Page 547 - Cote clinical veterinary advisor dogs and cats 4th

246 Demodicosis

○ The fluralaner, sarolaner, and lotilaner • The efficacy of the feline topical fluralaner • If only one mite is found on scrapings from
a dog, scrape more sites.
studies have dosed the drugs approxi- formulation for any species of feline Demodex • Consult the current literature for further
VetBooks.ir (fluralaner) and every 28-30 days encouraging. Consult the current literature information regarding the treatment of
is not known, but anecdotal reports are
mately as per the label (every 12 weeks
demodicosis using fluralaner or other
for more information on this newly available
(lotilaner and sarolaner), respectively. In
the afoxolaner study, dogs were treated
isoxazolines in cats.
on days 0, 14, 28, and 56; subsequent product. • Hair plucks (trichography) are an alternate
anecdotal experience suggests that afoxo- Possible Complications way of looking for Demodex in dogs.
laner is effective given monthly as per the • Macrocyclic lactones (ivermectin, oral • Skin scrape greasy terriers, particularly on
label. moxidectin, doramectin, milbemycin [p. the dorsal trunk, to look for D. injai. It can
• Oral ivermectin (e.g., 10 mg/mL bovine 566]): monitor carefully for neurotoxicity, be difficult to find because its numbers are
injectable solution) and educate clients about potential signs. low.
○ Extralabel use in dogs: the best studied • In general, these drugs should be avoided in • Hyperpigmented follicular ostia in dogs
of the oral macrocyclic lactones but dogs homozygous for the MDR1/ABCB1-Δ should increase the suspicion of demodicosis.
now largely replaced by isoxazoline gene mutation (p. 638). Dogs at risk for • In D. gatoi–endemic areas, treatment trials
drugs carrying this mutation, including herding are sometimes part of the workup for pruritic
○ Effective at 0.3-0.6 mg/kg PO q 24h, breeds, some sighthounds, and their cats.
recommend to incrementally increase to crosses, should be tested before the drugs • Check labels for minimum age, which is 6
full dose (e.g., over 7-10 days) are administered. months for some products.
○ Absolutely contraindicated in certain dogs • Isoxazoline class drugs have rarely been • Cats treated with inhaled glucocorticoids
(see Possible Complications below) associated with neurologic adverse reactions, may develop infection only in areas
○ Extralabel use in cats; likely effective including muscle tremors, ataxia, or seizures. where the face mask is used (i.e., chin,
for D. cati. Dosing information is muzzle).
scant. Recommended Monitoring
• Topical moxidectin with imidacloprid Skin scrapings typically are performed every Technician Tips
(Advantage Multi, Advocate) 4 weeks during therapy at the same sites that • Finding dead mites, or just mite segments,
○ Labeled for dogs with demodicosis in some were previously positive for mites. Score the is still considered a positive scraping.
countries (not United States) approximate number of mites, the proportion • Skin scrapings should examine all scraped
○ Monthly topical application (as labeled of live mites, the proportion of adults versus material.
in many countries) is likely insufficient. immature mites, and the number of eggs • Use a coverslip and increase contrast (e.g.,
○ Weekly administration (extralabel in many at each visit. Adjust therapy if parameters by lowering the microscope condenser);
countries) can be effective but less rapid are not improving. Continue therapy for 1 examine the slides under the 4× or 10×
than isoxazoline drugs month after two consecutive scrapings are objective.
• Amitraz dips obtained. • Demodex mite eggs are fusiform (spindle
○ Approved for dogs in the United States shaped) and important to record because
and Canada but rarely used due to PROGNOSIS & OUTCOME they indicate an actively reproducing
adverse effects. Additional references population.
should be consulted if treatment is • The prognosis for localized juvenile-onset • Some isoxazoline drugs must be admin-
considered. demodicosis is excellent. The prognosis for istered with food; be sure to instruct
• If deep or severe pyoderma present: systemic generalized juvenile-onset cases is good, clients if this is the case with the product
antistaphylococcal antibiotic therapy: empiri- but a small proportion requires long-term dispensed.
cal (e.g., cephalexin 22-30 mg/kg PO q 12h) treatment.
or based on bacterial culture if resistance is • In adult-onset demodicosis, the prognosis SUGGESTED READING
suspected for cure is guarded but mite populations Miller WH Jr, et al: Muller & Kirk’s Small animal
• Weekly benzoyl peroxide or chlorhexidine can usually be controlled with ongoing dermatology, ed 7, St. Louis, 2013, Saunders, pp
shampooing parasiticidal therapy. 304-315.
• In adult-onset cases, treat the underlying AUTHOR: Kinga Gortel, DVM, MS, DACVD
disease. PEARLS & CONSIDERATIONS EDITOR: Manon Paradis, DMV, MVSc, DACVD
Options for treating feline demodicosis:
• There is little information regarding the Comments
treatment of cats; all treatments are extralabel. • D. canis mites are usually easy to find by skin
For D. cati, daily oral ivermectin or weekly scraping in affected animals. However, this
lime sulfur dips have been used. For D. gatoi, test is sometimes skipped. Treatment trials
weekly topical imidacloprid and moxidectin are no substitute for skin scrapings, which
or weekly lime sulfur dips have been used should always be part of the dermatology
with variable results. minimum database.

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