Oral fluralaner treatment in a dog with desperate demodicosis: A case report

A 10-year-old castrated male Shih-tzu dog presented with a history of generalized demodicosis, refractory to conventional therapy with ivermectin and amitraz for a year. The patient was also diagnosed with concurrent deep pyoder-ma, Malassezia dermatitis, and otitis externa. Treatment with amoxicillin-clavula-nate, antifungal drugs (itraconazole, miconazole), and milbemycin oxime resulted in a good response for 90 days. Approximately 4 months later, the first relapse of demodicosis occurred and the miticidal therapy was changed to ivermectin. Additional diagnostic tests were performed to investigate an underlying cause for the recurrence of demodicosis, and endocrinopathies and allergic dermatitis were excluded based on the results. Although ivermectin therapy was sustained for 440 days, a second relapse occurred and amitraz baths were added to the therapy. Despite this therapy, the demodicosis persisted, and the miticidal therapy was changed to oral fluralaner, which led to rapid resolution. Demodicosis did not recur again before death approximately 920 days after administration of oral flu-ralaner. This case report describes the complete resolution of refractory demodico-sis using oral fluralaner in a dog.