Journals Watch 2001

This section features a constantly updated list of recently published articles relevant to nurse prescribing.

Abstracts of the papers are included and incorporate an expert's opinion about the article. Users are encouraged to submit their views about published papers through the feedback section.

Please note: In this section of the website we aim to cover articles on areas where nurses do prescribe. However, not all the treatments or appliances mentioned are prescribable by nurses. For that reason, nurses should check the up-to-date versions of the Nurse Prescribing Formulary and Drug tariff if they are in any doubt.

Lice and scabies
Click on the article titles below to read the summaries.

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  • Head lice and nurse prescribing

Ibarra J. Head lice: changing the costly chemotherapy culture. Br J Community Nursing 2001; 6(3):146-151.

Summary: The health resources devoted to treating head lice are disproportionate to the clinical importance of this problem. In this article, the author looks at efficacy evidence for the parasiticidal preparations commonly prescribed and concludes that unless prescribing nurses seek to ensure that clinical governance prevails, expenditure is likely to escalate.
In 1997/8, the UK market in conventional pesticide medicines was worth £29.7 million, from £14.4 million in 1994/5. Half the former sum was spent by the NHS on six million doses and the remainder on 4 million doses bought at a higher price by the public in pharmacies. Mechanical clearing methods and unlicensed ‘natural’ therapies are also in use. The scale of the resources devoted to this problem therefore makes accurate diagnosis and monitoring of efficacy and outcomes very important.
A live louse should be detected before any medication is used. Bug busting wet combing is a reliable detection method and parents should be encouraged to learn it. It can also be used to clear an infestation if the protocol is followed exactly and with commitment.
Prescribing nurses are able to prescribe malathion and pyrethroids and the author discusses the guidelines on their application. In 1999, a Cochrane review found no contemporary evidence for effectiveness of any of the four pesticides used in the UK, and none of the products carries a warning that lice may have developed resistance. Some trials have shown failure rates of 20% in children treated with pesticides and there is evidence that resistance can increase 100-fold between completion of a study and its publication.
A trial comparing the first Bug Buster kit (with a comb that was more laborious to use) with two overnight applications of malathion reported success rates of 38% and 78%, respectively. A trial comparing use of the newer kit with licensed products following the guidelines that one application is sufficient is now underway. The relative safety of the products is another consideration.
Prescribing nurses should follow local policy guidelines in treating head lice but their duties to accountability and patient safety mean that they should monitor outcomes. back

 

  • Scabies: identification and treatment

Hadfield-Law L. Dealing with Scabies. Nursing Standard 2001; 15(31):37-42.

Summary: Scabies is caused by mite infestation and spread by direct physical contact. Its persistent itch is frustrating and certain vulnerable groups are at risk of complications. Nurses therefore need to be aware of the possibility of scabies infestation so that cases are not missed. This article explains how to identify and manage scabies.

Diagnosis can be difficult as the rash can look like eczema. The increase in the itch at night can be misleading too, as all itchiness tends to be worse at night. Diagnosis can be confirmed by examining scrapings microscopically. Teenagers and children aged 8 to 12 are most at risk and people with compromised or immature immune systems also have higher incidence of infection. It is also common in institutions, particularly where there is social disruption, overcrowding and limited access to washing facilities. Nurses working in prisons and nursing homes, for example, need to be aware of the possibility of scabies infection.

In people with HIV, scabies is probably the most common infectious diease causing pruritis and can assume unusual clinical manifestations. Other vulnerable groups such as children, older people, those on steroids, and those with Down’s syndrome will also need careful monitoring after treatment.

A scabicide should be applied over the whole body in adults, but as with head lice, there is uncertainty over the safest and most effective treatment. The itchy rash can continue for 3-4 weeks after successful treatment. Although benzyl benzoate was the treatment of choice for many years, there are now better alternatives.

Permethrin is now the first-line treatment and the 5% dermal cream is reported to give a success rate of more than 90% after one application. It should be applied over the whole body and left to dry for 8-12 hours before being washed off. The head and neck should be included, at least in young children, older people, immunocompromised people and people in whom previous treatment attempts have failed. Sheets and clothes should be washed and dried at high temperatures.

One permethrin treatment for an adult could cost nearly £40. There is no reliable evidence for the efficacy of malathion compared with permethrin, although it is about half the price. The risk of transmission seems to be low for those who do not share clothes or have close physical contact but all close contacts should be treated at the same time.

The article discusses these and other aspects of scabies management in detail and highlights the important role of the nurse. back

Website: www.nursing-standard.co.uk