Kramer L, Crosara S, Gnudi G, Genchi M, Mangia C, Viglietti A, Quintavalla C
Department of Veterinary Science, University of Parma, Parma, Italy.
Department of Veterinary Science, University of Parma, Parma, Italy.
Vet Parasitol. 2018 Apr 30;254:95-97. doi: 10.1016/j.vetpar.2018.03.005. Epub 2018 Mar 9.
Melarsomine dihydrochloride (Immiticide®, Merial) is the only approved adulticidal drug for the treatment of canine heartworm disease (HWD). However, in cases where arsenical therapy is not possible or is contraindicated, a monthly heartworm preventive along with doxycycline for a 4-week period, which targets the bacterial endosymbiont Wolbachia, might be considered. There are published reports on the efficacy of ivermectin and doxycycline in both experimentally and naturally infected dogs, but no data on the use of other macrocyclic lactones (MLs) with a similar treatment regime. Preliminary results of studies in dogs show that a topical formulation of moxidectin, the only ML currently registered as a microfilaricide, is also adulticidal when combined with doxycycline. It is not yet known if the efficacy of these combination therapies is due to pharmacokinetic synergism. A recent study showed that serum levels of doxycycline in dogs treated with the combination protocol were not statistically different compared to dogs treated with doxycycline alone. However, lungs from dogs treated with the combination therapy showed a marked reduction in T regulatory cells, indicating that treatment efficacy may be due to a heightened immune response against the parasite. Further studies are necessary to evaluate the long-term clinical outcome of combination protocols and to establish the most efficient treatment for HWD in dogs.
盐酸美拉索明（Immiticide®，梅里亚公司生产）是唯一被批准用于治疗犬心丝虫病（HWD）的杀成虫药物。然而，在无法进行砷剂治疗或砷剂治疗存在禁忌的情况下，可以考虑每月使用心丝虫预防药物，并联合使用强力霉素治疗4周，强力霉素可靶向细菌内共生菌沃尔巴克氏体。关于伊维菌素和强力霉素在实验感染和自然感染犬中的疗效已有发表的报告，但尚无关于使用其他大环内酯类药物（MLs）采用类似治疗方案的数据。对犬的研究初步结果表明，莫昔克丁的一种局部用制剂（目前唯一注册用于杀微丝蚴的ML）与强力霉素联合使用时也具有杀成虫作用。目前尚不清楚这些联合疗法的疗效是否归因于药代动力学协同作用。最近一项研究表明，与单独使用强力霉素治疗的犬相比，采用联合治疗方案治疗的犬的强力霉素血清水平无统计学差异。然而，联合治疗的犬的肺部T调节细胞显著减少，这表明治疗效果可能归因于针对寄生虫的免疫反应增强。有必要进一步研究以评估联合治疗方案的长期临床结果，并确定犬心丝虫病最有效的治疗方法。
