Message 1604
Date: Sat Nov 24, 2001 3: 27 pm
Subject: Extralabel meds
The latest Board Notes (page 4 of Nov issue) discusses how a disciplinary action was taken for using Frontline in a cat's ears. An adverse reaction resulted and the actions of the veterinarian were deemed below the currently acceptable standard of care. I wonder what everyone is using as an otic parasiticide? I have been using cattle injectable ivermectin in propylene glycol for so many successful years against ticks, fleas and mites that I hate to have to switch but in these times. . . . .
The only currently approved tx for earmites is Acarexx (and Mitox?) which may work no better, and is much more expensive. It was discussed on another chatlist and I post below comments on the product.
If you do use an extralabel product, do you stop the proceedings to have the client sign a consent form? ? Thanks, Dave
Forwarded information on Acarexx from another list:
>>>>>
Thanks
to all who responded to my question about Acarexx! I have a better
idea of efficacy and cost (vs. off-label use of ivermectin) now and,
since most of the responses were fairly positive, might give it a try.
. . I've listed the question and the responses below in their entirety
since all were brief and to the point.
___________________________________________________________ ___________ Is anyone using Acarexx for ear mite treatment? Any idea on cost, dosage regime, and efficacy? TIA!
___________________________________________________________ ___________
I have just started using Acarexx, about a month or so. I like it so far.
I think it does a good job of killing the mites. It is a one time treatment
that I do in the office, eliminating client compliance problems.
The only draw back I have encountered is that the ears need to be cleaned
after about a week. I used to use Treasaderm (and still do with some cases
where the ears are inflamed etc. ) and the repeated treatments seemed to
take care of the cerumen build up better. I tell the client
to wipe the ears with an alcohol soaked cotton ball 7-10 days post treatment.
A lot of these are done during the puppy/kitten phase of vaccinations and
I get a recheck at some point, and I can see for myself if the ears are
clean. If not, I clean them for the client. I don't remember the cost,
I think about $4-6/ea. I think I charge about $18 to the client. (about
the same for Tresaderm).
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Expensive. It's just a drop or two of plain ol' ivermectin in a white liquid.
I've seen at least 3 animals in the past couple months that were treated
and still had live mites 3 weeks later. I think cost to client is around
12 bucks.
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Unfortunately, we pay upwards of $7. 40 per dose (don't know if that other
person buys in very large bulk). We also treat while at the office
(beware, the cat shakes its head and liberally doses anyone around
with the solution) and very dirty ears we send home with Tresaderm with
instructions to wait about 1 week before using it. So far, seems to work
fairly well in MOST of the cats (especially the kittens) but have had a
few that we have treated twice. We charge $25. 00 for the treatment.
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I have been using Acarexx for almost a year now and really love it! I used
to do the Tresaderm thing and that just about killed people trying to wrestle
their cats to treat. In the beginning of using Acarexx, I would do a cytology
recheck to see if the mites were gone
- after about 10 of these, I was convinced. Yes, there is residual
wax left behind, but you can clean that & there are no mites in it!
Altho the product says not to bother cleaning the ears, I most certainly
would to increase efficacy. And people love not having to treat those ears
(esp. those who have gone through Tresaderm! ) So I condone the product
and have not had any adverse effect - definitely get it. You'll be surprised
how happy those people will be! I think we charge $11 (we're in a little
more low income area).
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I've used it 4-5 times. Easy to use, inexpensive, and works well (so far!
).
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We're using Acarexx and it appears to be as effective as aural ivermectin
that we were using off-label. Often need to treat twice at 2-3 week interval.
Not sure on cost.
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Message 1606
Date: Sat Nov 24, 2001 4: 31 pm
Subject: RE: [texasvets] Extralabel meds
I think that 0. 1 cc of Ivomec in each ear for ear mites is probably
accepted by "standard of care"--so many practitioners do it. Not so many
practitioners putting Frontline in the ears. Would we not be protected
by "standard of care"?
- WB -
<<The latest Board Notes (page 4 of Nov issue) discusses how a disciplinary action was taken for using Frontline in a cat's ears. An adverse reaction resulted and the actions of the veterinarian were deemed below the currently acceptable standard of care. I wonder what everyone is using as an otic parasiticide? I have been using cattle injectable ivermectin in propylene glycol for so many successful years against ticks, fleas and mites that I hate to have to switch but in these times. . . . .
The only currently approved tx for earmites is Acarexx (and Mitox? ) which may work no better, and is much more expensive. It was discussed on another chatlist and I post below comments on the product.
If you do use an extralabel product, do you stop the proceedings to
have the client sign a consent form? ? Thanks, D.
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Message 1610
Date: Sat Nov 24, 2001 6: 42 pm
Subject: Re: [texasvets] Extralabel meds
Since ears are my special interest area I will address this. I use inject. ivermectin at b. w. x 0. 15 (150 micrograms). This is give subq. I try to wash the ears clean if the client will leave the cat. Once the ear is clean to the TM I may instill a small amt. of miticide or otomax. I recheck the ears in 10 days, and may give ivermectin again. I have been doing this for years. Too many time, in other ear problems too, we don't get the ears washed out which in my opinion is 3/4 the battle. In fact, I attended a derm. seminar a couple of years ago where the speaker went through all of this good stuff for the ears. At the break I talked with him and told him that IMHO he left out the most important part---washing the ears clean after diagnostics are completed---and he said "hey, you are right. " JW
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Message 1623
Date: Sat Nov 24, 2001 11: 28 pm
Subject: Re: [texasvets] Re: Extra label meds
In the computer here in Beaumont they have an ear cleaning fee, and then they have a fee that says something to the affect "Ear Flush/Dr. W" which is $30 or $35. 00. This is for all species not just ear mites, and anesthetic is additional. Some ears I see require complete anesthetic in order for me to get them clean enough to scope properly. There have been some ear canals that costed more than $35. 00. In all of these instances I spend a lot of time talking to the client about the whole program beginning to end.
Also, with regards to ear mites it is best if we can get the client to let us bath the cat or dog when we start treatment because some mites may be on the body when the cat or dog curls up and sleeps. They can reinfest themselves. Howsomever, Frontline, Advantage, and Revolution should kill those---still bathe them when ears are flushed. - JW -
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Message 1624
Date: Sat Nov 24, 2001 11: 33 pm
Subject: Re: [texasvets] Re: Extra label meds
In a message dated 11/24/2001 10: 04: 46 PM Central Standard Time, DPN writes:
<< We have made use of our MedRx scope and if these ears are really soupy, we sedate them and take pictures not only of the before and after, but of either ear drum rupture or the intact ones that exist. You would be surprised how many of those are not complete. Its a real selling point to our clients about the importance of follow-ups and extended bacterial coverage
I wrote an article called "THAT WAS THEN, THIS IS NOW" and in that article
I espoused the benefits of the MedRx. I consider this the single
best "high tech" piece of equipment for anyones practice. You will
use it much more than an endoscope, and ultrasound and the learning
curve is much shorter. Both of the other pieces of equipment are
great, but this one, IMHO, should be first on your list. I also stated
in the article "that if I ever find a practice that wants me as an
associate, and they don't have the MedRx, then I would buy it myself
and use it. "
-JW-
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Message 1626
Date: Sat Nov 24, 2001 11: 42 pm
Subject: Re: [texasvets] Extralabel meds
I don't even walk on egg shells. I have never had an adverse reaction
either. Maybe a release form is in order, but many times I am treating
a drop off animal. Guess we could call them and explain the whole
thing, then get two members of the staff to verify it on the phone,
document it in the record and place a note into the clients bill
atesting to the facts. Told ya there should only be one law school
in the Nation and it is used on an "as needed basis, " which means
it probably would not graduate a class untill 3000.
- JW (what DNP, the wormer said)
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Message 1627
Date: Sat Nov 24, 2001 11: 48 pm
Subject: Re: [texasvets] Extralabel meds
FWIW, our latest family kitten acquisition (at 7 weeks old) came complete with fleas and ear mites. As soon as it got home, I washed its ears with Epi Otic until no more exudates came out, gave it a bath, towel dried until damp, applied Frontline SPRAY all over lightly, including a couple of drops in each ear. That was 4 months ago. No adverse reaction(s), and still mite-free.
Of course, I wouldn't recommend this to just any client - maybe those with a dozen "barn cats" to treat with a single application, and then only after exhaustive off-label-use warnings were issued.
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Message 1639
Date: Mon Nov 26, 2001 9: 59 am
Subject: Re: [texasvets] Extralabel meds
In a message dated 11/24/2001 4: 28: 32 PM Central Standard Time, [email protected] writes:
The only currently approved tx for earmites is Acarexx (and Mitox? )
Revolution is also labeled for ear mites. I now routinely put cats and kittens with ear mites on Revolution. Takes care of the ear mites, fleas, intestinal parasites and prevents heartworms. I still deworm them with either strongid T or Drontal, however, since I'm not convinced about how good a job Rev does on intestinal parasites.
I know some people have not been happy with Rev for fleas but I'm using it on my own pets with good results.
BTW, I have no affiliation with Pfizer. : )
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Message 1640
Date: Mon Nov 26, 2001 11:
Subject: Re: [texasvets] Extralabel meds
I use Revolution for ear mites also. I attended a seminar somewhere
and they mentioned that because of the short life cycle, Revolution
needs to be applied every 2 weeks for 3 applications to clean up
the infection, then once a month for control. I have them put the
Revolution on the back of the head between the ears. I have treated several
cats with chronic ear mites this way - ya know, one beloved house
cat and MANY outside cats that get food only
- and it worked out very well until the owners decided they were "cured"
and stopped the monthly control treatments
-PLB-
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Message 1655
Date: Mon Nov 26, 2001 9: 38 pm
Subject: Re: [texasvets] Extralabel meds
I use Revolution on my cats as well. I have one all outdoor cat with
a chronic hookworm problem. Since I have had him on revol. I have been
getting negative stools! I also like it for ear mites. It usually gets
rid of them in 1 dose , though I have had a few that required the second
month's dose to get rid of all.
( I don't have any Pfizer affiliation either! )
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