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Pyrantel pamoate resistance in horses
receiving daily administration of pyrantel tartrate
Emily L. Brazik, DVM; Jan T. Luquire, DVM; Dianne Little, BVSc, MS, DACVS
Case Descriptions—16 horses treated daily with
pyrantel tartrate (2.64 mg/kg [1.2 mg/lb], PO) as part
of a prophylactic anthelmintic program.
Clinical Findings—Fecal worm egg counts (FWECs)
were obtained on all 16 horses. Mean FWEC was
478 eggs/g (epg; range, 0 to 4,075 epg). Three of the
16 horses were responsible for 85% of the total fecal
egg output for the herd on the day of sampling. Six
horses had FWECs < 200 epg. Three horses that had
arrived within 4 months of the sampling date had
FWECs < 100 epg.
Treatment and Outcome—An FWEC reduction test
was initiated the day after FWECs were obtained; all
horses with FWECs > 100 epg (9 horses) were treat-
ed with pyrantel pamoate (6.6 mg/kg [3 mg/lb], PO),
and 14 days later, the FWEC was repeated. During the
14-day period, all horses received pyrantel tartrate
(2.64 mg/kg, PO) daily. Fecal worm egg count reduc-
tion was calculated for each horse. Mean FWEC
reduction for the group was 28.5% (range, increase
of 21% in FWECs 14 days after treatment to a
decrease of 100% in FWEC 14 days after treatment).
Clinical Relevance—Farms should be monitored for
cyathostomes resistant to pyrantel pamoate prior to
use of pyrantel tartrate. Fecal worm egg counts should
be monitored routinely in horses before and after treat-
ment to ensure efficacy of cyathostome control mea-
sures. (J Am Vet Med Assoc 2006;228:101–103)
E ffective control of strongyles, particularly cyatho-
stomes, is becoming increasingly difficult in horses as
anthelmintic resistance becomes more commonly recog-
nized. Only 3 drug groups, the benzimidazoles, aver-
mectins, and pyrantel salts, have efficacy against
cyathostomes. Resistance to benzimidazoles is wide-
spread, and resistance to pyrantel salts is becoming
increasingly common, particularly in the southeastern
United States.1 Resistance to macrocyclic lactones has
not yet been reported. Daily administration of pyran-
tel tartrate at a dosage of 2.64 mg/kg (1.2 mg/lb), PO,
has been promoted as a means to control cyathostome
infection in horses. However, there is concern that this
practice may be associated with development of
cyathostomes resistant to pyrantel pamoate adminis-
tered at a dose of 6.6 mg/kg (3 mg/lb), PO.2 Findings
of the report presented here confirm anthelmintic
resistance to pyrantel pamoate administered at a dose
From Carolina Coastal Equine Veterinary Service, 1286 Hwy 117 N,
Burgaw, NC 28425 (Brazik, Luquire); and Carolina Colic and
Digestive Disease Program, Department of Clinical Sciences,
College of Veterinary Medicine, North Carolina State University,
Raleigh, NC 27606 (Little).
Address correspondence to Dr. Little.
JAVMA, Vol 228, No. 1, January 1, 2006
of 6.6 mg/kg, PO, in adult horses that were treated
with pyrantel tartrate administered prophylactically at
a dosage of 2.64 mg/kg, PO, daily for at least 1 year.
As part of routine veterinary health care, FWECs
of all horses were performed on a farm in which all
EQUINE
horses living on the farm were treated daily with
pyrantel tartrate (2.64 mg/kg, PO) as part of a prophy-
lactic anthelmintic program. The prophylactic
anthelmintic program had been in place for at least a
year; however, the anthelmintic history prior to this
time was not known. All horses had received iver-
mectin (200 µg/kg [91 µg/lb], PO, once) within the last
12 months, but records as to when this treatment had
been given were not available from the farm manager.
Horses were treated with pyrantel tartrate daily and
ivermectin by the farm manager on the basis of esti-
mated body weight; an accurate weight was not
obtained for any horse. Sixteen horses of various ages
(mean age, 10.1 years; range, 6 to 15 years), breeds
(Thoroughbreds [n = 6]; Quarter Horses [3],
Thoroughbred crosses [2]; Mustangs [2]; and 1 each of
Welsh Cross, pony, and Warmblood), and sexes (14
geldings and 2 mares) lived on the farm. Three horses
had arrived on the farm during the preceding 4
months. For part of the day, horses had access to 1 of 5
small paddocks in groups of 2 or 3, with several hors-
es moving regularly between pastures. Feces were not
removed from pastures, and pastures were not har-
rowed on a regular basis.
Fecal worm egg counts were obtained for all 16
horses by use of the McMaster technique with a lower
limit of sensitivity of 25 epg. Mean FWEC was 478
epg (range, 0 to 4,075 epg). Three of the 16 horses
were responsible for 85% of the total fecal egg output
for the herd on the day of sampling. Six of the 16
horses had FWECs < 200 epg. All 3 horses that had
arrived within 4 months of the sampling date had
FWECs < 100 epg. The next day, an FWECRT was
initiated; all horses with FWECs > 100 epg (9 horses)
were treated with pyrantel pamoate (6.6 mg/kg, PO),
and 14 days later, the FWEC was repeated. During
this 14-day period, all horses received pyrantel tar-
trate (2.64 mg/kg, PO) daily. Fecal worm egg count
reduction was calculated for each horse by use of the
following formula:
(FWEC before treatment –
FWEC after treatment/FWEC before treatment X 100)
Results of FWECRT for the 9 horses with FWECs
> 100 epg are depicted (Table 1). Mean FWEC reduc-
FWEC Fecal worm egg count
epg Eggs per gram
FWECRT FWEC reduction test
Scientific Reports: Clinical Report 101
05-05-0238.qxp 12/12/2005 11:00 AM Page 102
Table 1⎯Results of initial FWECs during daily treatment with
pyrantel tartrate (2.64 mg/kg [1.2 mg/lb], PO) and results of
FWECRT 14 days after treatment with pyrantel pamoate (6.6
mg/kg [3 mg/lb], PO), which was administered to 9 horses with
initial FWECs > 100 epg.
Initial FWEC (epg) FWECRT
4,075 36% decrease
200 25% decrease
175 0% decrease
925 21% increase
1,500 8% decrease
275 9% increase
125 100% decrease
275 18% decrease
100 100% decrease
EQUINE
Results expressed as percentage increase or decrease from
initial FWEC.
tion for the group was 28.5% (range, increase of 21%
in FWECs 14 days after treatment to a decrease of
100% in FWEC 14 days after treatment).
Prophylactic use of pyrantel tartrate daily was dis-
continued on the farm after the inefficacy of the con-
trol program was demonstrated. The 3 horses with the
highest FWEC before treatment were treated with fen-
bendazole (10 mg/kg [4.5 mg/lb], PO) once daily for 5
days, and then ivermectin (200 µg/kg, PO) was admin-
istered on day 6. Fecal worm egg counts were obtained
every 2 months for all horses, and horses were treated
selectively with ivermectin if the FWEC was > 200 epg.
Additionally, every horse was treated once yearly with
pyrantel pamoate (13.2 mg/kg [6 mg/lb], PO) for
Anoplocephala perfoliata.
Discussion
On the farm of this report, pyrantel tartrate admin-
istered at a dosage of 2.64 mg/kg, PO, daily did not
adequately control fecal egg output in mature horses.
Additionally, strongyles resistant to pyrantel pamoate
were identified in 7 of the 9 horses tested. Whether this
drug resistance was evident prior to initiation of pyran-
tel tartrate treatment or whether it was induced by use
of pyrantel tartrate cannot be determined. However,
daily administration of pyrantel tartrate was clearly
inadequate for prophylactic control of strongyles on
the farm. On the farm of this report, cyathostomes
resistant to pyrantel tartrate were only detected
because a monitoring program was instituted. If such a
program had not been implemented, it is expected that
cyathostome populations on the farm would have esca-
lated to the point in which clinical larval cyathostomi-
asis would have been identified in some horses living
on the farm, as has been reported previously when a
case of larval cyathostomiasis prompted investigation
of cyathostome drug resistance and identification of
cyathostome populations resistant to both fenbenda-
zole and pyrantel pamoate.3
Cyathostomes resistant to pyrantel have been
described in the southeastern United States and in
Europe.2 Reportedly, in the United States, the preva-
lence of pyrantel pamoate resistance is 20% to 40% in
Georgia,2,4 and on 33% of farms evaluated in Florida,
pyrantel pamoate resistance has been detected.5
Resistance to pyrantel pamoate has also been reported
in Louisiana.6 The mechanism of resistance to pyrantel
102 Scientific Reports: Clinical Report
pamoate appears to be a mutation of the nicotinic
acetylcholine receptor.7 In Georgia, on some farms in
which resistance to pyrantel pamoate has been report-
ed, there was a history of daily administration of pyran-
tel tartrate, suggesting that cross-resistance may devel-
op.2,4 Pyrantel tartrate administered daily at a dosage of
2.64 mg/kg, PO, is marketed for control of recently
ingested third-stage larvae, and both pyrantel tartrate
and pyrantel pamoate administered at a dose of
6.6 mg/kg, PO, are effective against fourth-stage lumi-
nal and adult cyathostomes. Neither drug has efficacy
against encysted cyathostomes.8,9
On the farm of this report, the distribution of par-
asite load among horses (3 of 16 [18.7%] of horses
responsible for 85% of the total egg output) is consis-
tent with the situation in most host-parasite interac-
tions, in which approximately 20% of the hosts con-
tribute approximately 80% of the parasite load10; this
distribution did not appear to have been altered by
daily administration of pyrantel tartrate. An FWECRT
for benzimidazole or ivermectin resistance was not
performed on the farm of this report for financial rea-
sons, but benzimidazole resistance was assumed to be
present, and ivermectin resistance was not assumed to
be present, given that in the United States, benzimida-
zole resistance is generally assumed to be widespread,
but ivermectin resistance has not yet been reported.1
Given the concern regarding development of iver-
mectin resistance, egg reappearance times and FWE-
CRT for ivermectin are being monitored on this farm.
The selective use of an anthelmintic such as iver-
mectin, to which resistance has not yet been reported,
in horses with FWEC > 200 epg on this farm should
decrease selection pressure for resistance by permitting
a proportion of cyathostomes to remain unexposed to
ivermectin and by decreasing the frequency at which
cyathostome populations are exposed to the drug.4,11,12
On the basis of our findings, before use of pyran-
tel tartrate can be recommended for use on an individ-
ual farm, we recommend that all horses undergo an
FWECRT for detection of cyathostomes resistant to
pyrantel pamoate. Furthermore, we recommend that
FWEC be performed for all horses twice yearly to mon-
itor for development of resistance to pyrantel tartrate
and, if failure of treatment efficacy on the farm is
detected by FWEC, that the use of pyrantel tartrate be
discontinued. As part of any monitoring program, pas-
ture and farm management practices should be evalu-
ated to determine if improvements can be made that
will decrease selection pressure for development of
resistance and the level of pasture contamination with
cyathostomes. The efficacy of benzimidazoles and
avermectins should be evaluated by FWECRT, and egg
reappearance times should be monitored for aver-
mectins. A cyathostome control program based on
selective treatment of individual horses should be ini-
tiated to decrease the risk of clinical disease in individ-
ual horses and the risk of development of cyathos-
tomes resistant to other drug classes on the farm.
Failure to monitor FWEC in horses treated daily with
pyrantel tartrate may result in failure to detect cyathos-
tomes resistant to pyrantel salts; breakdown of the con-
trol program in place on the farm; and, ultimately, sub-
JAVMA, Vol 228, No. 1, January 1, 2006
05-05-0238.qxp 12/12/2005 11:00 AM Page 103

clinical or moderate to severe clinical signs of cyathos-
tomiasis in individual horses caused by high cyathos-
tome burdens.
References
1. Kaplan RM, Klei TR, Lyons ET, et al. Prevalence of
anthelmintic resistant cyathostomes on horse farms. J Am Vet Med Assoc
2004;225:903–910.
2. Kaplan RM. Anthelmintic resistance in nematodes of hors-
es. Vet Res 2002;33:491–507.
3. Little D, Flowers JR, Hammerberg BH, et al. Management of
drug-resistant cyathostominosis on a breeding farm in central North
Carolina. Equine Vet J 2003;35:246–251.
4. Tarigo-Martinie JL, Wyatt AR, Kaplan RM. Prevalence and
and characterization of a pyrantel pamoate resistance cyathostome
population. Vet Parasitol 1996;66:205–212.
7. Robertson AP, Bjorn HE, Martin RJ. Pyrantel resistance
alters nematode nicotinic acetylcholine receptor single-channel
properties. Eur J Pharmacol 2000;394:1–8.
8. Herd RP, Majewski GA. Comparison of daily and monthly
pyrantel treatment in yearling Thoroughbreds and the protective
effect of strategic medication of mares on their foals. Vet Parasitol
1994;54:93–104.
9. Lyons ET, Tolliver SC, Drudge JH. Historical perspective of
cyathostomes: prevalence, treatment and control programs. Vet Parasitol
1999;85:97–112.
10. Wineland NPL. National Animal Health Monitoring System.
Internal parasites and US horses: strongyles. Washington DC: USDA,
1998.

clinical implications of anthelmintic resistance in cyathostomes of
horses. J Am Vet Med Assoc 2001;218:1957–1960.
5. Woods TF, Lane TJ, Zeng QY, et al. Anthelmintic resistance
on horse farms in North Central Florida. Equine Pract 1998;20:
14–17.
6. Chapman MR, French DD, Monahan CM, et al. Identification
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11. Matthee S, McGeoch MA. Helminths in horses: use of selec-
tive treatment for the control of strongyles. J S Afr Vet Assoc 2004;75:
129–136.
12. Dargatz DA, Traub-Dargatz JL, Sangster NC. Antimicrobial
and anthelmintic resistance. Vet Clin North Am Equine Pract 2000;
16:515–536.

Selected abstract for JAVMA readers from the

American Journal of Veterinary Research
Analgesic effects of epidural administration of hydromorphone in horses
Cláudio C. Natalini and Renata L. Linardi

Objective—To evaluate the effects of epidural administration of hydromorphone on avoidance thresh-

old to noxious electrical stimulation of the perineal, sacral, lumbar, and thoracic regions in horses. January 2006
Animals—6 healthy adult horses.
Procedure—Horses were assigned to receive hydromorphone (0.04 mg/kg) or a control solution (20 mL
of sterile water) administered as an epidural in the first intercoccygeal space. Treatments were admin- See the midmonth
istered at time intervals of ≥ 7 days. Electrical stimulation was applied for 6 hours after epidural injec-
tion over the dermatomes of the perineal, sacral, lumbar, and thoracic regions, and the avoidance issues of JAVMA
threshold voltage was recorded.
for the expanded table
Results—Administration of sterile water did not change the avoidance threshold. Hydromorphone sig-
nificantly increased the avoidance threshold by 20 minutes after injection, which lasted until 250 min- of contents
utes after epidural administration in the perineal, sacral, lumbar, and thoracic regions. Profound anal-
gesia (avoidance threshold > 40 V) was achieved only in the perineal region at 60 minutes after epidur- for the AJVR
al administration of hydromorphone. Analgesia for all dermatomes was considered moderate for 250
minutes after epidural injection. or log onto
Conclusions and Clinical Relevance—Epidural administration of hydromorphone increases the www.avma.org
avoidance threshold to noxious electrical stimulation in the perineal, lumbar, sacral, and thoracic regions
in horses for 250 minutes after injection. Hydromorphone epidural administration may prove useful in the for access
management of horses with pain of moderate to mild intensity. (Am J Vet Res 2006;67:11–15)
to all the abstracts.

JAVMA, Vol 228, No. 1, January 1, 2006 Scientific Reports: Clinical Report 103