Evaluation of a single-administration ototopical treatment for canine otitis externa: a randomised trial.

OBJECTIVE: To evaluate the efficacy and safety of a new, single-administration Otic Solution containing florfenicol, terbinafine and mometasone furoate for the treatment of canine otitis externa (OE). DESIGN: The clinical efficacy and safety study was a multicentre, controlled, masked and randomised field study conducted over 30 days. Two hundred and twenty-one (221) client-owned dogs of varying breeds with diagnosed bacterial and/or fungal OE were enrolled. PROCEDURE: Dogs were randomised to either Otic Solution or control groups. Evaluations were conducted over a minimum period of 30 days with a primary effectiveness endpoint based on the improvement in a clinical severity score at the final visit (day 30). Safety analyses were based on clinical and laboratory parameters and the occurrence of adverse events. RESULTS: The Otic Solution group demonstrated a significantly higher treatment success rate compared with that observed for the control group (72.5 per cent v 11.1 per cent, P value=0.0001) for cases of OE caused by Staphylococcus pseudintermedius and Malassezia pachydermatis. No significant safety findings were reported. CONCLUSIONS/CLINICAL RELEVANCE: This new ototopical formulation provides safe and effective treatment of canine OE and is an important alternative antimicrobial for this indication. The single-administration dosage regimen eliminates opportunities for client dosage administration errors and medication stockpiling.

Development of advantus(imidacloprid) soft chewable tablets for the treatment of Ctenocephalides felis infestations on dogs.

BACKGROUND: Studies reported here were conducted to evaluate the safety and effectiveness of advantus (imidacloprid) soft chewable tablets for the treatment of flea (Ctenocephalides felis) infestations on dogs and puppies 10 weeks of age or older and weighing 4 pounds or greater. METHODS: A pharmacokinetic study was conducted to evaluate parameters of orally administered imidacloprid. A dose confirmation study was conducted to confirm the efficacy of 0.75 mg/kg at 8, 12 or 24 hours post-treatment. A knockdown and speed of kill study was conducted to confirm the efficacy of 0.75 mg/kg dose at 0.5, 1, 4 or 24 hours post-treatment. The safety of a daily dose administered for six months at approximately 1, 3, and 5 times the maximum exposure dose of 3.75 mg/kg was evaluated in puppies. A field study was conducted to evaluate the safety and efficacy of a daily oral dose of 0.75 mg/kg for 14 days in client-owned dogs. RESULTS: The pharmacokinetic parameters of the final imidacloprid oral formulation were; Tmax 1.31 hours, Cmax 690.0 ng/mL, AUC 2615.5 h*ng/mL and half-life was 2.2 hours. The efficacy of 0.75 mg/kg BW was 98.6%, 99.9% and 100% at 8, 12 and 24 hours post-treatment, respectively. The live flea counts were significantly different (p < 0.0001) and the treatment was well tolerated. The flea counts at 1 hour post-treatment were significantly lower in the treated group and the speed of kill efficacy was 96.6% at 4 hours post-treatment in the knockdown and speed of kill study. The target animal safety study showed that the advantus soft chewable tablets administered orally to 10-week-old puppies once daily for 6 months at approximately 1, 3 and 5 times the maximum dose of 3.75 mg/kg was well tolerated and did not produce clinically relevant findings in Beagles. In the field study, efficacy of the soft chewable tablets administered daily for 14 days to flea-infested dogs was 98.2%. CONCLUSION: Imidacloprid administered orally as a soft chewable tablet for the treatment of fleas on dogs was safe and highly effective with a rapid knockdown effect and rapid elimination.

Effectiveness of isopropyl myristate/cyclomethicone D5 solution of removing cuticular hydrocarbons from human head lice (Pediculus humanus capitis).

BACKGROUND: In the treatment of human head lice infestation, healthcare providers are increasingly concerned about lice becoming resistant to existing pesticide treatments. Traditional pesticides, used to control these pests, have a neurological mechanism of action. This publication describes a topical solution with a non-traditional mechanism of action, based on physical disruption of the wax layer that covers the cuticle of the louse exoskeleton. This topical solution has been shown clinically to cure 82% of patients with only a 10-minute treatment time, repeated once after 7 days. All insects, including human head lice, have a wax-covered exoskeleton. This wax, composed of hydrocarbons, provides the insect with protection against water loss and is therefore critical to its survival. When the protective wax is disrupted, water loss becomes uncontrollable and irreversible, leading to dehydration and death. A specific pattern of hydrocarbons has been found in all of the head louse cuticular wax studied. Iso-octane effectively removes these hydrocarbons from human head lice's cuticular wax. METHODS: A method of head louse cuticle wax extraction and analysis by gas chromatography was developed. Human head lice (Pediculus humanus capitis) were collected from infested patients and subjected to any of three extraction solvents comprising either the test product or one of two solvents introduced as controls. A gas chromatograph equipped with a flame ionization detector (GC/FID) was used to determine the presence of hydrocarbons in the three head lice extracts. RESULTS: In the study reported herein, the test product isopropyl myristate/cyclomethicone D5 (IPM/D5) was shown to perform comparably with iso-octane, effectively extracting the target hydrocarbons from the cuticular wax that coats the human head louse exoskeleton. CONCLUSIONS: Disruption of the integrity of the insect cuticle by removal of specific hydrocarbons found in the cuticular wax appears to offer a mechanism for killing lice without the likelihood of encountering genetic resistance.

Pyrethroid pediculicide resistance of head lice in Canada evaluated by serial invasive signal amplification reaction.

BACKGROUND: Most people in the United States and Canada with pediculosis will be treated with neurotoxic pediculicides containing pyrethrins or pyrethroids. Their widespread use led to significant resistance reported from various countries. Although treatment failures are frequently observed in Canada, the resistance frequency to pyrethroid pediculicide of human head lice (Pediculus humanus capitis) has not been determined. OBJECTIVE: To determine the knockdown resistance (kdr) allele frequency in human head louse populations in Canada. METHODS: Patients infested with Pediculus humanus capitis, aged 4 to 65 years, residents of Ontario, Quebec, and British Columbia, were participants. Head lice were collected by combing and picking the enrolled subjects' hair. Lice were analyzed by serial invasive signal amplification reaction (SISAR) for genotyping the T917I mutation of lice indicating permethrin resistance. The permethrin-resistant kdr allele (R allele) frequency could then be evaluated in the head lice collected in Canada. RESULTS: Of the head louse populations analyzed, 133 of 137 (97.1%) had a resistant (R) allele frequency, whereas only 4 of 137 (2.9%) had a susceptible (S) allele frequency. CONCLUSIONS: The 97.1% resistant (R) allele frequency in head lice from Canada could explain the treatment failures encountered with pyrethrin and pyrethroid pediculicide treatments in Canadian populations infested with Pediculus humanus capitis as the latter will not be eliminated by those pediculicides.

North American efficacy and safety of a novel pediculicide rinse, isopropyl myristate 50% (Resultz).

BACKGROUND: Head lice infestations are a major nuisance in school-aged children and are a worldwide public health problem. There are growing concerns about the effectiveness of current treatments owing to increasing resistance, safety, and patient noncompliance. A safe, easy to use, effective alternative is needed. OBJECTIVE: A pediculicide rinse, 50% isopropyl myristate (IPM), was assessed in two phase 2 trials conducted in North America. The first trial was a nonrandomized (proof of concept) trial without a comparator conducted in Winnipeg, Canada. The second trial, conducted in the United States, was an evaluator-blinded, randomized superiority trial comparing 50% IPM rinse with a positive control (RID; pyrethrin 0.33%, piperonyl butoxide 4%). The primary end points were to determine the safety and efficacy of 50% IPM as a pediculicide rinse. METHODS: Subjects meeting inclusion criteria were enrolled in the above-mentioned trials with efficacy end points 7 and 14 days post-treatment. Subjects were also evaluated on days 0, 7, 14, and 21 for the presence of erythema and edema using the Modified Draize Scale. Other comments associated with the safety evaluation (ie, pruritus) were collected. RESULTS: IPM was found to be effective in the proof of concept study and comparator trial using a positive control. IPM was also well tolerated, with minimal adverse events. All adverse events were mild, resolving by completion of the study. CONCLUSION: Data suggest that IPM is a safe and effective therapy for the treatment of head lice in children and adults. IPM's mechanical mechanism of action makes development of lice resistance unlikely.