Ivermectin For Dogs Mange

Sarcoptic mange, caused by the Sarcoptes scabiei mite, is an infectious disease of wildlife, domestic animals and humans with international importance. Whilst a variety of treatment and control methods have been investigated in wildlife, the literature is fragmented and lacking consensus. The primary objectives of this review were to synthesise the diverse literature published on the treatment of sarcoptic mange in wildlife from around the world, and to identify the qualities of successful treatment strategies in both captive and free-roaming wildlife.

A systematic search of the electronic databases CAB Direct, PubMed, Scopus, Web of Science, EMBASE and Discovery was undertaken. Data pertaining to study design, country, year, species, study size, mange severity, treatment protocol and outcomes were extracted from eligible studies and placed in a table. Following data extraction, a decision tree was used to identify studies suitable for further analysis based on the effectiveness of their treatment protocol, whether they were conducted on captive or non-captive wildlife, and the quality of their post-treatment monitoring period.

Twenty-eight studies met our initial inclusion criteria for data collection. Of these studies, 15 were selected for further analysis following application of the decision tree. This comprised of 9 studies on captive wildlife, 5 studies on free-living wildlife and 1 study involving both captive and free-living wildlife. Ivermectin delivered multiple times via subcutaneous injection at a dose between 200–400 µg/kg was found to be the most common and successfully used treatment, although long-term data on post-release survival and re-infection rates was elusive.

To our knowledge, this review is the first to demonstrate that multiple therapeutic protocols exist for the treatment of sarcoptic mange in wildlife. However, several contemporary treatment options are yet to be formally reported in wildlife, such as the use of isoxazoline chemicals as a one-off treatment. There is also a strong indication for more randomised controlled trials, as well as improved methods of post-treatment monitoring. Advancing this field of knowledge is expected to aid veterinarians, wildlife workers and policy makers with the design and implementation of effective treatment and management strategies for the conservation of wildlife affected by sarcoptic mange.

Sarcoptic mange, caused by the mite Sarcoptes scabiei, is a globally-distributed, infectious disease of wildlife that is emerging in some species [1] and has been reported in greater than 100 species of mammals [2]. The sarcoptic mite burrows deep into the epidermis, causing inflammation, intense pruritis and, in advanced cases, a perturbed skin barrier that may result in death secondary to infection, dehydration and impaired thermoregulation [3, 4]. In highly susceptible populations, the mite has the capacity to spread rapidly, reduce reproduction and cause mass mortality events [5,6,7]. The death of only a few reproducing adults may have significant consequences for threatened or isolated populations [8], especially when combined with other threatening processes, such as habitat destruction [9, 10]. Consequently, the treatment and control of sarcoptic mange may play an important role in conservation. Whilst comprehensive reviews have been published on the pathogenesis and epidemiology of sarcoptic mange in wildlife [2, 11], to our knowledge no review has focussed specifically on methods of treatment and their long-term outcomes.

Thus, this review aims to systematically review primary articles on the treatment of sarcoptic mange in wildlife, with a focus on the qualities of successful treatment strategies and their long-term outcomes. The review also aims to highlight research deficiencies and to discuss when treatments may or may not be warranted. Greater synthesis and consensus in this field of knowledge is expected to assist veterinarians, wildlife workers and policy makers with the design and implementation of effective treatment and management strategies for the conservation of wildlife affected by sarcoptic mange.

This systematic review was conducted in accordance with the definition provided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement: ‘… a review of a clearly formulated question that uses systematic and explicit methods to identify, select and critically appraise relevant research, and to collect and analyse data from the studies that are included in the review’ [12] (see PRISMA checklist in Additional file 1: Table S1). We did not register the protocol for this review.

A systematic search of six electronic databases was conducted between May and August 2017. CAB Direct (1973–2017), PubMed (1951–2017), Scopus (1995–2017), Web of Science (1900–2017), EMBASE (1946–2017) and Discovery (1401–2017) were searched with no date restrictions but with results limited to those published in English, as permitted by the databases. The search strategy included the following key terms (and possible variants of the terms including alternate spellings): Sarcoptic mange, scabies AND wildlife, population, native, indigenous, local, animal, free-roaming, free-ranging, undomesticated AND treatment, therapy, cure, medicate, rehabilitate, remedy. Terms were searched in title, keyword and abstract (as permitted by the databases). The full search strategy is included in Additional file 2: Text S1.

Studies were exported into EndNote X6 and duplicates were removed. The inclusion/exclusion selection process is illustrated in Fig. 1. Titles and abstracts were screened for relevance, and irrelevant research was excluded based on the following exclusion criteria: (i) any paper not in the English language or published in full-text; (ii) any reviews (although reviews specific to sarcoptic mange in wildlife were retained for backwards and forwards searching); or (iii) any paper that did not refer to the treatment of sarcoptic mange in wildlife in its title or abstract. Studies already known to the authors were also considered for inclusion, based upon the criteria reported above. Reference and citation lists of relevant studies and reviews were screened to identify additional articles, which were subject to the same criteria as results from the database searches. This process continued until no further research was obtained. Finally, the entire manuscript was evaluated. Papers were eligible for inclusion if they described the therapeutic treatment of a wildlife species diagnosed with sarcoptic mange. Treatment refers to ‘… medical care given to a patient for an illness or injury’, as defined by the Oxford English Dictionary [13]. Wildlife refers to ‘… feral animals, captive wild animals and wild animals.’, where a wild animal is ‘… an animal that has a phenotype unaffected by human selection and lives independent of direct human supervision or control’ and a captive wild animal refers to an animal that has ‘… a phenotype not significantly affected by human selection but that is captive or otherwise lives under direct human supervision or control, including zoo animals and pets’, as defined by the OIE [14]. For the purpose of this study, articles on feral animals or wildlife not infected with S. scabiei were excluded from analysis. Articles that involved the treatment of S. scabiei in both wild and domestic animals were retained. Where there was any uncertainty regarding the inclusion of a study, the opinion of a second reviewer was sought.

Data were carefully extracted from eligible studies by a single independent reviewer under the following headings: study design, year and country of publication; taxonomic family and species of wildlife studied; number of animals treated; treatment environment (i.e. in the wild versus in captivity); severity of infection prior to treatment; treatment protocol (i.e. drug, dose, delivery method, number of doses delivered, and treatment interval between doses); and outcomes (see the complete data extraction table in Additional file 3: Table S2). Where not explicitly stated within studies, the degree of mange severity prior to treatment (i.e. mild, moderate or severe) was extrapolated from descriptions of the severity and distribution of mange lesions over the body of infected animals. Where not explicitly stated, study design was extrapolated using definitions from an authoritative textbook [15]. Outcomes were expressed as the percentage of animals that recovered with treatment (i.e. the treatment recovery rate), and adverse side effects were also documented.

Following the initial data collection, a decision tree was used to determine whether eligible studies were suitable for further analysis (Fig. 2). Studies that failed to identify S. scabies as the source of infection prior to treatment, or which did not document treatment outcomes or a post-treatment monitoring period were excluded from further analysis. The remaining studies were classified into two arbitrary categories: successful treatments (where greater than 50% of the animals treated for sarcoptic mange recovered following treatment) and unsuccessful treatments (where less than 50% of treated animals recovered following treatment). Successful studies were divided according to whether they involved the treatment of captive or free-roaming wildlife (otherwise referred to as non-captive, or free-ranging wildlife). They were then assessed on the severity of the animals’ mange prior to treatment, the treatment protocol, and the duration and outcome of post-treatment monitoring. A monitoring period was defined as a specified length of time for observing the process of recovery of one or more animals after delivery of the final medication in a treatment protocol.

As there is a dearth of literature in this area, all papers relevant to the subject were included in this systematic review, many of which were case reports and other forms of non-prospective or randomised studies. Therefore, we agree with the concern that much of the data could be subject to bias and have acknowledged this in the discussion. No formal statistical or meta-analysis was carried out and analysis to investigate statistical heterogeneity or publication bias was not performed because most of the studies were descriptive case series.

A total of 2205 publications were retrieved from the database search. Duplicates were removed through Endnote X6, leaving 1687 results. Following the screening process, a total of 28 unique and relevant studies were reported in this systematic review (see Additional file 3: Table S2). Seventeen studies were case reports or series, seven were non-randomised controlled trials, two were cohort studies, and two were cross-sectional studies.

This review looks at research on the treatment of sarcoptic mange in wildlife dating from the 1970s. Most studies were published following the year 2000, although in several cases the research start date was many years earlier than this. The majority of studies were undertaken in Australia, Europe and Africa (Table 1).

Across the 28 primary articles, 30 species of wildlife, comprising 14 different taxonomic families of mammals, were treated for sarcoptic mange. Two studies treated greater than one species of wildlife [16, 17] and one of these studies, by Gakuya et al. [17], involved the treatment of domestic and wild animals as part of the management of sarcoptic mange in a complex wildlife/livestock system. The most commonly studied families were the Bovidae and Canidae (Fig. 3). As some studies involved the treatment of more than one animal family, the cumulative total for ‘Number of studies’ in Fig. 3 is greater than 28.

Four studies documented adverse side effects following administration of subcutaneous ivermectin or adjunctive therapies. Side effects included severely loose stools [18], profuse watery diarrhoea [9] and death [19, 20]. Of the remaining 24 studies, only three studies specifically monitored for or stated an absence of deleterious side effects following treatments [21,22,23]. Adverse side effects were either absent or failed to be documented in the other studies.

Quality assessment using a decision tree left 15 studies suitable for further analysis. This comprised of nine successful studies involving captive wildlife with a post-treatment monitoring period, five successful studies involving free-living wildlife with a post-treatment monitoring period, and one successful study describing the treatment of both captive and non-captive wildlife [24]. This study was subsequently included in both of these analysis groups; hence the cumulative number of studies under the captive and free-ranging treatment group headings in Fig. 2 equates to 16 and not 15.

How often do i give my dog ivermectin for mange?

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    A: Demodicosis or Demodectic Mange occurs when there are excessive numbers of Demodex canis mites in the hair follicles. The mites are generally obtained shortly after birth from the mother. In most dogs the number of mites is very small and no clinical disease occurs. Demodectic mange is not contagious. Some dogs are genetically or immunologically susceptible to the proliferation of the mites which leads to the clinical signs. Certain breeds such as the pit bull terrier are predisposed to the disease. As the mites accumulate in the hair follicles the skin becomes red with areas of hair loss. Secondary bacterial infections are common and cause more severe lesions such as pustules and draining tracts. Lesions can occur anywhere but the face and the feet are most commonly affected. When the secondary infections are severe and deep the dog may appear systemically sick. Demodicosis is diagnosed by doing skin scrapings. A scalpel blade is used to collect a sample from the skin and the mites can be seen under a microscope. Skin scrapings are also used to monitor the treatment. Juvenile onset demodicosis is when the disease began when the dog is less than eighteen months old. While the disease can still be very severe, most (but not all) of these dogs can be cleared of the disease. Treatment may be needed for 6 months or longer. When older dogs develop demodectic mange there may be an underlying cause which is weakening the dog’s own ability to keep the number of mites low. Anything that weakens the immune system such as chemotherapy, cancer, hyperadrenocorticism, hypothyroidism, steroid therapy, internal parasites,or stress can lead to the development of demodicosis. Therefore it is recommended to do diagnostic testing to see if a cause can be found and treated. Unfortunately a cause can not be found in many cases and long term treatment is often required. It is important to treat the secondary bacterial infections. Long courses of antibiotics may be needed and culture and sensitivity testing are often necessary to choose the correct antibiotic.

    Q: My rescue Pitbull mix suffers from chronic demodectic mange, and the only thing that our vet has used to treat it is Ivermectin and some sulfur bath treatments. He is taking more and more Ivermectin with only occasional success (as in the hair loss will subside for a month or two, but then it falls out again and his skin gets so bad that it pusses.) The more Ivermectin he takes the more lethargic he seems. Isn’t there any other treatment?

    Mitoban dip can be used for dogs that do not tolerate Ivermectin. Mitoban contains amitraz. The dip must be diluted and applied properly in a well ventilated area. Long haired dogs must be clipped prior to dipping. The dips are done every 7-14 days for several months and can have a 60-80% cure rate. I would recommend that you bring your dog to see a veterinary dermatologist since demodectic mange can be a difficult and frustrating disease to treat.

    Milbemycin is an oral drug in the same class as ivermectin. It is tolerated by most dogs. Unfortunately it is more expensive and currently unavailable

    Giving oral Ivermectin daily is well tolerated and can be effective in most dogs (80-85%). Certain breeds of dogs such as Collies and other herding breeds do not tolerate the higher doses of ivermectin needed to treat demodectic mange. Dogs can be tested for the genetic mutation which can help predict which dogs can safely take Ivermectin. The dose of Ivermectin has a wide range and difficult cases will often require the higher end of the dose range. Ivermectin is often started at a low dose and the dog is observed for side effects. If there are no serious side effects the dose is increased gradually until an effective dose is attained. Periodic examinations and skin scraping are done to monitor the progress. Treatment is continued until there are no mites found on two skin scrapings one month apart.

    Rationalising treatments and designing a treatment-inclusion criteria

    With limited data on post-release survival and re-infection rates, the rationale for bringing wildlife into captivity for treatment may be reasonably questioned. If re-infection rates are high and survival rates are poor post-release, euthanasia and removal of infected bodies from the environment, as demonstrated in a study by Alasaad et al. [40], may be a more appropriate action to relieve suffering and reduce the transmission of disease. One must also question the ethics of treating endemic diseases in free-ranging wildlife with a healthy conservation status; whilst the presentation of sarcoptic mange may raise welfare concerns, it is possible that resultant deaths play a role in natural selection for resistant animals. Granted, where an animal’s conservation status is in question, attempts to treat free-ranging wildlife may be acceptable. One potential method for determining whether treatment is warranted would be to establish a treatment-inclusion criteria. Ideally, the criteria would take into consideration the severity of infection, the likely success of treatment, and post-release survival and re-infection rates. Other important factors for the criteria would include the conservation status of the animal and the likelihood of the animal transmitting infection to another species if left untreated. For example, in the study by Gakuya et al. [17], which focussed on the treatment of a population of threatened cheetahs, wild Thomson’s gazelles also received treatment for sarcoptic mange, despite being locally abundant. This is because they were a reservoir for mites and the primary source of infection for the critically endangered cheetah population. Lastly, the criteria should take into consideration whether the animal is being translocated into a new area in which sarcoptic mange is not endemic, such as a sanctuary or a game park. If this is the case, animals coming from a region where mange is endemic should be treated regardless of whether they show clinical signs of disease, because sub-clinical carriers of the mite have been implicated as the source of outbreaks in multiple captive animal collections [16, 25, 38]. A treatment-inclusion criteria would thereby help to prioritise which species and regions should be targeted for treatment, thus optimising the use of limited resources.


    How much ivermectin can I give my dog for mange?

    Using ivermectin or milbemycin to help clear mange

    Interceptor (0.5-0.9mg/kg/month) is a commonly used medication to prevent heartworm infections. To treat demodex mites, veterinarians prescribe higher doses (0.5 to 2.0 mg/kg) used daily for several weeks.

    How long does ivermectin take to work on mange?

    Three wk after treatment, the animals in the third phase of mange treated with a high dose (0.4 mg/kg bw) of ivermectin were completely cured. The same result was achieved after 4 wk of treatment in those animals in phase 3 of mange when 0.2 mg/kg body weight was used.