[AF] Pediculosis

[Ramón Díaz-Alersi]

At 15:14 03/04/2004, you wrote:
>Nuestro compañero Pedro, citó el enlace: Documentos Técnicos de Salud 
>Pública, de la Consejería de Sanidad de la Comunidad de Madrid
><http://www.madrid.org/sanidad/salud/educa/pdfs/dtpediculosis.pdf>http://www.madrid.org/sanidad/salud/educa/pdfs/dtpediculosis.pdf
>
>El apartado 5.3.5.2 dice:
>
>Trimetroprim-Sulfametoxazol
>
>.Probablemente actúa por destrucción de bacterias esenciales del intestino 
>del piojo que son las que ayudarían a este a digerir la sangre humana.
>
>.Los únicos datos de eficacia en pediculosis procede de estudios 
>observacionales y descripción de casos aislados, con lo que su uso en el 
>tratamiento de una enfermedad relativamente inocua como la pediculosis, 
>además de no estar autorizado, podría dar lugar a resistencias bacterianas 
>y perder con ello aun antibiótico* de gran valor .
>
>*Agente Antimicrobiano lo llamaría yo.
>
>Una vez más no deberíamos quedarnos con lo que promociona un determinado 
>laboratorio y tener en cuenta la ecuación riesgo/beneficio.
>

En realidad sí que hay datos procedentes de ensayos clínicos, esta búsqueda 
en Pubmed:

("Trimethoprim"[MeSH] AND "Lice Infestations"[MeSH])

Captura al menos dos ensayos clínicos publicados en 2001 con resultados 
contrarios; aunque, eso sí, nadie recomienda el uso del 
Trimetroprim-Sulfametoxazol como primera elección.

Saludos.

----------------------------------
Ramón Díaz-Alersi
UCI.- H.U. Puerto Real
11510.-Puerto Real, Cádiz
España.
http://www.uninet.edu
----------------------------------

A survey on head lice infestation in Korea (2001) and the therapeutic 
efficacy of oral trimethoprim/sulfamethoxazole adding to lindane shampoo.
Sim S, Lee IY, Lee KJ, Seo JH, Im KI, Shin MH, Yong TS.
Department of Parasitology and Institute of Tropical Medicine, Yonsei 
University College ofMedicine, Seoul 120-752, Korea.

Total of 7,495 children including 3,908 boys and 3,587 girls from a 
kindergarten and 15 primary schools were examined for head lice infestation 
(HLI). The overall prevalence of HLI in this study was found to be 5.8%. 
Head lice were much more commonly detected in girls than in boys with 
prevalence of 11.2% and 0.9%, respectively. Sixty-nine children with HLI 
were treated with 1% lindane shampoo alone (group 1), and 45 children with 
HLI were treated with 1% lindane shampoo and oral 
trimethoprim/sulfamethoxazole (group 2), and follow-up visits were 
conducted 2 and 4 weeks later. The children who still had HLI 2 weeks after 
the primary treatment were treated again. At the 2-week follow-up visit, 
the treatment success rates of groups 1 and 2 were 76.8% and 86.7%, 
respectively, and at the 4-week follow-up visit, the rates were 91.3% and 
97.8%, respectively. No statistically significant synergistic effect was 
observed for the combination of a 1% lindane shampoo and oral 
trimethoprim/sulfamethoxazole.



Head lice infestation: single drug versus combination therapy with one 
percent permethrin and trimethoprim/sulfamethoxazole.
Hipolito RB, Mallorca FG, Zuniga-Macaraig ZO, Apolinario PC, Wheeler-Sherman J.
Department of Pediatrics, University of California, Davis, California 
95616, USA. rbhipo en aol.com.

BACKGROUND: Head lice infestation (HLI) is a vexing problem for 
pediatricians and families because lice are becoming resistant to approved 
antipediculosis agents. OBJECTIVE: This study compared the efficacy of 3 
different treatments for HLI and determined whether combination therapy 
reduced treatment failures. DESIGN AND SETTING: A randomized, clinical 
trial performed in 3 private practices. PARTICIPANTS: The population was 
children ranging in age from 2 to 13 years. METHODS: HLI was diagnosed by 
direct inspection of the hair and scalp. Children were assigned to 1 of 3 
groups: 1) 1% permethrin creme rinse (1% PER; n = 39); 2) oral 
administration of trimethoprim/sulfamethoxazole (TMP/SMX; n = 36); and 3) a 
combination of 1% PER and TMP/SMX (n = 40). Follow-up visits were done 2 
and 4 weeks later, and parents or caregivers of those who did not return 
were interviewed by telephone. If HLI was present at the 2-week follow-up, 
the child was retreated per their protocol. We defined successful treatment 
as the absence of adult lice and nymphal stage or eggs (nits). The presence 
of nits alone was not considered a treatment failure. RESULTS: At the 
2-week follow-up visit, successful treatment for groups 1, 2, and 3 was 
79.5%, 83%, and 95%, respectively. At the 4-week follow-up, successful 
treatment was 72%, 78%, and 92.5% for groups 1, 2, and 3, respectively. The 
absolute risk reduction for recurrence comparing group 1 versus group 2 was 
6%, group 2 versus group 3 was 14%, and group 1 versus group 3 was 20%. No 
major adverse complications were seen in any treatment group. CONCLUSION: 
Our findings indicate that a combination of 1% PER and TMP/SMX is an 
effective alternative therapy for HLI. We recommend that the dual therapy 
with 1% PER and oral TMP/SMX be used and reserved in cases of multiple 
treatment failures or suspected cases of lice-related resistance to therapy.