Updated Hookworm Protocol

Hookworm image courtesy of the NIH Public Health Image Library #5205 and in the public domain. Used by permission.

Recently, I wrote about treatment of medication resistant hookworms in former racing greyhounds. Since that article was published, new research has been published and American Animal Hospital Association recommends a new treatment protocol. I’ll describe the new protocol after the break.

References

In this blog post, Dr Couto, DVM summarizes the new research and currently recommended protocols. Following Rocky’s new patient exam, Dr. Oberlander researched medication resistant hookworm treatment and located the new protocol. This is a refreshing change from my “all dogs are the same” former practice.

[5] is an update of the Dr. Ng, DVM article considering the findings of the research published last fall. In it she gives the maintenance protocol.

The Treatment Protocol

The treatment protocol is a monthly protocol that administers medication at the beginning of the month and checks the stool for hookworm eggs and antigens at mid-month.

Day 1: Treat with Drontal XL
Day 2: Treat with Advantage Multi
Day 15: Test of stool sample for hookworm antigens

The termination criteria is a number of consecutive months of hookworm negative samples. Once the termination criteria is achieved, a maintenance protocol commences.

In the past, it was commonplace to administer Drontal for intestinal parasites and “one and done.” There was no followup test as it was assumed that the medication would kill all of the larvae and that all of the eggs would be eliminated before they could hatch. We now know better. “Larval leak” is the term of art for hookworm larvae that hang out in the tissue and emerge when gut activity level drops. Treatment must be continued until larval leak re-infestation stops.

Fecal Antigen Testing

The IDEXX reference [6] explains the fecal antigen test. The advantage of this test over egg counting is that it detects larvae hiding out in tissue. When this test is clear for several cycles, all the leakers have been cleaned up. This is an outside test that is more sensitive than the in-house antigen test also offered by IDEXX. It’s cost is on the order of $100.

Interestingly, IDEXX offers a home collection kit with prepaid mail-in testing saving a trip to the vet. This is very similar to the mail in fecal colon cancer screening in common use in the US. The test antigens differ of course but the collection and shipping are similar.

Importance of Sanitation

In addition, the dog garden must be kept clean to protect uninfected dogs in the household and any children playing in the dog garden. That means a daily pick up. Poo leak is a thing. You’ll be amazed at the number of dried poo hiding in the dirt. Walk the whole dog garden every day.

The Maintenance Protocol

The maintenance protocol consists of monthly administration of Advantage Multi which covers heartworm, hookworm, roundworms, and fleas. The surveillance interval is increased. Normally yearly but this seems a bit long for a just cleared canine.

Flea Allergy

Flea bites provoke flea allergies. The systemic flea controls such as Advantage Multi require a flea to bite the animal which initiates the allergic reaction. Animals sensitive to flea bites should be treated with a topical agent that remains on the skin and coat. Anecdotal reports on dog Twitter are that Bayer Sorento collars are working well for the flea allergic dogs that reported in.

Ticks

This protocol does not prevent tick bites or ticks in residence. An additional product is needed . I prefer to use a tick control to manage deer ticks which, because they are small, may be missed in a normal inspection. Two are working well, Bravecto, a systemic, and Bayer Sorento, a topical continuous release product from a collar. Both are well regarded. Sorento will prevent biting. Bravecto will kill the tick before disease transmission occurs.