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Permethrin cream and pyrethrin lotion are first-line treatments for head lice, but resistance to these agents has been reported. In this international randomized double-blind trial, researchers compared two second-line treatments in patients and family members who reported that recent treatments with topical pyrethroid-based or malathion preparations had failed.
More than 800 people in 376 households received either weight-based single-dose oral ivermectin (which is not U.S. FDA-approved to treat head lice) or 0.5% malathion lotion; treatments were repeated 1 week later. Minimum age for enrollment was 2 years (median age of participants, 10 years).
In an intent-to-treat analysis, significantly more ivermectin recipients than malathion recipie…