What is the current treatment protocol for generalized demodicosis in dogs?

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Isoxazolines are first-line treatment for canine generalized demodicosis, with fluralaner, sarolaner, and afoxolaner all demonstrating >98% mite count reduction within 56–84 days of monthly oral dosing.13 Treatment should continue until two consecutive monthly skin scrapings are negative for live mites, then extended for an additional 2 months beyond that endpoint to prevent recurrence.4 Deep skin scrapings of the same sites performed monthly remain the monitoring standard throughout treatment.4 Fluralaner (oral, 25–56 mg/kg) administered at the labeled flea/tick dose achieves 98.9% mite count reduction by day 28 and eliminates mites from skin scrapings by day 56 in all treated dogs.5 In a large field trial, parasitological cure — defined as two negative skin scrapings one month apart — was achieved in 81% of adult-onset cases by 2 months and 100% by 4 months, and in 81% of juvenile-onset cases by 2 months and 100% by 3 months, with no adverse effects observed.9 A single oral dose of fluralaner (25–50 mg/kg) successfully eliminated generalized demodicosis in 66 of 67 dogs with adequate follow-up.8 A single oral or spot-on fluralaner treatment was also evaluated against imidacloprid-moxidectin in a European field study, with treatment considered efficacious when >90% of dogs were free of live mites at both days 56 and 84.12 Sarolaner (oral, 2–4 mg/kg monthly) achieves parasitological cure in 92.9% of dogs after three monthly treatments and 100% after five monthly treatments.10 Mite counts are reduced by 77.2% on day 30, 95.0% on day 60, 98.5% on day 90, and 99.0% on day 120, reaching 100% by days 150 and 180.10 Affected body surface area decreases by 94% with sarolaner versus 72% with imidacloprid-moxidectin.10 The combination product sarolaner + moxidectin + pyrantel (SMP, monthly oral) reduces mite counts by 88.8% on day 14, 99.2% on day 29, and eliminates all live mites by day 42 in laboratory conditions; in field conditions, 100% mite elimination is achieved by d