Head Lice : Medications and Administration

Drugs	Recommended Therapy	Note1
FIRST LINE
Children > 2 months Adults	Permethrin 1% w/v Lotion1 [2 x 30ml bottle] ·         Apply for at least 10 minutes on dried hair ·         Rinse completely ·         Re-apply after 7-10 days1,3,6	·         First line therapy6 ·         Category : B ·         Kills live lice but not unhatched eggs ·         Permethrin may continue to kill newly hatched lice for several days after treatment. ·         A second treatment often is necessary on day 9 to kill any newly hatched lice before they can produce new eggs3
Pregnancy and Lactation		·         Animal studies showed no evidence of impairment or harm to fetus ·         No sufficient information on breast milk excretio. However unlikely to cause any harm to infant ·         Consider witholding therapy or temporary discontinuation of nurisng
SECOND LINE / NOT AVAILABLE
Children > 50 kg Adults	Gamma Benzene Hexachloride (Lindane) 0.1% lotion1 ·           Apply sufficient amount onto clean, dry hair ·           Allow to remain for 4 minutes ·           Rinse off thoroughly with warm water	·         Second line ·         Category : B ·         Not available at our facility ·         Due to risk for neurologic adverse events1 ·         Use restricted to treatment failure or not tolerating other medications
Children > 6 months7 Adults	Malathion Shampoo 1%1 ·         Apply shampoo on wet hair and work up lather ·         Leave for 15 minutes and rinse, then comb ·         Repeat if necessary after 7 - 9 days	·         Category : C+ ·         Not available at our facility
1.       Formulari Ubatan KKM (November 2016) 2.       Pindaan / Tambahan Kepada Formulari Ubat KKM bil 2/2016 3.       Centres of Disease Control and Prevention (CDC) 4.       www.uptodate.com 5.       BNF for Children (September 2015-2016) 6.       Pediculosis and Scabies: A Treatment Update. Am Fam Physician. 2012 Sep 15;86(6):535-541. 7.       A-lices Scalp & Body Hygiene Shampoo Consumer Medicine Information