What's new in dermatology (Proceedings)
Multiple new flea control products have been released in the past few years. Comfortis® (Lily) is a spinosad insecticide that is administered orally. It provides very rapid flea kill that lasts a month. It should be given with a full meal to ensure complete absorption. The flea must bite the host to ingest the insecticide and die; however, this is not a barrier to effectiveness in flea allergic animals due to the rapid speed of kill. Comfortis® is approved for use in dogs only. The most common side effect seen is vomiting. It should not be used together with daily high dose ivermectin (for treatment of demodicosis) as ivermectin toxicity results. The label recommends owners seek veterinary advice before administering this drug to epileptics.
Vectra 3D® (Summit) is a new spot on flea control product for dogs only. It contains dinotefuran (a neonicotinoid insecticide), pyriproxifen (juvenile growth hormone analog), and permethrin. The concentration of permethrin in this product is toxic to cats. Vectra® has good efficacy against fleas (rapid flea kill), ticks, and mosquitoes. Frequent bathing may necessitate more frequent application than once monthly as recommended on the label, especially when dealing with insect bite allergic patients.
Vectra® (Summit) is also available for cats as a once a month spot on. It contains dinotefuran and pyriproxifen. It provides rapid adult flea kill as well as larvicidal activity of the pyriproxifen.Promeris® (Fort Dodge) is a once a month spot on for dogs containing metaflumizone and amitraz. Metaflumizone is a novel insecticide that provides rapid adult flea kill. Promeris® is labeled for flea and tick control. There is increased potential for drug interactions due to the amitraz (e.g. monoamine oxidase inhibitor use in patient and client). Promeris® has also been recommended as a treatment for generalized demodicosis. The "success" rate at day 84 of treatment was 42.9% with monthly application of the product and 62.5% with biweekly application of the product. Success was defined as a decrease in mite numbers. Longer term follow up was not reported in the study.
Promeris® (Fort Dodge) is also available as a monthly spot on for cats. The feline product contains metaflumizone only.
Older "new generation" flea control products we should not forget include Program® (lufenuron), Advantage® (imidacloprid), Frontline® (fipronil), Revolution® (selamectin), and Capstar® (nitenpyram).
True resistance of fleas to any of the above mentioned adulticides is extremely rare according to current monitoring efforts. What is seen as product failure is more likely to be inappropriate expectation of product performance on the part of the client or lack of a complete flea control program.
Simplicef ® (cefpodoxime proxetil) is a second generation cephalosporin for use in dogs. The dose is 5-10 mg/kg once daily. It is available in 100mg and 200mg coated tablets. It seems to cause less gastrointestinal upset than cephalexin so can be a good alternative for staphylococcal pyodermas. Cefpodoxime discs are available for sensitivity testing and should be used as sensitivity results for cephalothin do not equate to those for cefpodoxime.
Convenia® (cefovecin) is a third generation cephalosporin with good activity against staphylococcal organisms, but not Pseudomonas. It is approved for use in dogs and cats. The dose is 8 mg/kg given by subcutaneous injection every 14 days. Once reconstituted, the vial is good for 28 days if refrigerated (some discoloration is normal). Since superficial pyodermas should be treated for a minimum of 3 weeks, two injections of cefovecin are recommended. The drug is highly protein bound so some caution when using together with other highly protein bound drugs may be indicated.
Gastricalm® is a chelated zinc carnosine compound that protects the stomach lining and speeds repair of damaged gastric epithelium. It was designed for use with non-steroidal anti-inflammatories; however, it has demonstrated usefulness also in avoiding gastrointestinal upset caused by antibiotics (e.g. cephalexin) and cyclosporine.
3Vcaps HP: Eicosapentaienoic/docosahexanoic acid fatty acid supplement with free fatty acids. In humans these have been shown to have increased bioavailability.