An 18-month-old child who attends day care has head lice and has been treated with permethrin 1% (Nix). The parent brings the child to the clinic 1 week later, and the primary care NP notes live bugs on the child's scalp. The NP should order:
a. lindane.
b. malathion.
c. ivermectin.
d. permethrin 5%.
D
Permethrin is the first-line drug of choice for treating head lice and is usually effective in one application. Significant resistance to permethrin 1% has developed, and permethrin 5% is more effective. In pediculosis, if live lice can be found after 1 week, reapply treatment. This child may have been reinfected at day care and so should be treated again. Malathion is a second-line drug and is not recommended in children younger than age 2 . Lindane is a third-line drug. Ivermectin is a fourth-line drug.
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