Are anti-parasitic drugs overused?

RE: Are anti-parasitic drugs overused?

Bob Russell — Tue, 29 Dec 2015 17:43:00 GMT

Cigarette lighter! We were under the impression that it needed more heat to fix the slides!!!

RE: Are anti-parasitic drugs overused?

Martin Atkinson — Tue, 29 Dec 2015 17:20:28 GMT

[quote user="Bob Russell"] As a practice of non-smokers the biggest risk for us is burnt fingers from heat fixing the slides![/quote]How do you do it then - hold a lit match or lighter under the slide? We use an old electric hair dryer.

RE: Are anti-parasitic drugs overused?

Bob Russell — Tue, 29 Dec 2015 11:07:33 GMT

It is pretty routine for us to swab and stain!

A kitten hooching with ear mites and clogged up with dry wax will get a sample checked under the microscope in my room.

Adults rarely seem to get ear mites so those would be stained up. Vast majority will have malassezia Most cocci. The rarer, nastier ones will have rods!

Takes a very short time to stain things up. As a practice of non-smokers the biggest risk for us is burnt fingers from heat fixing the slides!

RE: Are anti-parasitic drugs overused?

Michael Woodhouse — Fri, 25 Dec 2015 00:29:52 GMT

[quote user="robloxley"]can you still get Otimectin Vet. 1 mg/g Ear Gel for Cats?[/quote]

Yes, you can. Vetsonic import it, but I believe it is in the wholesalers. Could even justify under the cascade in dogs. once weekly treatment for three applications. I'll attach the leaflet.

Dermatologists at college told us that the various lotions and potions just drown the ear mites - they contain nothing to specifically kill the otodectes. We'd generally just use Epi Otic and Stronghold.

RE: Are anti-parasitic drugs overused?

John Flynn — Thu, 24 Dec 2015 14:47:22 GMT

[quote user="Martin Atkinson"]AFAIA there are no longer any topical drops containing just an acaricide.[/quote]

There certainly are in Ireland!

There appear to be in UK as well including ones marketed specifically for this purpose:

http://www.vmd.defra.gov.uk/ProductInformationDatabase/SPC_Documents/SPC_123662.DOC

http://www.vmd.defra.gov.uk/ProductInformationDatabase/SPC_Documents/SPC_214901.DOC

[quote user="Martin Atkinson"]If you do have a case of bacterial otitis externa what do you put down the ear given that all ear drops contain some systemic antibiotics?[/quote]

It depends on the case. Maybe start a tangent thread with a specific case of bacterial otitis externa in mind (signalment, previous history, clinical and cytological findings) and I can say what I would do and others can share what they would do. One thing I won't usually do is tip useful systemic antibacterials of importance in human medicine down the ear canal - it may work, but I don't think that's a valid excuse; to do so in a case that is primarily due to otodectes I think is folly.

[quote user="Martin Atkinson"]I haven't come across one that has an exclusive topical only acting antibiotic in fact AFAIA no such thing exists?[/quote]

I think nomenclature here may cause confusion to others even if we know what we're tallking about ourselves, so to clarify what I personally mean by terms:

antibacterial = substance that kills bacteria

systemic antibacterial = substance that can be administered into the body safely at concentrations sufficient to kill bacteria in the body without killing the patient

useful systemic antibacterial = substance as per above that is used to kill bacteria in people which could otherwise kill them

antibiotic = an antimicrobial derived from a living organism

By "topical only acting antibiotic", I think you are using the term antibiotic as I would use antibacterial (i.e. we're probably discussing bacteria here rather than malassezia and other yeasts) and referring to antibacterial agents typically tipped down a dog's ear canal that, if injected intravenously, would not kill bacteria at a concentration which could be tolerated by the patient.

Some antibacterial agents fitting this description (in no particular order!) include:

acetic acid

chlorhexidine

PCMX

EDTA

Tromethamine

isopropyl alcohol

any solution of low pH

aluminium acetate

boric acid

surfactants

Hypochlorous acid

Gentian violet

mercurochrome

cresylate

silver sulphasalazine

There are proprietary solutions, including those specifically marketed for dogs, apparently available in the UK according to Google e.g.:

http://www.vmd.defra.gov.uk/ProductInformationDatabase/SPC_Documents/SPC_139863.DOC

http://www.medicines.org.uk/emc/medicine/17298

http://www.vetdispense.co.uk/dermapet-trizedta/284-dermapet-trizedta-crystals-for-dogs-cats-ears-118ml.html

http://www.vetruus.com/otodine2.html

http://www.vetuk.co.uk/ear-products-c-8/epi-otic-ear-cleaner-for-cats-and-dogs-p-654

Obviously no-one has a patent on vinegar etc which are readily available!

[quote user="Martin Atkinson"]To both of you. IME the majority of these have a secondary infection judging by the amount of discharge. [/quote]

I don't think the amount of discharge indicates a secondary bacterial infection requiring treatment. There is rarely significant bacterial overgrowth in my experience, but often copious debris present in ear canal.

[quote user="Martin Atkinson"]Do you swab and stain every one to prove there is no secondary infection? [/quote]

If there is not ear mites, then generally yes, I do ear cytology. If ear mites present I don't usually bother unless I suspected secondary infection for some reason (uncommon in my experience).

RE: Are anti-parasitic drugs overused?

Rob Loxley — Thu, 24 Dec 2015 13:39:43 GMT

[quote user="Martin Atkinson"]AFAIA there are no longer any topical drops containing just an acaricide[/quote]

can you still get Otimectin Vet. 1 mg/g Ear Gel for Cats?

RE: Are anti-parasitic drugs overused?

Martin Atkinson — Thu, 24 Dec 2015 13:15:29 GMT

[quote user="John Flynn"]To pour useful systemic antibacterials down the ear of ANY dog with external ear disease sounds inadvisable to me, but to decide to do so for a case of EAR MITES I think is unjustifiable.[/quote]It is well established that the ingredients in Canaural have action against otodectes. AFAIA there are no longer any topical drops containing just an acaricide. If you do have a case of bacterial otitis externa what do you put down the ear given that all ear drops contain some systemic antibiotics? I haven't come across one that has an exclusive topical only acting antibiotic in fact AFAIA no such thing exists?

[quote user="Bob Russell"]I would use Canaural if there was secondary infection only.[/quote]To both of you. IME the majority of these have a secondary infection judging by the amount of discharge. Do you swab and stain every one to prove there is no secondary infection? The ones with just mites and a bit of dry wax are rare.

RE: Are anti-parasitic drugs overused?

Bob Russell — Tue, 22 Dec 2015 10:51:50 GMT

A reasonable amount of ear cleaner plus a dose of Stronghold strikes me as immensely logical. Ear mites are generally a feature of puppies and kittens. Mites, roundworms and fleas in one go!

Not failed me yet!

I would use Canaural if there was secondary infection only.

I worked with a rescue centre some years ago. They had an 'intractable' ear mite problem in the cattery. Every cat had a small dose of ivermectin, s/c on the same day.

Was expecting to repeat it 10 days later but all the mites were gone so we never did repeat it!

RE: Are anti-parasitic drugs overused?

Hannah Wynne Richards — Tue, 22 Dec 2015 09:23:13 GMT

Totally agree with you Wren

Wynne

RE: Are anti-parasitic drugs overused?

Wren — Tue, 22 Dec 2015 08:49:06 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Wren"]BEVA started registering and regulating dentistry[/quote]

Ahem. BEVA/BVDA jointly, in fact.

And while we run the exam and issue the qualification and we work as closely with BAEDT as we can, we have no power to regulate. Nobody does.

It's worth mentioning that anybody who is not MRCVS engaging in equine dentistry is in fact working illegally, even the highly respectable ones. However as long as they do not attempt to work beyond Category 2 , a sort of official unofficial blind eye is turned.

[/quote]

Apologies. Sloppy English. Might have known this was the wrong place to be imprecise!

However since we're being precise then actually anyone unqualified working beyond Cat 1 is working illegally. People who have passed the BEVA/BVDA exam and appear on the BAEDT or WWAED registers are allowed to carry out Cat 2 procedures.

I have a huge issue with non-EDTs working in horses' mouths. I refuse to sedate horses for any of them to work. They frequently overstep the boundaries and use power tools or extract wolf teeth. They rarely (never) liaise with vets regarding further treatment or medication. Most (most) qualified EDTs are a different breed and are interested in working with other professsionals, carrying out regular CPD and in referring cases upwards. I often work with them on more complicated cases. There are certainly some who push the boundaries (eg. wolf teeth extractions without supervision), but I am more inclined to turn a blind eye to these guys.

It is the ones with no qualifications or, sometimes worse, 'American qualifications' (ie. a week training in the Midwest and a certificate proclaiming them to be proficient and fully educated) who worry me and I would like to see them seriously clamped down on. Either you're good enough, in which case sit the exam, or you're not, in which case pack up.

Anyway, I sniff a tangent, and this is a particular hobby horse of mine, so I'll shut up now before I write an essay...

RE: Are anti-parasitic drugs overused?

John Flynn — Tue, 22 Dec 2015 08:05:42 GMT

[quote user="Clive Ansell"]Canaural is a POM-V with a licence for treating external ear disease.[/quote]

"Canaural" is a combination of 2 useful systemic antibacterial agents and a useful antifungal agent (+prednisolone). To pour useful systemic antibacterials down the ear of ANY dog with external ear disease sounds inadvisable to me, but to decide to do so for a case of EAR MITES I think is unjustifiable.

I've heard Colistin is really good at drowning adult ear mites too.

RE: Are anti-parasitic drugs overused?

Evelyn Barbour-Hill — Mon, 21 Dec 2015 20:37:42 GMT

[quote user="Wren"]BEVA started registering and regulating dentistry[/quote]

Ahem. BEVA/BVDA jointly, in fact.

And while we run the exam and issue the qualification and we work as closely with BAEDT as we can, we have no power to regulate. Nobody does.

RE: Are anti-parasitic drugs overused?

Clive Ansell — Mon, 21 Dec 2015 19:16:29 GMT

Canaural is a POM-V with a licence for treating external ear disease.

Auroclens 50:50 with warm water, add a leetle bit of Aludex, and the likes of Stronghold or frontline applied directly into the ear canal are all off licence - I hope you all getting off label use disclaimers signed?

RE: Are anti-parasitic drugs overused?

Evelyn Barbour-Hill — Mon, 21 Dec 2015 18:29:21 GMT

[quote user="Martin Atkinson"]Why faff around with all this when a bottle of Canaural will do the trick and clear up the inevitable secondary infection as well?[/quote]

Because it worked better.

Because it saved the client the expense of a bottle of Canaural.

Because it only needed doing twice at the most.

Because it saved the client the mess and hassle of putting Canaural in at home.

Because it saved the patient the bother of having Canaural put in at home.

Because it was generally less messy.

Because I did it so I knew it got done properly.

Because if you kill the mites any secondary pathology will usually clear up by itself.

Because it was no faff. Unlike messing with Canaural.

RE: Are anti-parasitic drugs overused?

Martin Atkinson — Mon, 21 Dec 2015 10:48:58 GMT

[quote user="Evelyn Barbour-Hill"]I used to dilute Auroclens 50:50 with warm water, add a leetle bit of Aludex, syringe it down, massage to break up crusts, stand clear while patient shook head, repeat until ear clear or everyone fed up, repeat same in a week's time. Never entrust this to client, do it yourself. Of course you can't get Auroclens now so this is a bit irrelevant, but maybe it would work the same with your favourite cleaner. But, more usefully, I found that Panacur liquid worked equally well, again usually diluted a little with warm water.[/quote]Why faff around with all this when a bottle of Canaural will do the trick and clear up the inevitable secondary infection as well? You guys seem to be over-complicating things. Or maybe this will start a discussion on inappropriate use of antibiotics without doing a culture first!

RE: Are anti-parasitic drugs overused?

Hannah Wynne Richards — Mon, 21 Dec 2015 09:23:15 GMT

Better dentistry is undoubtedly a factor, and I've already said I think the increase in longevity is multi factorial, but it started well before 2000.

Wynne

RE: Are anti-parasitic drugs overused?

Wren — Mon, 21 Dec 2015 09:08:12 GMT

[quote user="Hannah Wynne Richards"]

Evelyn Thanks

Gilllian Yes Why not

Alastair I'm still waiting for an answer to a genuine scientific query - how do you explain the massive increase in equine longevity during my lifetime? Balls in your court

Wynne

[/quote][quote user="Hannah Wynne Richards"]Alastair I'm still waiting for an answer to a genuine scientific query - how do you explain the massive increase in equine longevity during my lifetime? Balls in your court[/quote]

Hope I'm not stepping on Alastair's toes here (haven't yet reached the end of the thread), but for me the answer is dentistry. Equine dentistry as a science (rather than just the basic and often ineffective 'rasping' of the past) emerged around 2000, coincidentally 15 years ago! When I was at vet school (mid/late 90s) we received virtually no equine dentistry education whatsoever. In my first job I was handed the proverbial rusty rasp and could borrow an equally rusty gag if I thought it was necessary (and the implication was that I wasn't much of a horse vet if I needed it). Around the turn of the century BAEDT appeared and BEVA started registering and regulating dentistry and 15 years later we have an absolute wealth of knowledge and practical expertise on the subject. The care that top level horses receive is phenomenal - think root canal procedures and endodontics etc. - and even little hairy ponies receive a far better service than before. The amount of dental kit in my car has expanded from the single rusty rasp to fill about a third of the boot! I honestly think that regular modern treatment has single-handedly extended the life of most of my patients.

RE: Are anti-parasitic drugs overused?

Anthony Todd — Sun, 20 Dec 2015 15:14:25 GMT

Back in the day, which must be further back than aeons 'cos it was in the era of Gamma BHC and Auroid [Willows Francis], it was once weekly for 4 weeks.

Ear mites were almost normal in cats and pups living with cats. I wonder if the success was the 4 weekly applications?

And, [it's coming back], we treated every animal ear in the household

RE: Are anti-parasitic drugs overused?

George Cooper — Sun, 20 Dec 2015 10:51:42 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="George Cooper"]

Ear mites. It has always bothered me that any "proper" treatment requires intense invasive application of squirty product and cotton buds to be effective thus ensuring that the poor pet is driven nuts and ends up head shy.

I've used a 0.5 dose of neat Frontline (or equivalent) directly into the ear for years. The rationale was that because it persists it then handles any subsequent hatching and developing from the single dose, and that single dose is lethal to any galloping insects deep in the darkness. Naturally permission is sought from the owner.

When I started doing this aeons ago, after a chat with a rep who thought that the work was being done back at base, I monitored the results at weekly intervals for a while and satisfied myself that this regime was effective, cost-effective, pet-effective, client- effective and vet effective. EBET (evidence-based-ear-treatment) it ain't, but it works.

[/quote]

I agree entirely. But even better, single ordinary dose of Stronghold applied to the skin, nowhere near the ear!

(Mites are arachnids, not insects Sorry, couldn't resist it)

[/quote]

We must, MUST remain true to ourselves at all times - and therefore ... ... I thank you!

RE: Are anti-parasitic drugs overused?

John Flynn — Sun, 20 Dec 2015 07:53:15 GMT

[quote user="John Flynn"]There was a paper earlier in year (not sure of geo area) which reported 80% success with 2 applications a month apart (and ear cleaning).[/quote]

Corresponding author is USA:

http://www.sciencedirect.com/science/article/pii/S0304401715000953

RE: Are anti-parasitic drugs overused?

Evelyn Barbour-Hill — Sat, 19 Dec 2015 22:06:54 GMT

[quote user="George Cooper"]

[/quote]

I agree entirely. But even better, single ordinary dose of Stronghold applied to the skin, nowhere near the ear!

(Mites are arachnids, not insects Sorry, couldn't resist it)

RE: Are anti-parasitic drugs overused?

George Cooper — Sat, 19 Dec 2015 13:40:08 GMT

RE: Are anti-parasitic drugs overused?

Beats — Sat, 19 Dec 2015 08:48:22 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Beats"]

Ear mites a problem here too.

Those with stronghold failures - are you applying directly into cleaned out ear canals or not?

[/quote]

I don't quite follow you. Are you saying that for success you apply the Stronghold directly into the ear? I've never done that. Why would you?

[/quote]

was just wondering if difference between those who find stronghold effective or not was method of application rather than the local mites.

RE: Are anti-parasitic drugs overused?

Evelyn Barbour-Hill — Sat, 19 Dec 2015 00:40:14 GMT

[quote user="Beats"]

Ear mites a problem here too.

Those with stronghold failures - are you applying directly into cleaned out ear canals or not?

[/quote]

I don't quite follow you. Are you saying that for success you apply the Stronghold directly into the ear? I've never done that. Why would you?

RE: Are anti-parasitic drugs overused?

Beats — Fri, 18 Dec 2015 22:11:39 GMT

Ear mites a problem here too.

Those with stronghold failures - are you applying directly into cleaned out ear canals or not?

Tried Otimectin (3 applications a week apart after cleaned by me each time conscious) recently in adult dogs that had had failures to clear ear mites with fortnightly stronghold - I'm reserving judgement.

I had stronghold failures when I worked in Scotland too, but always thought it was because I had been too lazy to clean them out well.

Ultimately I think suitable products applied into ears directly and daily for 3 weeks are probably most effective along with cleaning, but I haven't a good solution for those patients where that's a tall ask. Hoping that Bravecto turns out to be a wonder-drug