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S-TMP/Bactrim/Septra for head lice??

April 12, 2001 on Medscape site had current abstracts regarding treatment of
headlice. One specifically addressed use of Bactrim: "Head Lice
Infestation: Single Drug vs Combination Therapy with 1% Permethrin and
TMP/SMX" Pediatrics, 2001: 107: E30. I've head of this before, but don't
know the exact mechanism for Bactrim's effectiveness....the article in Peds
probably describes it. Kris McHarg, CPNP

S-TMP/Bactrim/Septra for head lice??

There was just an article about that on Medscape's Pharmacology site:

http://pharmacotherapy.medscape.com/Medscape/Dermatology/journal/2001/v0...

ca-md0412.01/ca-md0412.01.html#a2

See: Head Lice Infestation: Single Drug Versus Combination Therapy With One
Percent Permethrin and Trimethoprim/Sulfamethoxazole

The article comparred it with 1% Permethrin rinse used alone, TWP/SMX used
alone,and both used together. The combined therapy was most effective
against resistent infestations.

It should be mentioned that the goal was to kill the live critters, and did
not consider the later presence of nits a treatment failure.

Interesting, huh?
Judy T RN

S-TMP/Bactrim/Septra for head lice??

There is only anecdotal evidence--no good evidence-based medicine. 20 adult
patients treated with cotrimazole appeared to have resolution (minimal
effective dose 80 mg TMP/400 mg SMX twice daily for 3 days). See
Shashindran et al, British Journal of Dermatology, 1978, Vol 98. The
mechanism proposed (in a follow-up letter in same journal) is that
cotrimazole kills symbiotic bacteria in the gut of female lice which are
required for egg-laying. There have been no studies in children. I have
only used it in last-resort cases--our dermatologist here is more likely to
use ivermectin (still little data to support this as well).

Gregory Plemmons, MD
Assistant Professor,
Division of General Pediatrics
Vanderbilt University

---------------------- Forwarded by Gregory Plemmons/VUMC/Vanderbilt on
04/17/2001 09:27 AM ---------------------------

Question:

I saw a patient today who is struggling with recurrent, treatment
resistant head lice. Her mother says that last fall another doctor
in the HMO I'm working for gave them an antibiotic which got rid of
the lice. I found a note describing 3 days/6 doses of Septra.

Has anybody else heard of this? If it works, why does it work?

--
------------------------------------
Julia Winter Mason M.S. M.D.
General Pediatrician who studied Nutritional Sciences
in Waunakee, near Madison Wisconsin

S-TMP/Bactrim/Septra for head lice??

Head Lice Infestation: Single Drug Versus Combination Therapy
With One Percent Permethrin and Trimethoprim/Sulfamethoxazole

Ronaldo B. Hipolito, MD et al.

PEDIATRICS Vol. 107 No. 3 March 2001, p. e30

http://www.pediatrics.org/cgi/content/full/107/3/e30

I haven't tried this yet, but I'm thinking about it.

Len Leshin, MD, FAAP

RE: S-TMP/Bactrim/Septra for head lice??

A more recent reference, was e-Pediatrics, Vol.107, #3, March,2001 on the
use of dual therapy for treatment of head lice. Bottom line: resolution
with Permethrin, alone 72%; Bactrim alone 78%; both together 92.5%. Peter
Rappo

-----Original Message-----
From: Vince [mailto:hidden@email-address]
Sent: Tuesday, April 17, 2001 5:30 PM
To: hidden@email-address
Subject: Re: S-TMP/Bactrim/Septra for head lice??

I have had a lot of success in kids with persistent or resistant head lice
using Ovide lotion overnight. It is flammable, so I warn parents about
that, but it seems to work well and is well tolerated.

I haven't had to try Bactrim or Ivermectim yet.

------------

Vincent Iannelli, MD

Your Guide to Pediatrics
-----> http://pediatrics.about.com

on 4/17/01 9:35 AM, hidden@email-address at
hidden@email-address wrote:

> There is only anecdotal evidence--no good evidence-based medicine. 20
adult
> patients treated with cotrimazole appeared to have resolution (minimal
> effective dose 80 mg TMP/400 mg SMX twice daily for 3 days). See
> Shashindran et al, British Journal of Dermatology, 1978, Vol 98. The
> mechanism proposed (in a follow-up letter in same journal) is that
> cotrimazole kills symbiotic bacteria in the gut of female lice which are
> required for egg-laying. There have been no studies in children. I have
> only used it in last-resort cases--our dermatologist here is more likely
to
> use ivermectin (still little data to support this as well).
>
> Gregory Plemmons, MD
> Assistant Professor,
> Division of General Pediatrics
> Vanderbilt University
>
> ---------------------- Forwarded by Gregory Plemmons/VUMC/Vanderbilt on
> 04/17/2001 09:27 AM ---------------------------
>
> Question:
>
> I saw a patient today who is struggling with recurrent, treatment
> resistant head lice. Her mother says that last fall another doctor
> in the HMO I'm working for gave them an antibiotic which got rid of
> the lice. I found a note describing 3 days/6 doses of Septra.
>
> Has anybody else heard of this? If it works, why does it work?
>
> --
> ------------------------------------
> Julia Winter Mason M.S. M.D.
> General Pediatrician who studied Nutritional Sciences
> in Waunakee, near Madison Wisconsin
>

> in the body of the message.
>
>
>
>

> in the body of the message.
>

S-TMP/Bactrim/Septra for head lice??

I have used Bactrim for head lice and have had good luck with it. My understanding is that the bactrim is ingested by the feeding lice and kills their gut bacteria so that they literally starve to death. Doesn't address the nit issue, though. If I am satisfied that the parent is using a shampoo correctly *and* manually removing nits but still having problems, then I will prescribe bactrim. I still preach nit-picking to reinforce that the bactrim alone is not a cure.

The dose I use is:

Bactrim (40 mg/5 cc) 1 cc/kg/d divided bid for 3 days then repeat 1 week later bid for 3 days.

Eve Switzer, MD
rural peds

On Mon, 16 April 2001, Julia Winter Mason wrote:

>
> Question:
>
> I saw a patient today who is struggling with recurrent, treatment
> resistant head lice. Her mother says that last fall another doctor
> in the HMO I'm working for gave them an antibiotic which got rid of
> the lice. I found a note describing 3 days/6 doses of Septra.
>
> Has anybody else heard of this? If it works, why does it work?
>
> --
> ------------------------------------
> Julia Winter Mason M.S. M.D.
> General Pediatrician who studied Nutritional Sciences
> in Waunakee, near Madison Wisconsin
>

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S-TMP/Bactrim/Septra for head lice??

At 04:30 PM 04/17/2001 -0500, Vince wrote:
>I have had a lot of success in kids with persistent or resistant head lice
>using Ovide lotion overnight. It is flammable, so I warn parents about
>that, but it seems to work well and is well tolerated.
>
>I haven't had to try Bactrim or Ivermectim yet.
>
>
>------------
>
>Vincent Iannelli, MD

Ovide (malathion) was used in Los Angeles a number of years ago for a
Medfly infestation. It was sprayed from helicopters and residents were
warned to cover their cars (it could possibly cause paint damage) and bring
their pet dishes inside because of potential toxicity to animals. Granted,
the concentration in Ovide lotion might be different than what was used for
aerial spraying, but there's no way that a Los Angeles resident who
remembered malathion spraying could be convinced to put it on their kid's head!

Michael K. Sachs, M.D.
General Pediatrician

S-TMP/Bactrim/Septra for head lice??

I have had a lot of success in kids with persistent or resistant head lice
using Ovide lotion overnight. It is flammable, so I warn parents about
that, but it seems to work well and is well tolerated.

I haven't had to try Bactrim or Ivermectim yet.

------------

Vincent Iannelli, MD

Your Guide to Pediatrics
-----> http://pediatrics.about.com

on 4/17/01 9:35 AM, hidden@email-address at
hidden@email-address wrote:

> There is only anecdotal evidence--no good evidence-based medicine. 20 adult
> patients treated with cotrimazole appeared to have resolution (minimal
> effective dose 80 mg TMP/400 mg SMX twice daily for 3 days). See
> Shashindran et al, British Journal of Dermatology, 1978, Vol 98. The
> mechanism proposed (in a follow-up letter in same journal) is that
> cotrimazole kills symbiotic bacteria in the gut of female lice which are
> required for egg-laying. There have been no studies in children. I have
> only used it in last-resort cases--our dermatologist here is more likely to
> use ivermectin (still little data to support this as well).
>
> Gregory Plemmons, MD
> Assistant Professor,
> Division of General Pediatrics
> Vanderbilt University
>
> ---------------------- Forwarded by Gregory Plemmons/VUMC/Vanderbilt on
> 04/17/2001 09:27 AM ---------------------------
>
> Question:
>
> I saw a patient today who is struggling with recurrent, treatment
> resistant head lice. Her mother says that last fall another doctor
> in the HMO I'm working for gave them an antibiotic which got rid of
> the lice. I found a note describing 3 days/6 doses of Septra.
>
> Has anybody else heard of this? If it works, why does it work?
>
> --
> ------------------------------------
> Julia Winter Mason M.S. M.D.
> General Pediatrician who studied Nutritional Sciences
> in Waunakee, near Madison Wisconsin
>

> in the body of the message.
>
>
>
>

> in the body of the message.
>