ORIGINAL ARTICLE

Effectiveness of oral Albendazole as a Treatment for Pediculosis Capitis

Essam Bakr Abdel-Al, MD, Hamed Mohamed Abdo, MD
Mohamed Abdel-Ghaffar Attiah, M.B, B.Ch.

Department of Dermatology, Faculty of Medicine, Al Azhar University, Cairo, Egypt

ABSTRACT
Background: Pediculosis capitis remains a problem worldwide. In addition, there is evidence that head louse is becoming
resistant to common pediculicides.
Objective: The aim of the present study was to evaluate the effectiveness of oral albendazole therapy in the treatment of
pediculosis capitis.
Patients and Methods: Sixty patients with pediculosis capitis were enrolled in this study. They were divided into 3 groups.
Group I included 20 patients treated with oral albendazole (400 mg single dose). Group II included 19 patients treated
with topical 0.5% malathion lotion. Group III included 21 patients treated with both regimens. All patients were instructed
to repeat treatment at day 10. Two weeks after the initial visit, patients were reexamined to evaluate treatment outcome.
Patients with moving adult lice or nymphs were regarded as failure of the therapy. Also patients were asked about side
effects from treatment.
Results: Out of the 60 patients, 58 were girls and 2 were boys. Their ages ranged from 4-14 years with a mean age of 9.25
years (mean SD; 9.25 3.452). Successful treatment was observed in 31 patients (51.67%, 30 females and 1 male). They
were 6 out of 20, 11 out of 19 and 14 out of 21 in group I, II and III respectively. Regarding overall treatment outcome,
there was no statistically significant difference between the 3 groups (p-value = 0.051). However, the number of responding
patients in group III was more than that in group II and I (14 out of 21, 11 out of 19 and 6 out of 20 patients respectively).
Side effects were rare and minimal.
Conclusion: Although not statistically significant, 400 mg oral albendazole/topical malathion combination was more
effective than either one alone, while the least effective was the oral albendazole.

KEYWORDS: Albendazole, treatment, pediculosis capitis

INTRODUCTION viable nit on the head. Using lice combs increases

Human head louse, Pediculus humanus capitis, or the chances of finding live lice and is a helpful
pediculosis capitis, is a common health problem screening tool.3
in the world. Pediculosis capitis is the most There are three fundamental methods that are
prevalent parasitic infection of children in many effective in treatment of pediculosis; topical
countries. Scalp itching is a common symptom in pediculicides, wet combing and oral therapy.1
the infested people, although infested patients with The pyrethrins and pyrethroids are the major
pediculosis can be asymptomatic.1 Pediculosis commercially available pediculicides in the market
capitis occurs primarily in school-aged children, currently.4 First-line pharmacologic treatment of
but may affect all age groups and socioeconomic pediculosis is permethrin 1% lotion or shampoo.
levels.2 The gold standard for diagnosing head lice Multiple novel treatments have shown limited
is the identification of a live louse, nymph, or a evidence of effectiveness superior to permethrin.
Correspondence: Dr. Hamed Mohamed Abdo, Departement of Dermatology, Faculty of Medicine, Al Azhar University, Cairo, Egypt
E-mail: [email protected] - Mobile: +2/ 01066339011

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 Effectiveness of oral Albendazole as a Treatment for Pediculosis Capitis

Wet combing is an effective non pharmacologic 2. Examination and diagnosis of pediculosis

treatment option.5 capitis: A) Presence of moving lice or nits, B)
The recent increase in the prevalence of pediculosis Erythema, scales, erosion, impetigo or folliculitis
internationally, has been suggested to be the affecting scalp, face or neck, C) Presence of
result of incorrect use of topical insecticides, and lymphadenopathy, D) Active infestation was
consequently growing resistance to commonly diagnosed by the presence of moving adult louse
used pediculicides with a neurotoxic mode of or nymph.
action, such as those containing permethrin and
malathion.2 The extensive use of pediculicides 3. Medication: Patients were divided into 3
with a neurotoxic mode of action has led to the groups as follows: Group I included 20 patients
development and spread of resistant head lice treated with oral albendazole (400 mg single dose
populations all over the world. This triggered the - tablet or syrup). Group II included 19 patients
development of compounds with other modes treated with topical 0.5% malathion lotion.
of action.6 This study aimed to evaluate the Group III included 21 patients treated with both
effectiveness of oral albendazole therapy in the malathion and oral albendazole. All patients were
treatment of pediculosis capitis. instructed to repeat treatment at day 10. Patients
with signs of secondary bacterial infection were
PATIENTS AND METHODS treated additionally with appropriate systemic
This study included 60 patients with pediculosis antibiotic. Patients used malathion were asked
capitis. They were recruited from the attendants to follow the following instructions: a) Adequate
of the outpatient dermatology clinics of Al-Azhar amount of the malathion lotion should be applied
University Hospitals in the period from April on dry hair especially behind the ears and on the
2014 to October 2014. back of the head (to wet the hair completely),
Exclusion criteria included: patients with avoiding contact with the face. b) Allow the hair
known hypersensitivity to albendazole; previous to dry. c) Leave the lotion for 12 hours. d) Rinse
treatment directed against head louse in the past the hair thoroughly with tap water.
month; and patients below the age of two years.
An informed consent was taken from all patients 4. Follow up: Two weeks after the initial visit,
(or their parents or guardians) before enrollment patients were reexamined to evaluate treatment
in the study. outcome. Patients with moving adult lice or
nymphs were regarded as failure of the therapy.
All members were subjected to: Also patients were asked about side effects from
1. History taking: A) Age, sex, residence, history treatment.
of medications and history of drug sensitivity, B)
History of previous treatment directed against STATISTICAL ANALYSIS
pediculosis, C) History of scalp complaints (e.g. Statistical analysis was carried out using SPSS
itching). (version 17.0; SPSS Inc., Chicago, IL, USA).
Quantitative data were analyzed using mean and
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 Essam Bakr Abdel-Al et al.

standard deviation (SD). Paired t test was used respectively) (Table 1). The side effects were
to test for significant difference between two rare and minimal, with no statistically significant
sample means. P values < 0.05 were considered difference between the 3 groups (p-value = 0.997).
significant. These included 1 patient with mild abdominal
pain in group I, 1 patient with burning sensation
RESULTS in the scalp in group II and 1 patient with anorexia
Out of 60 patients with pediculosis capitis, 58 and mild abdominal pain in group III (Table 2).
were females and 2 were males. Their ages ranged Table 2 Side effects among the three groups
from 4-14 years (mean SD; 9.25 3.452).
Side effects
Group I patients were 19 females and 1 male; their Chi-Square
Treatment
ages ranged from 4-14 years (mean SD; 9.2 groups Incidence Type
3.254). Group II patients were 19 females; their N % X2 P-value

ages ranged from 4-14 years (mean SD; 8.473 Group I Mild abdomi-
(oral
3.82). Group III patients were 20 females and 1 albendazole) 1 5.00 nal pain

male, their ages ranged from 5-14 years (mean Group II Burning sen-
(topical sation in the
SD; 10 3.286). 1 5.26
malathion) scalp
Successful treatment was observed in 31 patients Group III Anorexia and
0.0053 0.997

(51.67%, 30 females and 1 male). It included 6 out (oral + 1 4.76

mild abdomi-
topical) nal pain
of 20, 11 out of 19 and 14 out of 21 in group I, II,
and III respectively. Regarding overall treatment DISCUSSION
outcome, there was no statistically significant For several decades, treatment of head lice
difference between the 3 groups (p-value = 0.051). infestation has centered primarily on topical
However, the number of responding patients in ovicides and pediculicides. Lice have become
group III was more than that in group II and I (14 increasingly resistant to pyrethroids (such as
out of 21, 11 out of 19 and 6 out of 20 patients permethrin) and lindane. Permethrin is no longer

Table 1 Treatment outcome among the three groups

considered ovicidal.7 The emergence of resistance
to commonly used pediculicides has long been
Treatment outcome recognized. Therefore, to avoid such resistance to
Treatment Successful Treatment Chi-Square
treatment failure
pediculicides, the use of different drugs may be
groups Total
N % N % X2 P-value important. Several anthelminthic agents including
Group I ivermectin and levamisole have been reported as
(oral 6 30.00 14 70.00 20 effective treatments for pediculosis capitis.8
albendazole)
Group II Albendazole is a benzimidazole with broad
(topical 11 57.89 8 42.11 19 spectrum of activity against helminth parasites.9
malathion) 5.947 0.051
Ayoub et al10 reported successful treatment
Group III
(oral + 14 66.67 7 33.33 21 with topical application of albendazole in four
topical) patients with head lice. Akisu et al8 investigated
Total 31 51.67 29 48.33 60 if albendazole could be used in the treatment
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 Effectiveness of oral Albendazole as a Treatment for Pediculosis Capitis

of pediculosis capitis in combination with 1% albendazole + topical malathion). Both studies

permethrin or alone. They reported various degree indicate that the combined therapy is more
of effectiveness in their study groups. effective than either one alone.
This study was done to evaluate the anti-louse effect A more successful treatment outcome with 0.5%
of systemic albendazole in an attempt to confirm malathion application was also reported by
or contradict its reported efficacy in pediculosis Chosidow et al11 (85.0% versus 57.89% in our
capitis. We investigated oral albendazole (400 study). They used 0.5% malathion lotion, given
mg) in the treatment of pediculosis capitis alone, on days 1 and 8, for patients with live lice, not
and in combination with malathion 0.5% lotion eradicated by topical insecticides used 2 to 6
versus topical malathion 0.5% alone. We found weeks before enrollment. Three hundred and fifty
that only 30% of patients (6 out 20) receiving 400 two of the 414 patients were free of head lice on
mg albendazole orally showed effective results day 15. Although both gave positive result, the
manifested by absence of moving head lice. difference between both studies may be attributed
This unsatisfactory result (30% efficacy) was to the difference in number of patients (414 versus
not similar to those of Akisu et al8 who reported 60), or the difference in infestation density or
the successful use of oral albendazole alone and patient compliance.
combined with permethrin in the treatment of Ivermectin is an antihelminthic agent which was
pediculosis capitis. In their study, 150 children investigated in the treatment of head lice. In a
were randomly divided into five equal groups. study conducted by Youssef et al12 topical 0.8%
Group 1 got albendazole in a single dose (400 ivermectin lotion was shown to be effective in all
mg), group 2 got albendazole at 400 mg for 3 25 patients included in their study. Also patients
days, group 3 was given 1% permethrin, group 4 who received topical 0.5% ivermectin lotion were
took 1% permethrin and albendazole in a single more louse-free than those who had received
dose (400 mg), and group 5 got 1% permethrin vehicle control.13 Chosidow et al11 have suggested
and albendazole in a dose of 400 mg for 3 days. that for difficult-to-treat head-lice infestation, oral
Groups given albendazole were also given another ivermectin (400 mcg per kg), given twice at a
400 mg dose of albendazole after 1 week. The 7-day interval, had superior efficacy as compared
success rate of treatment at the 2-week follow-up with topical 0.5% malathion lotion. Moreover,
for all groups was 61.5%, 66.6%, 80.0%, 84.6%, in an in vitro assay examining the effectiveness
and 82.1%, respectively. of 1, 0.5, and 0.25% ivermectin formulations for
In Akisu et al8 study, the use of topical 1% the topical treatment of the human head louse,
permethrin increased success rates of oral the formulations were 100% effective in killing
albendazole from 61.5% and 66.6% in group permethrin-resistant lice after 10-min exposures.14
1 and 2 to 84.6% and 82.1% in group 4 and Another potent and broad-spectrum antiparasitic,
5 respectively. In line with the result, the use thiabendazole, was reported to be also effective
of topical 0.5% malathion increased success against pediculosis capitis. Namazi15 found that
rate of oral albendazole from 30% (group I; 61% of patients with head lice showed complete
oral albendazole) to 66.67% (group III; oral response after using thiabendazole 20 mg/kg
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 Essam Bakr Abdel-Al et al.

twice daily for 1 day, repeated after 10 days. The safety of albendazole. Albendazole has been
author proposed that thiabendazole, either alone shown to be both safe and easy to administer
or in combination with other agents, may prove to within the community.9
be of particular use in areas where head lice shows
resistance to common pediculicides. CONCLUSION
Interestingly, Kurt et al16 compared the result Although not statistically significant, the
of medical pediculicides, to combing only by combined oral albendazole and topical malathion
precision detection comb (combing every second was more effective than either one alone, while the
day for 14days) or metal pin comb (combing least effective was the oral albendazole. Because
once in every 4 days for 15 days). To see if it of emerging pyrethroid resistance, malathion
could be an effective alternative to the use of is considered an effective alternative. However
anti-lice products in children, a total of 560 and with time, a malathion resistance could
children from two rural schools in Turkey were also emerge. So, we encourage large scale new
screened. They were divided into two groups (dry researches using the systemic antihelminthic and/
combing and wet combing) for both trials. In the or other agents as an oral or topical therapeutic
end, no louse was found in 54.1% and 48.9% tool for treatment of pediculosis.
of children in the precision detection comb and
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