November 14, 2012Volume 7 - Issue 46  

DynaMed Weekly Update

For the week ending November 9, 2012

Last week 586 articles were evaluated via DynaMed's Systematic Literature Surveillance and 316 were added to DynaMed content.   


Based on the editors' criteria of selecting "articles most likely to change clinical practice," one article of significant interest was selected for the DynaMed Weekly Update.

Feature Article

Single Application of Topical Ivermectin is Effective for Eradication of Head Lice


The American Academy of Pediatrics recommends permethrin or pyrethrin insecticide as first-line treatment for head lice (Pediatrics 2010 Aug;126(2):392), but resistance to these agents has been increasing worldwide. Malathion, a common second-line option, has been effective in adults and older children, but it must be left on for 8-12 hours, and it is flammable and odorous. Furthermore, it is not recommended for children < 2 years old. Two recent identical randomized trials suggest that topical ivermectin may be an option for treatment of head lice when local resistance patterns or safety concerns limit the appropriateness of other agents.


A total of 289 households were randomized in 2 trials to a single application of topical ivermectin 0.5% vs. placebo for each household member ≥ 6 months old with at least 1 live head louse. The youngest member of each household who had at least 3 live head lice was included in primary analysis (83% were < 12 years old). An extended analysis included patients in the primary analysis plus any other household member with at least 1 live louse (492 additional household members treated). The treatment was applied as a lotion to dry hair (by patient or caregiver), left on for 10 minutes, and then rinsed with water. No nit combing was performed.  Data from the 2 trials were pooled for analysis.


Patients were followed for 2 weeks. In the primary analysis, 94.9% in the ivermectin group were lice-free after 2 days compared to 31.3% in the placebo group (p < 0.001, NNT 2) (level 1 [likely reliable] evidence). The lice-free rate was also higher with ivermectin at 15 days (73.8% vs. 17.6%, p < 0.001, NNT 2). Ivermectin was also more effective in the extended analysis, with lice-free rates of 95.5% vs. 35.3% (p < 0.001, NNT 2) at 2 days and 78.7% vs. 22.2% (p < 0.001, NNT 2) at 15 days. In a subgroup analysis of 533 patients with pruritis at baseline, 66.7% in the ivermectin group were pruritis-free at 2 days compared to 42.6% in the placebo group. There were no significant differences in incidence of adverse events including pruritus, excoriation, or erythema (N Engl J Med 2012 Nov;367(18):1687).


For more information, see the Head lice topic in DynaMed.

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DynaMed Events  

American Society of Hematology (ASH) Annual Meeting and Exposition, December 8th - 11th, 2012


Senior Deputy Editor Alan Ehrlich will be attending the American Society of Hematology Annual Meeting and Exposition held at the Georgia World Congress Center in Atlanta, Georgia. Representatives will be available at the DynaMed booth to discuss peer review, mobile access, and free trial information.


Visit the American Society of Hematology's website to learn more about the event and for registration information.

Call for Peer Reviewers

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Basal cell carcinoma of the skin  

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About DynaMed Weekly Update

Prepared by the clinician members of the DynaMed Editorial Team, DynaMed Weekly Update is a compilation of one to five articles selected from DynaMed's Systematic Literature Surveillance as articles most likely to change clinical practice.

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CME Information


0.25 AMA PRA Category I Credit(s)™
Family Physicians: 0.25 Prescribed credits
Nurse Practitioners: 0.25 Contact hours
Release Date: November 14, 2012
Expiration Date: November 14, 2013
Estimated Completion Time:
15 minutes
There is no fee for this activity.

To Receive Credit 
In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon at the end of the article.

Program Overview

Learning Objectives


Upon successful completion of this educational program, the reader should be able to:


1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.


Faculty Information
Alan Ehrlich, MD - Assistant Clinical Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Senior Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

Michael Fleming, MD, FAAFP - Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company

Dr. Ehrlich, Dr. Fleming, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.


No commercial support has been received for this activity.

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ACCME: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Antidote Education Company and EBSCO Publishing. Antidote is accredited by the ACCME to provide continuing medical education for physicians. Antidote Education Company designates this enduring activity for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AAFP: Enduring Material activity, DynaMed Weekly Update, has been reviewed and is acceptable for up to 13 Prescribed credits by the American Academy of Family Physicians. AAFP certification begins March 7, 2012. Term of approval is for one year from this date with the option of yearly renewal. Each Weekly Update is worth .25 Prescribed credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


AANP: This program is approved for 0.25 contact hour of continuing education by the American Academy of Nurse Practitioners.


Program ID: 1210392K

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