Published online August 31, 2007
PEDIATRICS Vol. 120 No. 3 September 2007, pp. 688 (doi:10.1542/peds.2007-1723)
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Pediculosis Capitis (Head Lice)
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LETTER TO THE EDITOR

Therapy for Head Lice

William B. Weil, MD
Professor Emeritus
Departments of Pediatrics and Human Development
College of Human Medicine
Michigan State University
East Lansing, MI 48824-1317

To the Editor.—

I am writing because of concern about the article "Therapy for Head Lice Based on Life Cycle, Resistance, and Safety Considerations."1 My first concern is the recommendation to use malathion, an organophosphate pesticide, as the first-line therapy when permethrin is also recommended by the American Academy of Pediatrics Committee on Infectious Diseases for this purpose.2 As an organophosphate, malathion is in the class of pesticides that includes chlorpyrifos, which has now been banned as a home-use pesticide. Malathion is also not recommended for children <6 years of age. Thus, malathion has a greater possibility for toxicity than permethrin.3,4 Under these circumstances, it would seem reasonable to use permethrin unless treatment failure is documented.

My second concern is that the third author of this article serves as vice president of and is a major shareholder in the sole pharmaceutical company that manufactures and markets Ovide, a product that is 0.5% malathion and is recommended in this article as the first-line therapy for head lice in children. The conflict of interest is obvious and should have resulted in more than just listing the author's statement in very small print under the location of the authors’ place of employment.

REFERENCES

  1. Lebwohl M, Clark L, Levitt J. Therapy for head lice based on life cycle, resistance, and safety considerations. Pediatrics. 2007;119 :965 –974[Abstract/Free Full Text]
  2. American Academy of Pediatrics. Summaries of infectious diseases: pediculosis capitis and pediculosis capitis. In: Pickering LK, ed. Red Book: 2006 Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2006:488
  3. Environmental Protection Agency. Other insecticides, acaricides, and repellents. In: Reigart JR, Roberts JR, eds. Recognition and Management of Pesticide Poisonings. 5th ed. Washington, DC: Environmental Protection Agency; 1999:68
  4. American Academy of Pediatrics. Chemical and physical hazards: pesticides. In: Etzel RA, ed. Pediatric Environmental Health. 2nd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2003:331 –335
PEDIATRICS (ISSN 1098-4275). ©2007 by the American Academy of Pediatrics

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This article has been cited by other articles:


Home page
 PediatricsHome page
K. Ross
Head Lice, Resistance, and Malathion
Pediatrics, January 1, 2008; 121(1): 222 - 222.
[Full Text] [PDF]

eLetters:

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Re: Therapy for Head Lice
Joanna Ibarra
Pediatrics Online, 6 Sep 2007 [Full text]
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Pediculosis Capitis (Head Lice)
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