Please look at http://www.dermapet.com to see our many updates, Protocols including the popular TrizEDTA Bacterial Otitis Protocol (Step 6 in the SEVEN Steps to Treating Ears as described in detail in this Newsletter), the Pruritic Clinical Trial, previous Newsletters and articles. THE NEW BROCHURE IS ON LINE.
This newsletter, in an article by Lou Gotthelf, will address the need for alternative protocols now that Gentamycin and thus Otomax, has been pulled from the market. Many generics are already rumored to be on the market. One must wonder if the gentamycin source for the world's biggest supplier is no longer available then how is it that others are finding a source? Would not Schering also have the same sources available? Is it possible that the FDA has regulated the market leader and hoped the rest of the market would voluntarily self regulate? Of course, some will say, this is written by the only other source of a published (in-vivo and in-vitro) and market proven product that is effective against Malassezia otitis, the acetic/boric acid Ear/Skin Cleanser. And, we have the TrizEDTA to facilitate your Pseudomonas protocols.
Please go to http://www.dermapet.com or call 800-755-4738 for DIRECT sales. We also sell via select distributors such as Burns (http://www.burnsvet.com), Columbus Serum (http://www.columbusserum.com), NLS (http://www.nlsanimalhealth.com), MWI (http://www.mwivet.com), Penn Vet, PVP, Merritt, Premier, R. Weinstein (Hawaii), TW Vet Supply, Vet Med Supply and Vetpo. We now can provide you a dominant distributor anywhere you may be in the USA (including Alaska and Hawaii). We are also available in Japan, Thailand, Taiwan, Korea, Hong Kong, Central America and soon in Europe.
We hope to see you at the Penn SCAVMA meeting on Economics on 3/30 in Philadelphia. and/or the AAVD meeting in Norfolk from 4/4-8. In Norfolk on Thursday night please come to the DermaPet and MedRx Wine Social (Serving Rosenblum wine).
GENTAMYCIN NO MORE
Lou Gotthelf
According to reliable sources at Schering Plough Animal Health, their supply of gentamycin has dried up. There is some problem with the FDA and the manufacturer of gentamycin in China. For information on this import ban go to http://www.fda.gov/ora/oasis/7/ora_oasis_c_cn.html
What does this mean? NO MORE OTOMAX, MOMETAMAX or GENTOCIN OTIC.
So it is important to rethink how we can treat Malassezia without Otomax. For those of you that still believe that clotrimizole is effective against Malassezia, Lotrimin and Lotrisone will still be available. I personally do not have much faith in this topical antifungal. I recommend a daily cleaning with DermaPet Ear/Skin Cleanser for a week to 10 days and then as an astringent preventative once weekly. I have had terrific success with this protocol for over 6 years on literally thousands of ear cases. This treatment is in addition to uncovering the cause of the ear disease, such as atopy, food hypersensitivity, hypothyroidism, etc. On rare occasions, when the ear canal is stenotic and Malassezia is found on ear cytology, I will prescribe ketoconizole orally for 10 days at a dose of 10mg/kg (one 200mg tablet for 44 lbs. once daily).
My first line drug for treating Pseudomonas otitis externa has been gentamycin. However, I have found that either tobramycin or amikacin are also very effective first line aminoglycosides to use. I would recommend holding off using Baytril Otic until the culture shows that the Pseudomonas is resistant to gentamycin, tobramycin or amikacin, but sensitive to enrofloxacin. In addition, when rods are present on cytology, I also use the TRIZEDTA as a pre-treatment 5 minutes before instilling the antibiotic. At a pH of 8.0, Tris-EDTA seems to increase the effectiveness of the aminoglycoside and fluoroquinolone antibiotics.
Editor's note: Even with Otomax, the acknowledged market leader up to this point in treating otitis, available it still would be ototoxic to any dog or cat with a ruptured tympanum. Amikacin, another aminoglycoside, is also ototoxic. The reader should look at the Seven Steps to Ear Therapy at http://www.dermapet.com to learn more about alternative protocols for treating Malassezia and bacterial otitis externa and media.
Chlorhexidine is perhaps the most common cause of ototoxicity. BEWARE of the recent introduction of chlorhexidine containing "flushes" that do not mention use in the ear or even mention the word ear on the label. These should not be used in the ear or marketed for such use. Remember that chlorhexidine can not be used even if there is an intact tympanum as it crosses membranes.
New Products
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Ohio
My airport delay was shortened by conversation with Ray Kersey, Saunders publisher, who also offered me a ride to the convention center. The DermaPet booth and the convention center were alive with the buzz about our new DermaPet trade show rep, Stacey Melman. Stacey gained the confidence of super-reps Nic Miller, Jeff Houk and Bubba Lichtenburg and the Peterson (Craig, Bob and Bruce) clan from Columbus Serum (CSC) , who we are happy to announce as our latest distrbutor. Brian Bollensof CSC is the brother of my classmate Ken (Pittsburgh) and uncle of my daughter, Jessica's classmate, Ken (PENN '03). Thank you to Big Donn Griffith, Alternative Therapy VIN monitor who bought most of our the products that we had left over for a real bargain.
Lynette Cole was gratious in her comments on our products, in particular TrizEDTA , our Ear/Skin Cleanser and the MalAcetic line.
San Antonio, AAHA
TERESE DeMANUELLE braved through the flu and lectured on the right way to treat Malassezia dermatitis and otitis and again had kind remarks about our products.
One of the favorite new books was HOSKINS and WHITFORD'S new book on FIRST CHOICE PROTOCOLS with a CD-rom from AVLS at 800-444-3634 (ask for the DermaPet special). I REALLY like many of their Derm and Ear protocols. Of course, I wrote many of them.
ALAN GARETT of http://www.ihatealangarett.com was again with us. Those of you know Alan know how entertaining he can be.
Houston/MedRx seminar
I stopped in to visit a sold out seminar in Houston on Sunday, March 18. Assisting Lou Gotthelf were his son, Gabe, Kenny Keith, Jeff McLaughlin and Chris Perry. Writer/vet Jim Humphreys was there.
MedRx is offering CE doing their EAR Seminars on the road next in Chicago on March 25, ATLANTA on April 8, PHOENIX on April 22, TAMPA on April 29, SAN FRANCISCO on May 13. . Be there to hear LOU GOTTHELF teach you the latest, state of the art otology. Ears represent the #1 complaint of pet owners to vets (VPI insurance claims, 2000). Call Kenny Keith at 888-392-1234 to register or find out when one is coming near you.
Malassezia and Bacterial Otitis PROTOCOLS While it is true that the acetic/boric acid products have efficacy against Pseudomonas, they are actually FIRST LINE topical treatment while the TrizEDTA (Step 6) remains the best protocol for treatment after the acetic/boric acid is used using Step 3b or Step 4 (See the Seven Steps to Treating Ears under Protocols at http://www.dermapet.com). BOTH OF THESE PRODUCTS CAN BE USED IF THERE IS A RUPTURED TYMPANUM.
For more details on this look at previous (12/00, 1/01 &2/01) Newsletters. We will be focusing on Bacterial Otitis and Step 6 in this Newsletter. The entire text for the Seven Steps to Treat Ears is available at http://www.dermapet.com.
RECENT RESEARCH by Dr. Louis GOTTHELF and SULIMAN GBADAMOSI (Tusk, Micro Dept) indicate that there is no need to wait 15 minutes after instilling TrizEDTA to use antibiotics. In fact, when testing samples that were previously reported as resistant to flouroquinolones (using MICs), eight dilutions of our stock TrizEDTA were required to not inhibit growth. This indicates that the TrizEDTA is bactericidal by itself.
Step 6.
1.Orbafloxin (Dicural/Ft Dodge) Marbofloxin (Xenoquin/Pfizer) or Baytril (Bayer) systemically for at least 21-60 days.
From Lou Gotthelf
For those of you wanting to know how much Baytril to give a patient orally, you need to know the MIC of the organism. The rule of thumb is that you want a tissue level of Baytril to be 8 times the MIC. You can find tissue levels in the package insert for Baytril. Based on the tissue level, you can figure out how many mg/kg you will need to administer to your patient. Are you OK with 5mg/kg or do you need to use 20mg/kg?
Most labs do not give you this information, only if it is sensitive, intermediate, or resistant. If you want to know the endpoint MIC for your intermediate or resistant Pseudomonas, please send the specimen and a check for $12.00 to Dr. Sulaiman Gbadamosi, Tuskegee University, School of Veterinary Medicine, Tuskegee, Alabama 36088. He will do the endpoint MIC for you.
2.Clean with TrizEDTA twice daily.
3.Approximately 15 minutes after each cleaning, instill Baytril in either a TrizEDTA GEMISH (12 ml of TrizEDTA and 50-200 mg of Baytril injectable) or diluted with saline. Some people use aminoglycosides even though they are ototoxic.
4. For the first 14 days, I would use systemic prednisone at 1 mg/kg IF OM is diagnosed. The rationale is to decrease the inflammation, mucous secretion from the mucoperiosteum, pain and viscosity of the exudate in the tympanic cavity.
5.If OM is diagnosed, I would anesthetize and, with visualization, flush the ear with TrizEDTA and directly instill Baytril and NaDex phosphate into the tympanic bulla. If th tympanum is present and OM is suspected then I would do a myringotomy. The location of the myringotomy should be ventral. Maintenance therapy would include biweekly TrizEDTA cleansing longterm. Some people recommend our acetic/boric acid Ear/Skin Cleanser instead since it has activity against Pseudomonas as well as Malassezia.
Remember: Do NOT be misled by various forms of misinformation as to why certain companies do not use boric acid with acetic acid. The reality is that DermaPet holds a patent on this combination.
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JOB OPPORTUNITY
If you are looking to be our rep in Texas (Southwest) or California (West Coast) and do not work for one of our distributors then please contact us. DermaPet IS the largest veterinary dermatologic company in virtual reality and the fastest growing. Our Newsletter list, now approaching 12,000 is the largest in the industry with another 7,000 posted indirectly and countless more that read it reposted in newsgroups or lists. Those who receive this newsletter and wish to pass it along to colleagues, please do.
And from out good friends at VIN:
"Don't forget to look for DermaPet as a Featured Company on VIN's Industry Partners Site, an electronic exhibit hall providing 6,000 plus VIN members and all online veterinarians, access to current information from over 900 companies, manufacturers and distributors of the products and services they use daily.
| Steven Melman VMD DermaPet Animal Dermatology and Behavior Clinics Potomac, MD 20854 |
dermapet@aol.com http://www.dermapet.com 800-755-4738 fax 301-365-0191 |
8909 Iverleigh Court 
Potomac, Maryland 20854
301-983-8387 800-755-4738 Fax 301-365-0191
E-mail dermapet@aol.com