Lungworm treatment

Re: Lungworm treatment

Bob Russell — Thu, 17 Nov 2011 17:14:44 GMT

Bob Martins Double Action flea killer = £10.49 for 3

Bob Martins Spot on 12 week =£ 6.10 for 3

£16.59 for three doses. We don't stock Advantix so not sure how much people charge for a three pack but on our computer it comes out at about £20 for three.

Pet Shop products are much cheaper to buy than vet ones. A can of Bob Martins equivalent to Indorex was selling in the local pet shop for under a tenner. The price to vets is much higher than price to pet shops so not us profiteering!

Re: Lungworm treatment

Martin Atkinson — Thu, 17 Nov 2011 16:51:54 GMT

[quote user="David Mills"]

This in my view is a highly inappropriate use of milbemax. It is an incredibly useful drug but should not be wasted on puppy worms when you've plenty of other things like fenbendazole that will do the job. It only increases resistance using this 'club for a fly' technique.

[/quote]

A high proportion of puppies come with fleas and from dodgy breeders/dealers/pet shops so likely will have dipylidium and potentially hookworm. They are also likely to have giardia and other monocellular parasites so a case for both a multi-wormer and fenbendazole perhaps?!

Re: Lungworm treatment

David Mills — Thu, 17 Nov 2011 16:16:03 GMT

Clarity is responsibility of the poster, thanks for the clarification.

Must be some mark up if advantix is more expensive than supermarket Bob Martins. Ouch.

Re: Lungworm treatment

Bob Russell — Thu, 17 Nov 2011 16:00:13 GMT

[quote user="David Mills"]

[quote user="Bob Russell"]

We are in a major tick area and one of the many things I don't think Advocate can do effectively is tick control!

[/quote]

Hmmmm.

[/quote]

I will phrase it a little more clearly for those who don't understand. Advocate does not have an a ingredient that claims to control Ticks. It is not and never has been licensed or claimed to control ticks. It is therefore not an ideal product to use in areas with high tick numbers. This inability is IMO compounded by it failure to perform adequately as a treatment for demodectic mange, it has not killed ear mites in affected puppies and kittens and I have seen Advocate treated puppies that have passed a 'belly' full of worms when treated with Milbemax.

Hope that is better!

Re: Lungworm treatment

Hannah Wynne Richards — Thu, 17 Nov 2011 15:26:11 GMT

It's a case of horses for courses I'm in a major lungworm area, so lungworm and toxocara are my main priorities I don't have a problem with ticks or hydatid -as I treat town dogs Other practices in the region who's catchment area extends to the Gower, or the valleys have these to consider as well

Wynne

Re: Lungworm treatment

David Mills — Thu, 17 Nov 2011 15:17:49 GMT

[quote user="Bob Russell"]

We are in a major tick area and one of the many things I don't think Advocate can do effectively is tick control!

[/quote]

Hmmmm.

Re: Lungworm treatment

Kate Richardson — Thu, 17 Nov 2011 12:54:34 GMT

Absolutely agree Bob. I don't think anyone suggested using Advocate for tick control anyway did they?

Anyway there seems to be a lot of 'random' use of fenbendazole without a specific diagnosis; I'm not necessarily knocking this, as diagnosis of some parasites is very difficult, so a therapeutic trial with fenbendazole can be justified, but should we be worried about resistance to fenbendazole in the future (or even now)?

Re: Lungworm treatment

Bob Russell — Thu, 17 Nov 2011 12:19:45 GMT

[quote user="David Mills"]

[quote user="Bob Russell"]

I had several puppies produce large amounts of dead roundworms when wormed with Milbemax

[/quote]

Re other comments, I've no idea why you'd use advocate for tick control when there's Advantix, a fantastic product that stops ticks even attaching.

[/quote]

I couldn't disagree more!

Puppies need the best quality of wormer, owners need it in a form to ensure best compliance! I think it is an absolutely appropriate use for the drug. Having said that I tend to use Stronghold for puppies and kittens until they are ready to meet the outside world. Does the fact that a puppy still has a belly full of worms after Advocate not worry you? It does me!

Advantix does nothing for lungworm so not relevant here. I understand it provides three weeks of good flea control and after that it tails off rapidly.

Clients are not that good at putting stuff on monthly so all of the Imidacloprid based products have this weakness. It is also available on Morrison's shelves. Put Bob Martins flea product (Imidacloprid) and Bob Martins flea and tick product (Permethrin) on the same dog and amazingly you get an Advantix equivalent and cheaper!

I would not use Advocate for tick control because it does not control ticks (perhaps I could have been clearer in my phraseology).

Re: Lungworm treatment

David Mills — Wed, 16 Nov 2011 21:37:06 GMT

[quote user="Bob Russell"]

I had several puppies produce large amounts of dead roundworms when wormed with Milbemax

[/quote]

Re other comments, I've no idea why you'd use advocate for tick control when there's Advantix, a fantastic product that stops ticks even attaching.

Re: Lungworm treatment

Thomas Johnson — Wed, 16 Nov 2011 17:51:29 GMT

[quote user="Hannah Wynne Richards"]

Hope it's not a collie

[/quote]

I'm not that silly! It's a border terrier, hasn't responded to Advocate and we can't get Aludex at the moment.

Re: Lungworm treatment

Bob Russell — Wed, 16 Nov 2011 17:46:49 GMT

We are in a major tick area and one of the many things I don't think Advocate can do effectively is tick control! We found it close to useless for demodex, could not kill ear mites in puppies and pretty unimpressive for roundworm control. I had several puppies produce large amounts of dead roundworms when wormed with Milbemax despite being treated monthly with Advocate.

I have to admit we have not used it for years because of this unimpressive performance!

We will be updating our training to look for lungworm starting tomorrow.

Re: Lungworm treatment

Sarah Keir — Wed, 16 Nov 2011 17:36:10 GMT

Don't forget the saying: you won't find it unless you look for it. Unless you are actively surveying for Angiostrongyulus then you'll miss that it is there!

Re: Lungworm treatment

Tim Mainland — Wed, 16 Nov 2011 17:31:40 GMT

[quote user="Bob Russell"]

My Staffie has had an occasional soft. fluidy cough for months. Jumping round and behaving like a two year old. last couple of weeks became more frequent. X-rays not particularly exciting. Normal sinus rhythm etc so cardiac disease not particularly high on my priorities.

Not much change following Milbemax last week but almost miraculous reduction in coughing following Fenbendazole. Thinking cap time for me I think!

Just spoken to our lab down the road. They have diagnosed very few cases this year. I want to do the best for my patients but don't want to get involved with the Bayer 'hysteria' about the risks of lungworm!

I may consider the alternate month Milbemax/Panacur or Granofen treatments as this means we will not have to change our tick prevention recommendations.

[/quote]

Bob,

Why be put off by the "Bayer hysteria"? All that matters is what you say in the consulting room and what the product does. If a lot of your clients are already buying Frontline, well Advocate will be subsidised greatly by stopping that. Beyond that it covers a load of other useful preventative stuff beyond Angiostrongylus. And....it's POM.

I just don't see the need to find an alternative - from a prevention perspective.

Re: Lungworm treatment

Sarah Keir — Wed, 16 Nov 2011 17:20:10 GMT

I totally agree. And that is how we (as a practice) started to convince ourselves that it was a real problem and not just invented by a drugs company. Just bear in mind the limitations of the testing.

I think there was a published case in the Vet Record of lungworm in a dog that had never left Glasgow. So everyone should be keeping their eye peeled!

Re: Lungworm treatment

Bob Russell — Wed, 16 Nov 2011 17:09:26 GMT

[quote user="Sarah Keir"]

I don't know if talking to your lab would give a true picture. I do alot of faecal tests in house so the labs would never see them. Also you really need to do a pooled 3 day sample to increase the sensitivity. If I have a suspicion and the test is negative I still treat as the consequences for not treating may be huge and the treatment is 'relatively' cheap and non-toxic. And visa versa, if it is a tumour I want a biopsy conformation before considering chemo!

[/quote]

I understand this but as I have not seen any cases (until recently) that I thought may be lungworm related I thought this would be a good place to start! If I am going to try to convince owners I need to be fairly convinced that the risk is high enough to justify a big change in our protocols. We have enough problems trying to get owners to worm regularly and a lot of people are getting wormers on-line now!

Re: Lungworm treatment

Graham Bilbrough — Wed, 16 Nov 2011 16:22:02 GMT

The sensitivity can be improved by pooling samples from consecutive days. But, it is worth remembering that the parasite needs to be viable for detection by the Baermann technique and this is not always the case by the time the sample is received by the reference lab.

Re: Lungworm treatment

Sarah Keir — Wed, 16 Nov 2011 15:24:03 GMT

Re: Lungworm treatment

Bob Russell — Wed, 16 Nov 2011 15:07:26 GMT

Not much change following Milbemax last week but almost miraculous reduction in coughing following Fenbendazole. Thinking cap time for me I think!

I may consider the alternate month Milbemax/Panacur or Granofen treatments as this means we will not have to change our tick prevention recommendations.

Re: Lungworm treatment

Sarah Keir — Wed, 16 Nov 2011 14:56:37 GMT

[quote user="Hannah Wynne Richards"]

Bob Presentations can vary Can sound like kennelcough-really honking, can be wheezy Bad resp case and lung rads looklike dense ballls of cotton wool Can be haemorrhagic, can be ocular-you often see larvae with ophthalmoscope ,can be neurological If history and symptoms are suspicious they get treated for it [/quote]

In addition to these presentations, I've seen one which was purely weight loss until after a couple of months it started bleeding. And my own dog (ebarrassed ) had mild exercise intolerance ie trotting along the path instead of through the woods and bit of effort to get on the sofa. I treated my own dog with Milbemax and she was 80% better after a week/one dose and 100% better after the two doses; I carried on for the licenced 4 doses at weekly intervals.

For prevention I use milbemax for my own dog at monthly intervals but for clients usually recommend Advocate as it is licenced for Angiostrongylus prevention. Interesting to see some people don't think it works very well. I am still struggling to convince some people in the practice that Angio is a real threat. I used to think like this until my own dog got it.

Sarah

Re: Lungworm treatment

Hannah Wynne Richards — Wed, 16 Nov 2011 14:17:19 GMT

Hope it's not a collie

Wynne

Re: Lungworm treatment

Thomas Johnson — Tue, 15 Nov 2011 17:19:24 GMT

Does anyone know if ivermectin is effective against lungworm? I'm treating a dog for demodex and the owner is concerned about other parasites as she can't apply Advocate, My suspicion is that ivermectin should do the job, but does anyone know for certain?

Re: Lungworm treatment

bob lehner — Mon, 14 Nov 2011 16:23:04 GMT

Very interesting - thanks.

Re: Lungworm treatment

Hannah Wynne Richards — Mon, 14 Nov 2011 15:31:05 GMT

I find a half strength course of panacur for 7 days given alternate months with a normaldose of milbemax very effective for prevention I've never had a clinicalcase in dogs on this regime, despite extreme environmental challenge Last year a survey was done and someone on this forum (I think JGW ) was astonished that samples with SA postcodes (Swansea ) had no worms at all-well those were from my practice, and they were truly random-1st dogs that walked through the door-but I do nag owners about worming For treatment,a 21 day course of 1/2 strength panacur and give steroid and covering antibiotic as well The academics will probably want me shot for giving antibiotic, but if not primarily bacterial it's guaranteed to develop secondary bacterialpneumonia with it's bronchi full of dead worms, and it's already too ill for a setback Steroid and antibiotic essential for clinicalcases

Hope this helps

Wynne

Re: Lungworm treatment

David Mills — Mon, 14 Nov 2011 13:23:58 GMT

There are some good prospective studies out there that show no significant difference in kill rates (measured by presence L1 larvae in faeces) between moxidectin/imidacloprid spot on and fenbendazole, though interestingly pre-and post treatment rads showed resolution of radiographic signs more quickly with moxidectin/imidacloprid.

Willesen JL, Kristensen AT, Jensen AL, et al. Efficacy and safety of imidacloprid/moxidectin spot-on solution and fenbendazole in the treatment of dogs naturally infected with Angiostrongylus vasorum (Baillet, 1866). Vet Parasitol 2007; 147:258–264.

You'll need Wiley access to get hold of it.

However, it's not the whole story. Fenbendazole is associated with a slower 'kill' which may actually be beneficial as the exposure of immunostimulatory molecules from dead parasites is slower and more gradual whereas moxidectin kills quicker- therefore there may be an apparent worsening of clinical signs with the latter associated with hypersensitivity/profound immunoreactions rather than a treatment failure. That's why preds/dex are a great idea in these cases. Milbemycin-oxime 0.5mg/kg PO q7d is also effecitve and may be a good compromise.

Far more important to survival seems to be sickness at presentation, and area of country. Mild-mod dyspnoea have shown a 100% survival rate, but upto 15% mortality for those in severe dyspnoea. In non-endemic areas e.g. north England a recent case series showed 80% mortality, suggesting that immunological naivety may be a factor.

[quote user="Louise Alexander"]

I'm not sure if a drug which claims to kill so many parasites can be effective at killing each and every one. Thoughts?

[/quote]

I don't agree at all. The argument is based on number alone, and has nothing to do with the mechanism of action or otherwise. It's also not just one drug. Antibiotics work on a far more diverese range of bacteria that moxidectin/imidacloprid on parasites but we don't doubt their efficacy purely on numbers. I think Advocate is a fantastic product in terms of versatility and lungworm prevention. I also think that GP vets' (barring some farm vets) knowledge of anthelmintics, in general, is poor.

Re: Lungworm treatment

Louise6732 — Mon, 14 Nov 2011 12:01:25 GMT

We had a rep from Bayer talk to us about Advocate, and she suggested that if you suspect a lungworm case, apply Advocate and within 48hrs the animal will be better if it was lungworm. She had me convinced that it was the better treatment. After this thread I'm not so sure...!

Also, she was hammering home the fact that we should be using Advocate every 4 weeks without fail throughout the year, for public health reasons as children were going blind from toxocara infections, which is rife in parks and carried on dogs' fur apparently. When I raised my concerns that as we have seen in equines and farm animals, shouldn't we be concerned about resistence developing with such overuse? She pointed out there was no evidence of this thus far and unlikely to be in the future. I can't help but think if, as she suggested, every dog in the UK is given Advocate every four weeks, that this may accelerate potential resistence? If anyone knows of any research on this please let me know as I'm quite interested!

Anyways, I think she was just going for the hard sell, it seemed a bit OTT to me. I'm not sure if a drug which claims to kill so many parasites can be effective at killing each and every one. Thoughts?

Louise