied twice at an interval of 7 to 11 days, are typically used for treatment. Resistance of lice to insecticides, particularly pyrethroids, results in treatment failure. The efficacy of alternative agents is controversial.

Methods
We conducted a multicenter, cluster-randomized, double-blind, double-dummy, controlled trial comparing oral ivermectin (at a dose of 400 µg per kilogram of body weight) with 0.5% malathion lotion, each given on days 1 and 8, for patients with live lice not eradicated by topical insecticide used 2 to 6 weeks before enrollment. The cluster was defined as the household. Infestation was confirmed and monitored by means of fine-toothed combing. Patients were at least 2 years of age and weighed at least 15 kg; all were treated at the study sites. The primary end point was the absence of head lice on day 15.

Ivermectine 400 µg/kg -Stromectol ® Cp à 3 mg
POIDS CORPOREL (kg)
DOSE
(en nombre de comprimés à 3 mg)
15 à 24 Deux
25 à 35 Quatre
36 à 50 Six
51 à 65 Huit
66 à 79 Dix
> 80 Douze


Results
A total of 812 patients from 376 households were randomly assigned to receive either ivermectin or malathion. In the intention-to-treat population, 95.2% of patients receiving ivermectin were lice-free on day 15, as compared with 85.0% of those receiving malathion (absolute difference, 10.2 percentage points; 95% confidence interval [CI], 4.6 to 15.7; P<0.001). In the per-protocol population, 97.1% of patients in the ivermectin group were lice-free on day 15, as compared with 89.8% of those in the malathion group (absolute difference, 7.3 percentage points; 95% CI, 2.8 to 11.8; P=0.002). There were no significant differences in the frequencies of adverse events between the two treatment groups.

Conclusions
For difficult-to-treat head-lice infestation, oral ivermectin, given twice at a 7-day interval, had superior efficacy as compared with topical 0.5% malathion lotion, a finding that suggests that it could be an alternative treatment.

(ClinicalTrials.gov number, NCT00819520
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