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Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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New Head Lice Treatment for Children and Adults: Natroba

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Natroba
Outdoor adventures sometimes take us to locations where the sleeping arrangements create exposure to mites and lice. While some may think of this as a problem more common to lower socioeconomic classes and third world countries, the fact is that these tiny pests cut across most boundaries, both geographic and sociologic.

There are occasional treatment failures with currently accepted methods of therapy (e.g., permethrin 1% [Nix] or malathion 0.5% [Ovide]), so the recent news that the Food and Drug Administration (FDA) has approved spinosad (Natroba Topical Suspension 0.9%) for the treatment of head lice infestation in patients ages four years and older is welcome indeed.

As noted in the FDA press release, head lice are found in scalp hair, eyebrows and eyelashes. They do not transmit disease, but feed on human blood. The most common cause of transmission is head-to-head contact (such as children at play), but the lice are crawlers and can also be transmitted from inanimate objects.

Natroba is a topical product intended to be used on the affected scalp. It can be irritating to the eyes, so should not be applied to the eyebrows. (Eyebrows and eyelashes may be treated by applying a thick layer of petroleum jelly twice a day for eight days.) The bottle is shaken well to achieve a uniform suspension, and then the product is applied to the dry scalp and hair, using only the amount needed to cover the scalp and hair. It is left in place for 10 minutes, and then rinsed off with warm water. If live lice are seen seven days after the first treatment, the treatment may be repeated. Because the product contains benzyl alcohol, it absolutely should not be used for infants below the age of 6 months. Safety has not been established for use in children under the age of 4 years.

Other lice management methods that should be employed simultaneously are hot water washing or dry cleaning all recently worn clothing, hats, used bedding and towels; washing personal care items (e.g., brushes, hair clips, combs) in hot water; and combing the hair with a fine-tooth comb or special nit comb to remove dead lice and nits.

 From the NATROBA website (www.natroba.com): “NATROBA Topical Suspension contains 9 mg spinosad per gram in a viscous, slightly opaque, light orange colored vehicle consisting of water, isopropyl alcohol, benzyl alcohol, hexylene glycol, propylene glycol, cetearyl alcohol, stearalkonium chloride, ceteareth-20, hydroxyethyl cellulose, butylated dydroxytoluene, and FD&C Yellow #6. Spinosad causes neuronal excitation in insects. After periods of hyperexcitation, lice become paralyzed and die.”

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Tags: Bites & Stings

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About the Author

Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.

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