Page 2289 - Cote clinical veterinary advisor dogs and cats 4th

1134.e8 Nasal Infusion of Clotrimazole

• Four 30-mL vials of 1% clotrimazole in a et
polyethylene glycol base npf
VetBooks.ir Anticipated Time
About 2 hours total: 30 minutes for setup and
anesthetic induction, 1 hour for treatment, and
30 minutes for recovery
Preparation: Important nf
Checkpoints ic
Imaging studies are followed by rhinoscopic sp hp
evaluation, debridement of gross fungal plaques, s
and clotrimazole infusion during the same
anesthetic episode if diagnostic results are highly
cp
suggestive of fungal rhinitis. cp
mfs
Possible Complications and rfs
Common Errors to Avoid lfs
The inflated balloon of the nasopharyngeal
Foley catheter must be palpated through the NASAL INFUSION OF CLOTRIMAZOLE Sagittal section of an anesthetized dog in dorsal recumbency.
soft palate, just caudal to the hard palate. The Image shows position of endotracheal tube (et), nasopharyngeal Foley catheter (npf), pharyngeal sponges (s),
infusion catheter (ic), and rostral nasal Foley catheter (nf) in relation to the hard palate (hp), soft palate (sp),
balloon is initially held in place with a finger, cribriform plate (cp), rostral frontal sinus (rfs), medial frontal sinus (mfs), and lateral frontal sinus (lfs). (Reprinted
which is then replaced with laparotomy sponges. with permission from Mathews KG, et al: Computed tomographic assessment of noninvasive intranasal infusion
Failure to fully inflate the balloon or ensure in dogs with fungal rhinitis. Vet Surg 25:309-319, 1996.)
proper positioning will result in leakage of
clotrimazole into the oropharynx.
• All catheters and sponges are removed and improve outcome by acting as an antifungal
Procedure counted. drug depot (increased antifungal contact time).
• Place animal in lateral recumbency. • Clotrimazole is allowed to drain out of the
• Before infusion, aggressively debride fungal nares by tilting the animal’s nose downward SUGGESTED READING
plaques manually and/or using nasal lavage. at the edge of the treatment table. Greci V, et al: Retrospective study of one hour
The presence of plaques will negatively • Suction and dry sponges are used for ensuring intranasal infusion of 1% clotrimazole solution
impact treatment outcome. that the pharynx is dry before recovery from for treatment of sinonasal aspergillosis in dogs:
• Pass a 24-Fr Foley catheter orally and then into anesthesia. 47 cases [abstract]. Br Small Anim Vet Assoc Proc
the nasopharynx with the aid of a long needle • Repeat treatment if nasal discharge does not 51:441, 2008.
holder. Bend the Foley catheter tip 180° such cease by 2 weeks after treatment.
that the tip flips and comes to be seated dorsal • New evidence suggests that affected dogs ADDITIONAL SUGGESTED
to the soft palate. While palpating through should be rhinoscopically re-evaluated READINGS
the soft palate, fill the Foley balloon with approximately 1 month after treatment to Belda B, et al. Sinonasal aspergillosis: Outcome after
air. Withdraw the balloon if necessary until determine whether any fungal plaques persist. topical treatment in dogs with cribriform plate
it is just caudal to the hard palate. Place lysis. J Vet Intern Med 32(4):1353-1358, 2018.
laparotomy sponges in the oropharynx to Alternatives and Their Hayes GM, et al: Distribution and persistence of
prevent caudal migration of the balloon. Relative Merits topical clotrimazole after sinus infusion in normal
• Pass a 10-Fr polypropylene or red rubber • Orally administered antifungal drugs may canine cadavers. J Small Anim Pract 53:95-100,
2012.
infusion catheter through each nostril and be used in place of intranasal infusion of Mathews KG, et al: Comparison of topical admin-
into each dorsal meatus (premeasure to the clotrimazole or as an adjunct to topical istration of clotrimazole through surgically versus
medial canthus). therapy. Itraconazole 5 mg/kg, q 12h PO non-surgically placed catheters for treatment of
• Place a 12-Fr Foley catheter into each nostril with food for at least 2 months has been nasal aspergillosis in dogs: 60 cases (1990-1996).
to prevent solution from leaking out the associated with the greatest response rate J Am Vet Med Assoc 213:501-506, 1998.
nostrils. Place a single nylon suture in each (60%-70%) and requires intermittent Mathews KG, et al: Assessment of clotrimazole gels for
nostril to prevent rostral balloon migration. monitoring of liver enzymes. Posaconazole in vitro stability and in vivo retention in the frontal
Fill balloons with air until obstruction occurs. and terbinafine have also been used in sinus of dogs. Am J Vet Res 70:640-647, 2009.
• Roll animal into dorsal recumbency. combination to treat refractory disease. A Pomrantz JS, et al: Repeated rhinoscopic and serologic
assessment of the effectiveness of intranasally
• Fill two 60-mL syringes with the 1% single 1-hour infusion of clotrimazole is administered clotrimazole for the treatment of
clotrimazole solution (Lotrimin solution). equally effective if the medication is injected nasal aspergillosis in dogs. J Am Vet Med Assoc
Administer 60 mL per side each hour by catheters placed in dorsal sinusotomies. 236:757-762, 2010.
through the infusion catheters. • Enilconazole can also be applied topically Sissener TR, et al: Combined clotrimazole irrigation
• Place hemostats across any Foley if fluid is in place of clotrimazole. and depot therapy for canine nasal aspergillosis. J
present within the catheter. • Enilconazole can be administered by dorsal Small Anim Pract 47:312-315, 2006.
• Position the animal’s head during infusion: sinusotomy catheters as small volumes daily. Stewart J, et al. Treatment of refractory sino-nasal
15 minutes dorsal, 15 minutes left lateral, 15 • New evidence shows fungal granulomas can aspergillosis with posaconazole and terbinafine in
minutes right lateral, and again 15 minutes be adequately debrided by trained rhinos- 10 dogs. J Small Anim Pract 58(9):504-509, 2017.
dorsal. The animal’s body should remain in copists without the need for sinusotomy. Reproduced from the third edition in modified
dorsal recumbency. Endoscopic placement of sinus catheters form.
followed by 1-hour infusion with 1%
Postprocedure clotrimazole has a similarly high success rate. AUTHOR: Kyle G. Mathews, DVM, MS, DACVS
• After treatment, the animal is placed in • Instillation of 1% clotrimazole cream into the EDITORS: Leah A. Cohn, DVM, PhD, DACVIM; Mark S.
Thompson, DVM, DABVP
sternal recumbency. frontal sinuses after fungal debridement may
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