National guidance on managing head lice infection in children

National Guidance on Managing Head Lice Infection in Children

Annex 2 Head lice: notes and guidance for pharmacists

General

• Head louse infection is not primarily a problem of schools but of the wider community.

• Pharmacists are an important source of advice on the management of head louse infection. They should be knowledgeable and competent on the subject, be able to teach patients the technique of detection combing, and be prepared to advise appropriate treatment.

• Pharmacists have an especially important role in limiting chemical treatment to true cases of infection, reducing unnecessary and inappropriate treatment, and thereby reducing the risk of further development of resistant strains of lice.

• Health professionals should be able to identify a louse at all stages of its development.

• Patients should be made aware that head lice are only transmitted by direct, head to head contact.

Specific

• If practical, consider nominating a member of staff to be responsible for advising patients on head louse problems.

• Liaise, as appropriate, with your local family practices, school nurses, health visitors, head teachers, infection control nurses, early years services and Consultant in Public Health Medicine.

• Where possible, stick to the following principles of control:

• definite diagnosis; a living, moving louse found by detection combing;

• simultaneous thorough and adequate treatment of all confirmed cases with one of the standard chemical insecticidal lotions and a repeat of the treatment after seven days, or the use of the wet combing method, also known as 'bug busting' every 3 days for up to 3 weeks. Ensure that patients are provided with information, advice and support. At a first consultation, it may be sufficient to ensure that they know how to undertake detection combing and what to do if there are head lice present.

• Do not assume a patient has head lice unless you yourself have seen a living, moving louse, or you have physical evidence from the patients; ask them to stick one of the lice on a piece of paper with clear sticky tape and bring it in.

• Make every effort to discourage unnecessary or inappropriate treatment with insecticides.

• Only recommend treatment if a louse has been clearly identified (as described above).

• Ensure that patients know the correct use of insecticidal lotions - follow the British National Formulary's recommendation of two applications of the same lotion ( not shampoo), seven days apart.

• Do not assume that "reinfections" or "treatment failures" are truly infections. Make sure that a louse is found or produced.

• Do not recommend re-treatment without first of all establishing that living, moving lice are still present after two applications of the same lotion seven days apart and after a full professional assessment as to the ways in which the family may not have complied carefully with the first attempt.

• Generally, Malathion or one of the pyrethroids is considered as first line treatment, and Carbaryl as second line treatment. There is little resistance so far to Carbaryl, but it is available only on prescription.

• Bear in mind that different formulations of the same active ingredient may be differently efficacious. When a first treatment has definitely failed, it may be useful to try the same agent in a different formulation.

• The use of electronic combs, repellent sprays, or chemical agents not specifically licensed for the treatment of head louse infections, should not be supported.

• Ensure that you can provide patients with an effective detection comb. This will have rigid plastic teeth set not more than 0.3mm apart.

• Do provide advice and support to families who do not wish to use insecticidal lotions.

The 'Bug Buster Kit' is now available for prescribing by health professionals. Only one kit is required for a family and it is reusable. The kit, which includes an illustrated guide and combs, is available from some pharmacies and by mail order from:

Community Hygiene Concern (Charity reg no: 801371)
6 - 9 Manor Gardens
London N7 6LA
Help Line: 020 7686 4321
Internet: www.chc.org

(This document has been adapted from appendix 2 of Head Lice: a Report for Consultants in Communicable Disease Control (CCDCs).)