Permethrin Treatment of Head Lice with Knockdown Resistance–like Gene

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Abstract
Chosidow and colleagues (March 11, 2010, issue)1 justify their study of oral ivermectin for the treatment of pediculosis capitis by the increasing resistance of head lice to pyrethroids because of amino acid substitutions (Thr929Ile and Leu932Phe) in the alpha subunit of the voltage-gated sodium channel. These substitutions are considered to reduce or delay the insecticidal effects of permethrin and dichlorodiphenyltrichloroethane (DDT).2 The DNA sequence bearing the two mutations is called the knockdown resistance (kdr)–like gene, which has been detected in up to 95% of head lice examined in Europe.3,4 However, the gene has not been studied in relation to treatment outcomes in prospective studies.