Assessment of the Therapeutic Effectiveness of the Combination of Oral Ivermectin and Azithromycin in the Treatment of Head Lice Infestations in Rural Areas of Senegal
1 Maladies Infectieuses Négligées Émergentes au Sud (MINES), Campus International Institut de Recherche pour le Développement (IRD), Université Cheikh Anta Diop de Dakar (UCAD) Hann, Dakar 10700, Senegal; (G.D.); (D.N.); (N.D.); (B.R.T.B.); (E.H.B.); (A.D.); (H.B.)
2 Departments EMR MINES/UMR MEPHI/RITMES, Campus IHU, Aix-Marseille University, Assistance Publique, Hôpitaux de Marseille (AP HM), Microbes, Évolution, PHylogénie (MEPHI), 19-21 Boulevard Jean Moulin, 13005 Marseille, France; (O.M.); (A.H.)
3 Institut Hospitalo-Universitaire (IHU) Méditerranée Infection, 13005 Marseille, France; ; (S.C.); (P.P.); (D.R.)
4 Institut Pasteur de Paris, 75015 Paris, France;
5 Departments EMR MINES/UMR MEPHI/RITMES, Campus IHU, Aix-Marseille University, Assitance Publique, Hôpitaux de Marseille (AP HM), Service de Santé des Armées (SSA), Risques Infectieux, Tropicaux, Microorganismes Émergents (RITMES), 19-21 Boulevard Jean Moulin, 13005 Marseille, France
* Author to whom correspondence should be addressed.
Received: 7 Oct 2025 / Accepted: 15 May 2026 / Published: 22 Jun 2026
Abstract
Introduction: Head lice infestations are widespread in Senegal and widely distributed throughout the world with high proportions. Recent studies involving classical treatment modalities and alternative ivermectin treatment indicated the existence of an ivermectin-resistant head lice population. Method: Our study involved oral combination of ivermectin with azithromycin to prevent mutant-resistant lice to treatment with oral ivermectin alone. Each infested participant weighing at last 15 kg was administered orally a single dose of 333 µg/kg of ivermectin combined with one or two 250 mg tablets of azithromycin and/or one 500 mg, repeated on day 7 if lice infestation persisted. Result: Of 315 participants, 308 and 304 patients were respectively followed-up on days 7 and 15, with a respective reduction in infestation of 27.6% and an effectiveness of 66.4% (p ˂ 0.001). On day 28, 280 were no longer infested with lice or living eggs, revealing 96.2% (280/291) effectiveness (p ˂ 0.001) achieved without any participant stopping treatment. Conclusion: After conducting PCR-RFLP assays and sequencing the two mutation sites, no mutation for either polymorphism occurred and no resistant lice were found. Resistant lice subjected to oral ivermectin treatment alone is not likely to be apparent in an infested population treated with oral ivermectin and azithromycin combination.
Keywords: oral ivermectin and azithromycin combination; head lice treatment; ivermectin resistant lice; rural areas; Senegal
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CITE
Diatta, G.; Ndiaye, D.; Diagne, N.; Richmond Tra Bi, B.; Mediannikov, O.; Hammoud, A.; Ba, E.H.; Diallo, A.; Bassene, H.; Vray, M.; Cortaredona, S.; Parola, P.; Raoult, D.; Sokhna, C. Assessment of the Therapeutic Effectiveness of the Combination of Oral Ivermectin and Azithromycin in the Treatment of Head Lice Infestations in Rural Areas of Senegal. AJPME 2026, 4, 1.
Diatta G, Ndiaye D, Diagne N, Richmond Tra Bi B, Mediannikov O, Hammoud A, Ba EH, Diallo A, Bassene H, Vray M, Cortaredona S, Parola P, Raoult D, Sokhna C. Assessment of the Therapeutic Effectiveness of the Combination of Oral Ivermectin and Azithromycin in the Treatment of Head Lice Infestations in Rural Areas of Senegal. AJPME. 2026; 4(1):1.
Diatta, Georges; Ndiaye, Dame; Diagne, Nafissatou; Richmond Tra Bi, Broaly; Mediannikov, Oleg; Hammoud, Alissa; Ba, El Hadji; Diallo, Aldiouma; Bassene, Hubert; Vray, Muriel; Cortaredona, Sébastien; Parola, Philippe; Raoult, Didier; Sokhna, Cheikh. 2026. "Assessment of the Therapeutic Effectiveness of the Combination of Oral Ivermectin and Azithromycin in the Treatment of Head Lice Infestations in Rural Areas of Senegal." AJPME 4, no. 1: 1.
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