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Dr. Kara
Dr. Kara, Veterinarian
Category: Dog
Satisfied Customers: 16331
Experience:  Over 20 years of experience as a veterinarian.
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Hi my dog has an infected ear she has had numerous tablets

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Hi my dog has an infected ear she has had numerous tablets etc from our vet but none of them work for very log she is a 3 year old Labrador and I'm told it could be an allergy she has had apoquel but that has stopped working I'm at the end of my tether with it now any advice would be really appreciated
Submitted: 3 years ago.
Category: Dog
Expert:  Dr. Kara replied 3 years ago.
Hello, my name is***** and I have over 20 years of experience as a veterinarian. I am so sorry to hear about Annie's itchy repeated ear infections. I understand that this is frustrating for you and very uncomfortable for your girl.

Ear infections are often related to allergies, either food allergies or inhaled allergies. If we don't treat the underlying allergies it is likely that the ear infection will return.

However are we sure that her original infection completely cleared? Sometimes an infection will look cleared just by looking but infectious agents still linger and if we stop without checking an ear cytology to make sure she is cleared the infection can return quickly after treatment because it was never truly gone. I recommend checking a cytology and then if negative treating for another 5 to 7 days to make sure.
If cytology hasn't been done then it is absolutely necessary. There are some bacterial ear infections that are very difficult to resolve, for example pseudomonas infections, without a long, tailored protocol of treatment. These infections are resistant to our commonly used medications and thus won't respond.

Food allergy is very possible with her as food allergic dogs often have very itchy ears, which produce more wax then usual and are inflamed setting up a perfect environment for an infection. Dogs can develop allergies to any protein or carbohydrate so even if she is only fed one thing that can be what she is allergic to. Dogs with food allergies tend to lick and scratch their paws, face and ears the most, but any of the "allergy reactive areas" can be affected, and sometimes the only symptom can be repeated ear infections.
I don't know if you've tried any diet restrictions other then a chicken free diet, but often the pet store hypoallergenic or low allergen diets are not restrictive enough. You could try a true hypoallergenic diet like Hills z/d or Purina Veterinary Diets HA. No treats, flavored medication or bones while on the diet and it must be used for a least 12 to 16 weeks to see the full effects. Most clients do report some improvement in 8 weeks.

If her ears and skin seem to worsen seasonally then her allergies can be inhaled (like grass pollen, dust mites or molds) and you can use a combination of antihistamines and high doses of omega-3 fatty acids to help with those (they also help with the symptoms of flea allergy). In combination fatty acids and antihistamines work synergistically, much better than either one alone.
You can try:
1)Benadryl (diphenhydramine only don't use the combination products with decongestants or acetaminophen as they can be toxic to dogs) at 0.5mg to 1mg per kilogramof body weight or one 25mg capsule per 7 to 12 kilos of body weight orally every 8 hours.
OR 2)Claritin (loratidine) at 5mg per 12 kilos of body weight once or twice daily.
OR 3)Hydroxyzine at 0.5mg per kilogram of body weight orally every 8 hours.
OR 4) Chlorpheniramine at 4mg to 8mg per dog once or twice daily.
Some dogs do better on one antihistamine rather than another.
Give the one you choose a week trial and if it isn't working try another. Be aware antihistamines can cause sleepiness or hyperactivity in some dogs. These side effects do wear off with repeated use.
Omega-3 fatty acids are fish oil products. 3V by DVM or Derm Caps ES are good brand name products. Use the high end of the dosing schedule for your pup's weight. I recommend an omega 3 fatty acid dose based upon the EPA portion (eicosapentanoic acid) of the supplement as if we do that the rest of the supplement will be properly balanced. Give her 20mg to 40mg of EPA per kilogram of body weight per day. For example an 40 kilogram dog could take 800mg to 1600mg of EPA per day.

I also recommend using a gentle ear cleaner twice a week minimally even when there are no signs of infection. This removes excess wax and keeps the ear pH at levels that discourage infections. It also allows you to know what a normal ear looks like and catch ear infections very early. Sometimes with an early infection simply cleaning the ear daily is enough to stop it in its tracks. Ideally keep the hair plucked out of her ears to keep wax from getting caught and allow air to circulate in the ear.

If these steps aren't enough to control ear inflammation sometimes I will use a topical ear anti-inflammatory such as Synotic 2 to 3 times as week to prevent inflammation and the resulting ear infection.

Please feel free to respond with further questions.
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