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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Cat Veterinary
Satisfied Customers: 28439
Experience:  University of California at Davis graduate veterinarian with 45 years of experience.
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My cat started with a bad ear infection that I treated with

Customer Question

My cat started with a bad ear infection that I treated with an ivermectin mixture. After another inspection, the veterinarian found a yeast infection that resulted from the ivermectin. At first I was using Tresaderm. The tresaderm started on 9/6/15 and
was prescribed for twice per day for 10 days. The veterinarian also told me to do it once a day for 10 more days if her ears are still dirty. So I had the ears checked at another veterinarian because this one was closed for for a couple of days. She does seem
to be acting a lot better, shaking her head less, and still performing everyday functions alright. The other veterinarian said she still had a yeast infection. She suggested ketoconazole for a couple of weeks, but told me she was wanting to give me a supply
that was good enough for 60 days. She said I could stop when there was no more yellow looking discharge and yucky ears. So I am at a loss of what to do. Should I continue the tresaderm for the 8 more days to see if it clears up before committing to the ketoconazole?
I've heard that ketoconazole can result in hepatic toxicity. What is your opinion?
Submitted: 1 year ago.
Category: Cat Veterinary
Customer: replied 1 year ago.
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Expert:  Dr. Michael Salkin replied 1 year ago.

I regret that I'm not allowed to communicate with customers by phone. The use of ketoconazole in cats is controversial. Most of us recommend that it not be used in cats because of its toxic potential. Fluconazole or itraconazole should be considered in its place. For severe refractory yeast otitis externa or otitis media (outer ear or middle ear infection) in addition to topical antifungal treatment such as the Tresaderm, systemic antifungal therapy may be helpful if administered for at least 3-4 weeks and continued 1-2 weeks beyond complete clinical cure. Fluconazole at 5 mg/lb daily with food or itraconazole at 5 mg/lb daily with food is recommended. Please respond with further questions or concerns if you wish.

Customer: replied 1 year ago.
Hello, do you suggest that I ask my vet for Fluconazole instead? I did already purchase the Keta, but did not know and was not told of the toxicity effects. I haven't used any of it yet.
Expert:  Dr. Michael Salkin replied 1 year ago.

Yes, I would request that the ketoconazole be replaced with fluconazole or itraconazole. You're likely to find fluconazole more cost-effective.

Customer: replied 1 year ago.
Thank you - just one more question, why did the tresaderm not work and do you think it will take the remaining days that the vet suggested for it to finish ridding my cat of the infection?
Expert:  Dr. Michael Salkin replied 1 year ago.

The thiabendazole in the Tresaderm should have effectively addressed Malassezia (yeast). Perhaps the dose has been too small or it hasn't been able to reach the lining of the ear canal because too much exudate remains in the ear canal. It can, however, take 3-4 weeks of therapy for any of the antiyeast drugs to be completely effective. Please continue our conversation if you wish.