Dermatología Pediatrica

Pediatric Dermatology
March 2006      (     Volume 23, Number 2     )
Albendazole: Single or Combination Therapy With Permethrin Against Pediculosis Capitis

Akisu C, Delibas SB, Aksoy U
Pediatric Dermatology.      2006;23(2):179-182

Pediculosis capitis (PC; head lice) poses an increasing health concern worldwide, due in part to the dual threats of pediculicide resistance and epidemic spread. As the most common human ectoparasites, the head louse (Pediculus humanus capitis) is thought to spread through direct head-to-head contact or fomites, such as hairbrushes, hats, and clothing. Traditional topical treatments include permethrin, lindane, and pyrethroid compounds, combined with nit combs and shampoos to strip away egg casings. Although these treatments are all effective,[1,2] resistance to 1 or several agents is becoming an emerging global concern.[3,4] Oral antihelminthic agents, such as ivermectin, levamisole, and albendazole, are promising alternatives to topical therapy for PC. The risks and benefits of these agents have yet to be fully explored.

In this Turkish study, Akisu and colleagues divided 150 school children with PC (51.5% girls; mean age, 9.6 years) into 5 treatment groups (N = 30 per group), who were randomized to receive one of the following regimens:

Oral albendazole 400 mg, single dose, repeated after 1 week;

Oral albendazole, 400 mg/day x 3 days, then a repeated single 400-mg dose after 1 week;

Topical 1% permethrin (shampoo and comb) monotherapy, repeated after 1 week if pediculosis was still evident;

Combination 1% permethrin and albendazole (400 mg single dose, repeated after week); or

Combination 1% permethrin and albendazole (400 mg/day x 3 days, then a repeated single 400-mg dose after 1 week).
Active infestation was diagnosed on the basis of the presence of live adult lice, nymphs, or nits close to the scalp. Clinical assessments were made before and 2 weeks after the final treatment. Success rates for groups 1-5 were 61.5%, 66.6%, 80.0%, 84.6%, and 82.1%, respectively. No adverse treatment reactions were reported. Study limitations included the lack of placebo controls and failure to provide long-term follow-up for PC recurrence.

Comment

Studies such as this one are welcomed and necessary, given the global prevalence of PC and the emergence of resistance among head lice to commonly used pediculicides, such as permethrin and lindane. Albendazole (benzimidazole carbamate), the antihelminthic agent used in this study, is used to treat a variety of human endo- and ectoparasites worldwide, and has a good pediatric safety profile. In the above Turkish study, this drug also showed promise as a treatment for PC.

Although Akisu and colleagues reported higher cure rates in the groups using topical 1% permethrin shampoo, children treated with albendazole alone still had relatively high clearance rates, even following the administration of a single 400-mg dose. The investigators noted no synergistic effect between permethrin and albendazole; however, albendazole use could prove useful when treating populations infected with potentially permethrin-resistant head lice. Furthermore, single-dose albendazole therapy may prove to be logistically more feasible than topical regimens when treating large infested populations; this would be especially true for impoverished children and adults who may lack the resources to follow a complex topical regimen.

References

Roberts RJ. Head lice. N Engl J Med. 2002;346:1645-1650.
Dodd CS. Interventions for treating headlice. Cochrane Database Syst Rev. 2001:CD001165.
Mumcuoglu KY, Klaus S, Kafka D, et al. Clinical observations related to head lice infestation. J Am Acad Dermatol. 1991;25:248-251.
Baily AM, Prociv P. Persistent head lice following multiple treatments: evidence for insecticide resistance in Pediculus humanus capitis. Australas J Dermatol. 2000;41:250-254.
Abstract