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Tuesday, February 15, 2011

Best Heartworm/Flea Preventatives?

Krissy, a veterinary student at UC Davis, sent me this question last week.

Thanks again for your insight on your blog, I really enjoy reading. Today we had a rep (a vet) from Bayer (the company that sells advantage) and they said there was this study and that only THEIR heart worm/flea preventative (Advantage Multi) was the only one that prevented heart worm in 8 out of 8 dogs. Very interesting, you can see the info just released this past month.
I understand this is a very small data sample, but of course they wanted to have to infect and kill as few dogs as possible. I also know that different products are better than others depending on the situation, like some permethrin tick preventatives are toxic to cats. I think it is difficult as a consumer to understand which product is the best on the market and most cost effective (in this economy). I have found some info on the internet, and in a clinic I worked in previously we primarily used Frontline and Revolution. But I was wondering if you would share your personal thoughts on this topic. If you would like of course! 

Krissy, you'll find that this is a complicated topic, and every pharmaceutical company can present hard data on why THEIR product is better than their competitors.  So you can't completely go by what the reps say, as their job is to convince you to use their product over all of the others.  That doesn't mean that they're wrong or deceptive.  You just have to understand their perspective and reasons for communicating.

I wasn't familiar with the data in the article so it was an interesting read.  I am very familiar with Dr. Blagburn, and have heard him lecture several times as well as have spoken to him personally at a conference.  I have a lot of respect for his opinions and research, and overall trust his judgment.  However, besides the small sample size remember that this was also a laboratory setting.  Real-world data may be different.  So while Advantage Multi may be a good product, I wouldn't use this one study to prove that it's the best product on the market.  Lastly, one of the problems facing parasitologists is the increasing data showing likely resistance of certain populations of heartworms to current preventatives.  I foresee this being a big problem within a decade or so.

Now you asked my opinion, and I'm happy to give it.  But remember that this is my personal opinion.  Yes, it's based on all of the data I've come across, as well as lectures by Dr. Blagburn and others, personal experience, and information gleaned from journal articles.  I certainly don't consider myself an expert in this area, and I'm sure my views can be contested by others.

Heartworm prevention:  Personally I really like Proheart.  Studies have shown that it's just as safe as any other prevention on the market, and it's had limited enough use that I'd be surprised at any resistance.  What I really like is the fact that it's not dependent on the client remembering to give a pill or apply a product every month.  Twice annual injections (once annual in some countries) and you're covered.  I still think the ivermectin-based preventions (Heartgard, Iverhart, etc.) are effective for most pets.  I worry that topical products like Advantage Multi and Revolution can be made less effective by frequent bathing and other factors, though admittedly those are not going to be common situations.  I haven't seen evidence that one prevention completely overwhelms the others.  In my practice we use Proheart 6, Revolution, and an oral ivermectin preventative.

Flea prevention:  There are a lot of strong opinions on this topic.  For my first choices I really like Comfortis and Vectra (sold under the brand FirstShield at Banfield Pet Hospitals....same product, different names), each for different reasons.  My views are based on discussions with Dr. Blagburn (and some pointed questions to him a few years ago) and local dermatology specialists.  I think that the Bayer products (Advantage, K9 Advantix) are still good and I do think they are worthwhile choices.  I haven't been a fan of Frontline for many years.  I also don't like Program/Sentinel, as it doesn't actually kill fleas.

Krissy, I hope this answers your questions.  As flea season is beginning soon, this is a good reminder of the importance of these products.