Commentary

Community nurses and parents in the UK, as elsewhere in the world, are engaged in a constant battle with head lice. The current treatment options are physical methods (eg, combing) and/or the application of pediculicides.

This is the first published randomised controlled trial that compares combing with chemicals, although the bug busting approach is strongly promoted by the UK National Health Service website as the “effective” option of first choice.¹ Non-chemical treatments may appear attractive in view of the increasing resistance of head lice to insecticides and a natural disinclination to expose children to chemicals.² This trial by Roberts et al, however, suggests that bug busting alone is less effective than malathion alone; the study did not examine the effectiveness of the combined use of bug busting and malathion. A recent systematic review found no evidence that any pediculicide is more effective than others and suggested that any treatment decisions should take into account local patterns of resistance.³

The findings of Roberts et al are useful to practitioners because the study was grounded in “real world” practice, where parents themselves did the treatment. The fact that only half the participants complied fully and accurately with the instructions is important, and even lower rates of concordance may be expected outside of a research study.

The conclusions offer practitioners a firm basis for advising concerned parents and teachers of the relative merits of combing and malathion.