Either 1% permethrin or pyrethrins are reasonable first-line treatments for active infestations, unless resistance in the community has been established. These over-the-counter products should be applied at least twice, ideally 9 days apart.

In areas with proven resistance, parents may consider manual methods such as wet-combing or using petroleum jelly to suffocate the lice.

When permethrin or pyrethrins do not effectively treat a documented infestation, benzyl alcohol 5% may be used for children older than 6 months, and malathion 0.5% may be used for those 2 years or older.