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Animals with right-sided congestive heart failure require stablisation with diuretics, ACE inhibitors and cage rest before treatment for heartworm disease is implemented. Animals with severe respiratory signs also require stabilisation with oxygen supplementation, anti-inflammatory doses of corticosteroid and anti-thrombotic drugs. The specific adulticidal treatment for ''Dirofilaria immitis'' is melarsomine dihydrochoride, a new generation arsenical compound. Melarsomine is administered
Animals with right-sided congestive heart failure require stablisation with diuretics, ACE inhibitors and cage rest before treatment for heartworm disease is implemented. Animals with severe respiratory signs also require stabilisation with oxygen supplementation, anti-inflammatory doses of corticosteroid and anti-thrombotic drugs. The specific adulticidal treatment for ''Dirofilaria immitis'' is melarsomine dihydrochoride, a new generation arsenical compound. Melarsomine is administered
intramuscularly into the epaxial, and pressure should be applied during and after needle withdrawal<sup>3</sup>. A "graded-kill" protocol is recommended: an initial injection is followed one month later with two injections at an interval of 24 hours, given on opposite sides<sup>1-4</sup>. This spreads the killing effects over two treatments, with an aim to reducing the occurence of thromboembolism after parasite death. Cage rest and anti-inflammatory doses of corticosteroids in the week following melarsomine treatment can also reducce the likelihood of pulmonary thromboembolism. Adulticidal treatment may be declined by the owner, owing to the risk of thromboembolism. Alternatively, it may not be possible to implement adulticidal treatment if the patient is suffering renal or hepatic failure<sup>3</sup>. In these cases, is declined by the owner,
intramuscularly into the epaxial, and pressure should be applied during and after needle withdrawal<sup>3</sup>. A "graded-kill" protocol is recommended: an initial injection is followed one month later with two injections at an interval of 24 hours, given on opposite sides<sup>1-4</sup>. This spreads the killing effects over two treatments, with an aim to reducing the occurence of thromboembolism after parasite death. Cage rest and anti-inflammatory doses of corticosteroids in the week following melarsomine treatment can also reducce the likelihood of pulmonary thromboembolism. Adulticidal treatment may be declined by the owner, owing to the risk of thromboembolism. Alternatively, it may not be possible to implement adulticidal treatment if the patient is suffering renal or hepatic failure<sup>3</sup>. In these cases, monthly administration of prophylactic doses of ivermectin
monthly administration of prophylactic doses of ivermectin
is a reasonable treatment option, as it prevents further infection and may kill some adult nematodes<sup>2</sup>.
further infection and may kill some adult nematodes.
Even low grade infections in cats may result in pulmonary thromboembolism with adulticidal treatment. Because of this, symptomatic treatment of sick cats may be followed by surgical or catheter-based extraction of nematodes once the patient is stable<sup>3</sup>. Stablisation is similar to that for feline asthma, and can include cage rest, oxygen supplementation, bronchodilators (e.g. theophylline), tapering doses of prednisolone, and balanced fluid therapy if indicated<sup>3</sup>. Heartwoms have a much shorter life-span in cats, and spontaneous remission is seen in some cases. Regular monitoring may therefore be the best course of action in clinically well cats.
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Patients with severe caval syndrome may benefit from
Patients with severe caval syndrome may benefit from
physical removal of worms from the right side of the
physical removal of worms from the right side of the
No drugs are specifically approved for microfilaricidal treatment of ''Dirofilaria immitis'', and successful elimination of adult worms should results in the demise of circulating microfilariae four to six weeks later<sup>2</sup>. Single doses of ivermectin, milbemycin oxime, moxidection or selamectin are, however, effective at removing microfilariae from the circulation. The sudden death of large numbers of microfilariae may invoke an anaphylactic response, and oral prednisolone may be administered with microfilaricides to help prevent this.
No drugs are specifically approved for microfilaricidal treatment of ''Dirofilaria immitis'', and successful elimination of adult worms should results in the demise of circulating microfilariae four to six weeks later<sup>2</sup>. Single doses of ivermectin, milbemycin oxime, moxidection or selamectin are, however, effective at removing microfilariae from the circulation. The sudden death of large numbers of microfilariae may invoke an anaphylactic response, and oral prednisolone may be administered with microfilaricides to help prevent this.