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Drug-Resistant "Super Heartworms" Force Change In Treatment

Reviewed by Dr. Melissa Beall, DVM, PhD on Thursday, September 10, 2015
Posted July 31, 2013 in A Vet's Life

For more from Dr. Ernie Ward, find him on Facebook or at www.drernieward.com.

Most of us are familiar with news stories describing how certain bacteria have become resistant to previously life-saving antibiotics. Now we have drug-resistant parasites, as in a newly discovered strain of super heartworms.

Heartworms are a leading cause of death in dogs and cats in the US. Heartworm disease is transmitted by the bite of infected mosquitoes. For the past few years, veterinary researchers have been tracking a particularly tough strain of heartworms in the mosquito heaven known as the Mississippi River Valley region. Dogs in this region have been reported to develop heartworm infection despite using preventives.

Puppy Close UpIt turns out there’s a new strain of super heartworms that have evolved to be increasingly resistant to the most common heartworm preventive drugs – macrocyclic lactones (ML). This class of drugs includes all of the major active ingredients of heartworm preventives - ivermectin, selamectin, milbemycin oxime and moxidectin.

The good news is that our existing drugs still easily prevent the vast majority of heartworm disease. In fact, research proves that by administering a monthly preventive as prescribed, even the Mississippi River Valley, mutant super heartworms can be defeated. As long as the drug is given every month, even these super heartworms can’t cause infection. The problem is many pet parents forget a dose or two. Missing even a dose could be enough for these super-heartworms to cause an infection in an unprotected dog or cat. Monthly preventives and yearly testing is your best – and only – defense against this deadly disease.

In addition to increasing the importance of not missing a monthly preventive and having your dog tested for heartworm disease once a year, there have been big changes in how heartworm disease is treated. For the past several years there’s been a gradual increase in the number of heartworm-positive dogs treated using the “slow-kill” method. For the record, I’ve never recommended nor trusted this regimen. In short, the “slow-kill” technique involves giving only an ML preventive in an attempt to kill adult heartworms. This technique is cheaper, easier, and not as risky as traditional treatment using injectable Immiticide (melarsomine dihydrochloride). Unfortunately, it also doesn’t work in many cases. The latest recommendations for treatment advise veterinarians to discontinue this treatment approach.    

Researchers are concerned that not only is “slow-kill” ineffective, it may also increase the

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Ernie has more than 20 years of experience in the veterinary industry and is a well-known veterinarian, media personality and author. He is also a founding member of IDEXX’s Pet Health Network team.

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The opinions and views expressed in this post are those of the author's and do not necessarily represent the beliefs, policies or positions of all veterinarians, Pet Health Network, IDEXX Laboratories, Inc. or its affiliates and partner companies.