NEJM Audio Summary - Nov 1, 2012

今回は、アタマジラミの治療に関する論文。日本では、ピレスロイドの１つ、フェノトリンを含むスミスリンパウダーかスミスリンシャンプーを使用するが、耐性を獲得した虫が多い欧米では、代替え治療としてイベルメクチンの内服、外用も行われるらしい。内服治療に関しては、以前にNEJMでも論文が出ている。今回は外用の効果についてです。

0:56 | "Topical 0.5% Ivermectin Lotion for Treatment of Head Lice" by David Pariser from Eastern Virginia Medical School, Norfolk. New treatments for head lice are needed. Two trials involving 765 patients investigated the efficacy and safety of a single application of a new 0.5% ivermectin lotion formulation as compared with vehicle control, an identical formulation without ivermectin, in patients with head-louse infestation. In the intention-to-treat population, significantly more patients receiving ivermectin than patients receiving vehicle control were louse-free on day 2 (94.9% vs. 31.3%) and day 15 (73.8% vs. 17.6%). The frequency and severity of adverse events were similar in the two groups. A single, 10-minute, at-home application of ivermectin was more effective than vehicle control in eliminating head-louse infestations at 1, 7, and 14 days after treatment. 

In editorial Olivier Chosidow from Hôpital Henri-Mondor, Créteil, France asks "How should head-louse infestation be managed?". With good comparative-effectiveness research still lacking, indirect comparisons support the 2010 American Academy of Pediatrics recommendations to use 1% permethrin or pyrethrin insecticide as first-line therapy. If resistance in the community has been proven or live lice are present 1 day after the completion of treatment, a switch to malathion may be necessary. Other options include wet combing or treatment with dimethicone or other topical agents, depending on the availability of the agents in the country. Nit removal is useful. Ivermectin should be the last choice, whether topical (for still-infested persons) or oral (especially for mass treatment). Management should also include more frequent checking for head-louse infestation in families and schools. (273 words / 136 sec = 120 wpm)