Do not steal and pass this info off as your own without written permission from The Fox Hospital, and please credit The Fox Hospital as the source. We create this information for rehabbers, rescues and sanctuaries to learn from not steal from.
Especially in Urban and Semi-Urban Areas
This article seeks to attempt to provide more information to rescuers and rehabbers of foxes, wildlife rescues and hospitals, sanctuaries and members of the public, with further learning and counter a lot of misinformation or misunderstanding.
Many health conditions in foxes get overlooked or missed as a result of a lack of knowledge on basic principles of mineral deficiency. Particularly when it comes to common health issues, treatments and guesswork. It is a long article but it contains some very vital and important information for anyone treating patients with the conditions listed in the title, even experienced rehabbers and rescues who have been treating for years, there is very likely information in here that even experienced fox rehabbers are not aware of and some learning opportunity.
I should start by saying, for the avoidance of doubt, I am not necessarily against the treating of certain conditions in fox patients in the field/in situ without the need to capture - after all, it is not always possible to capture foxes; some avoid humane traps as well as other methods of careful capture, some do not come close enough to manually net and during cub season, there are times when capturing a nursing vixen without her still-nursing cubs would be an obvious unrealistic scenario. With that said, this article highlights the issues associated with incorrect treatment and misunderstanding of what mange actually is and how the fox ended up with an infestation - spoiler alert, adult foxes do not get mange mites for no reason, and it is virtually always a much more serious systemic problem that led to them which usually goes untreated by most fox rescues who assume that the fox only needs treatment for mange and nothing else.
So, onto the article.
I will start with the general treatment schedule I use for patients who come in with confirmed mange mites and this should give you an idea of why just treating for only mange is nowhere near sufficient, and highlight why the way foxes are generally treated for mange by many rescues is incorrect. Firstly, if a fox has mange mites (confirmed with skin scrapings under microscopy, then they are already at a point of decline enough for parasites to be taking over. For a fox to get to this stage it usually means they are suffering from acidosis, a liver and kidney functioning problem and inability for the lymphatic system to remove cellular waste, acids and toxins from the body quickly enough or at all. This then leads to the decline of the body in general, dehydration, damaged cells, poor skin and organ condition, nutrient deficiencies and general decline. It could even be that a mineral and/or vitamin deficiency through malnutrition or an infected wound led to these conditions. Eventually the fox declines, parasites start to develop and finally they can end up with mites. Mange mites are never usually a primary cause or starting condition because a healthy fox would not normally be affected by them. So you can see that the mites are usually much further down the line and the least of the patient's worries on top of more important issues to deal with. This is why it is such a major issue that many rescues only send out 'mange treatment' whether medical or homeopathic which I will talk about later in this article. There is also the legal aspect of rescues illegally sending out prescription medication they are not authorised or qualified to since they are prescription only medication by a vet. Below is an example schedule that The Fox Hospital starts in chronological order for any patients who come in exhibiting signs of mites.
At this point it is vital to understand that a patient with mange is usually severely nutrient, mineral and vitamin deficient, with kidney and liver disorder of some level, and clinically dehydrated (far beyond just giving water in a bowl, we are talking cellular dehydration and potential mitochondria disfunction to some degree whereby just giving water would not hydrate the cells without the presence of sodium, potassium and magnesium for example. Schedule
First and foremost, when a fox is showing blatant signs of a mange mite infection (namely crusty infected skin, do not administer any parasite treatment yet, to avoid toxicity or toxic shock, especially if patient is dehydrated (which they always are) and since there is an obvious lymphatic system stagnation so their is nowhere yet for waste or toxins from pharmaceutical medication to drain to. It may be up to a week or few before any parasite treatment is safe to give otherwise the risk of toxicity, toxic shock and/or potentially fatal adverse reaction or damage to the kidneys, liver or brain in the case of neurotoxic medication is quite high.
Take vitals (Heart Rate / Pulse Rate, Breathing Rate, Temperature).
(If temperature hypothermic or hyperthermic, warm or cool patient safely and accordingly, avoid giving any food or drink until stable).
If temperature is stable, attempt to take blood sample to run haematology and chemistry markers to determine anaemia level, and potential base status of organs and other functions, then;
Fluid Therapy to rehydrate patient safely, for example Hartmann's Solution according to weight and dehydration level, ideally IV through an infusion pump administered by an appropriately trained nurse, vet or qualified and competent individual ensuring the blood results are factored in accordingly to ensure it is safe to do so.
Faecal sample, centrifuged and examine under microscopy for GI parasites.
Urine Sample for, among other things, pH level to gauge acidity.
Skin scraping samples examined under microscopy to attempt to determine level of external parasites and species.
Mineral support (vital) which should be from bioavailable sources, not synthetic. A few examples include celtic sea salt vital mineral blend, spirulina, chlorella, bladderwrack (fucus vesiculosus), kelp (laminariales), sea moss (chondrus crispus) (unless the patient has a thyroid issue), jamaican sarsiparilla (smilax ornata), all of which rich in a high amount of all or most of the essential minerals, which helps with both the anaemia and other mineral deficiency based symptoms.
Since 'mange' patients always have a level of acidosis, its vital to alkalise the body to eliminate those acids causing disease, which can be helped with alkalising fruits which help to provide an environment for the body to heal. The body wants to and is capable of healing, but it needs to have the right environment within itself. Giving alkalising astringent fruits like organic honeydew melon, blackberries, raspberries, strawberries and blueberries, either whole or blended and syringe fed if the patient is picky to ensure they eat it.
Since we know in order for these patients to get to the state they are means various systems and organs in their body are not functioning properly (otherwise they wouldn't be in this state in the first place) we add various herbs that are known and proven to help repair damage to or support specific systems and organs to food also. If potency is needed we will provide them in tincture form initially since ttinctures get right into the bloodstream via mucus membranes and generally don't get to the gut as they act really quickly so are particularly good for chronic and acute cases or immediate treatment (usually a tincture we provide has over 53 compounds/herbs with all constituent parts required which address 5 systems of the body (because the body needs treating as a whole, not just isolated areas) and fresh or dried are sometimes added to food for additional support: - These include but are not limited to Dandelion root and leaves as well as whole ground Milk Thistle both for liver repair. Nettle Seed, Nettle Leaf for kidney and lymphatic support and repair, cleavers/clivers herb for the lymphatic system, etc. Often we use a combination of various remedies to address the kidneys, lymphatic system, liver, gut, endocrine system and generally the body as a whole during their stay to maximise potential for proper healing rather than just treating symptoms.
A mild but quality natural diet, usually low protein to reduce strain on the liver during recovery. It is also useful to introduce fasting which aids the body in recovering faster and promotes healing cells much quicker. this can be done by way of one meal per day thereby providing a 20-23 hour period between meals. (sometimes referred to as intermittent fasting). It is still recommended, due to dehyration being a factor, for a fluid such as coconut water to be provided as the drinking source since it is one of if not the best sources of hydration on earth and contains potassium and sodium with some magnesium required for fluid to get into the cells of the body (which cannot be done with just normal H2O alone if there is a lack of those minerals since they are the key to allowing hydrated cells). A dehydrated, mineral deficient patient given just H2O alone will not be able to be properly hydrated so just providing a bowl of water to drink from is not sufficient for a patient lacking minerals, which these types of patients quite obviously are. If coconut water is unaffordable or unavailable (through lack of availability, not through laziness or lack of desire or belief) then something like Celtic Salt (which is not the same as regular or table salt, it is a special mineral blend) can be provided to the patient under the tongue right before administering water but since this is difficult in non-compliant patients like foxes, coconut water is easier and since it is naturally sweet is is well tolerated and enjoyed by them.
It may seem tempting to give parasite treatment immediately, but its vital to stabilise the patient to the point of their eliminatory organs and lymphatic system working properly otherwise whatever toxins go in are going to struggle to or be unable to come back out and will make the patient worse - think of it like a blocked toilet and continuing to put stuff down it, you need to clear the pipes and ensure waste removal is optimal before putting more in. The lymphatic system and the eliminatory organs' job are to remove cellular waste, dead cells, etc and toxins (which all parasite prescription treatments are) so the priority for these patients is to clear the eliminatory pathways first otherwise the dead parasites and medication toxins have nowhere to go and may end up causing more problems, especially if the body then starts to try to wrap them in fat and potentially lead to small cancerous masses.
Once stable, and functioning properly, consideration can be made regarding parasite treatment according to which parasites are present. Natural remedies are great and effective but can take a long time, prescription drugs can work fast but be toxic, so it will depend on the patient.
Sometimes it can be as soon as within 2 weeks of intake that we start mange mite treatment (in addition to all the other treatments for the root causes), other times it may be a month or so before we do while we are treating and healing the more urgent issues first and in order. It really depends on the patient, severity and condition The main thing to note is not to rush mange treatment. One reason rescues rush it is the myth that "they lose their territory". The fact the fox has got to that stage shows that they're severely malnourished, meaning there isn't enough nutrients / food for that fox and either they are being bullied away from food, or there simply is not enough in the area hence them declining to that stage - this means they didn't have a territory at that point, they were being bullied or driven out, food stolen, picked on or its just not a suitable area for that individual fox or family to be. This is also an indicator that it is probably a bad idea to release that specific individual back to the rescue location for them to end up in the same state later, because same environment, same foxes, potentially same bully, same hazards and most importantly, same lack of nutrients or resources. They will almost definitely decline again if we think logically and understand fox behaviour properly.
One very important thing to be aware of, even if treating for mange with medical prescription medication, all studies indicate (and we can confirm from clinical in house data of skin scraping mange patients regularly throughout treatment) that it can take 60 days for all mites to be eradicated, and in fact in studies some mites still persisted after multiple treatments at day 58 with all the major known treatments and brand names. This means that releasing foxes after just 2 or 3 weeks of treatment is most definitely negligent, and it usually takes between 8-16 weeks, sometimes more, to properly treat a patient with mange because as you can see from above, the mange mites are the least important symptom. The root cause of the systemic issues are what need repairing and those take time. Liver is fairly quick but lymphatic system, kidneys, endocrine system, adrenals, anaemia and acidosis, etc all take a while.
It is also important to note that the effective schedule for mange treatment, with ivermectin for example, differs from that listed in the BSAVA Small Animal Formulary. It has been found that most fox rescues (in the UK at least) are only providing 2 to 3 treatments, one week apart, for 2 weeks. This is insufficient (more details further down in this article) . Not only does the formulary state generalised treatments 1 to 2 weeks apart for up to 8 weeks, there are links below to studies whereby resistance caused the need for an increased schedule and frequency. the Fox Hospital con confirm we have indeed seen cases of resistance resulting in increased schedule length so it is vital that fox rescues, rehabbers and sanctuaries get up to date instead of assuming knowledge originally obtained years ago is still current, especially when releasing patients so quickly and thereby not actually seeing real world clinical results and going only off assumptions. Releasing after 2 to 3 weeks also shows that none of the conditions discussed above have been addressed either which shows a distinct lack of understanding of proper care for patients with mange which has generally come about through complacency in minimal knowledge or learning only from either bad practice or minimal internet searches or information. The purpose of the above information is to improve the care offered to patients with mange. This is more of an issue in the UK, and we are aware of a small number of rehabbers outside the UK, particularly in the US who do indeed keep mange patients in for many months to ensure proper and full growth of fur at least, giving more time for overall recovery), but in general we are seeing rescues, rehabbers and sanctuaries outside of the UK copying methods done by UK fox rescues which is a problem. This seems to stem from fox groups of social media sites like facebook that span multiple countries, meaning misinformation is spreading much faster and out of control, particularly since members of the public with no experience in rehabbing foxes copy paste or repeat misinformation due to the volume it is repeated and believed to be fact when it is not. The problem started a number of years ago and is now out of control so it is essential that the information in this article is understood, digested and used as a minimum guide.
For those foxes who most people assume look “mangey“, who allegedly recover in the wild after a couple of weeks or so - I have news for you, they didn't have mange and more likely were either moulting or had a wound or irritation of some sort. As you can see from above it takes months to recover from the conditions that led to mange and even the mites themselves take a minimum of a couple of months to properly eradicate, then the recovery starts after that.
If they do have mange though, I'll start by saying virtually all fox patients seen are anaemic and mineral deficient with significant cellular dehydration, and some types of anaemia and mineral and/or vitamin deficiency can become terminal very quickly. It should not be underestimated and definitely needs addressing properly.
For rehabbers who do keep foxes with mange in for a few months to properly ensure their fur grows back fully, but who have only really provided mange treatment, perhaps worming and maybe antibiotics and some food and water who have patients recover, please understand that some of this is down to luck and sufficient time for the patient to stabilise and you will see from the 'anomalies' section below that there is still a chance of kidney failure or damage later if mange treatment is not done carefully or too soon. If only the mange itself is treated, then it hasn't really healed the underlying root causes, only treated the symptoms in an allopathic way. There is still a chance they can decline after release just in a slower manner and they may be floating on a generalised 'ok' state, but the slightest issue in future in the wild could cause a decline. There is certainly the chance that they continue to recover slowly internally over the period of a few more months to a year in the wild, this is the recovery we do not see. So this is why it is vital to go to great lengths as detailed above to give them a much higher chance of faster recovery and not leave things to chance of hope or get used to negligent care - remember, we as rehabbers must strive to be at a nursing level as a minimum because these are medical patients we are dealing with, it is not a subject that can be winged or be blasé about or rely solely on vets since these patients can decline out of hours and a rehabber's job is to ensure proper care in all hours.
If you are a rescue or rehabber of foxes and you don’t beleive the mange patients you've had in are or were anaemic, then either you did not have blood tests run to determine this, or you did not learn how to interpret them or your vet did not interpret them to you sufficiently or at all or you simply misunderstood what was interpreted because almost every mange patient we have ever had in was/is severely anaemic - please be aware of how serious and common it is. I hope to change that and am happy to help and discuss with any rescue, rehabber or sanctuary.
I want to address a major issue in the fox rescue community and foxes on social media in general. I’ve had people, rescuers, and fox organisations argue with me on this but unfortunately I have more than enough clinical data and evidence from getting haematology and biochemistry bloods run on fox patients to back it up to the hilt medically. Not only that, one must understand what is going on biologically with patients such as these to fully appreciate the proper way to treat and heal systemically instead of just seeing mites as a main or only issue. The way foxes are treated in the UK in particular for mange needs to change drastically.
In hundreds of fox patients who have been assumed to have mange by most people on social media (including well known and 'experienced' fox rescues, I have found a large percentage did not confirm any mites on multiple skin scrapings. They did have a ragged and tatty appearance, however this is where the issue lays. Tatty appearance in the summer/winter can be the result of natural moulting, which is often why you hear anecdotes about homeopathic remedy drops put in food that “cure” them of mange in a couple of weeks. Truth is that’s actually nonsense. A fox with actual mange requires far more than those remedies and depending on severity usually takes many months to treat because the issue is systemic, not topical, in other words there is a reason they got the mites, they don't get them for no reason. Tatty appearance or missing fur patches can also be the result of an irritating wound or infected wound (often found to be fox fight wounds, mating wounds or cat bites), yeast or fungal infections or general irritation. It can sometimes be due to internal pain too as foxes gnaw at areas of or near pain sites.
Essentially though this is what happens:
Urban wild foxes are often struggling for food because humans poison their natural prey with rodenticide (which is horrific), councils and developer build on land that foxes naturally lived and the result is foxes desperately trying to survive any way possible - it’s not like they can pack bags and go to live in the countryside, that’s not how it works. So alas, they end up desperate and even when kind humans help to feed them, society is so messed up that many feed human junk food like jam/jelly sandwiches, pies, biscuits, cakes, just chicken only, scraps, expired meats, cat food, wheat products, bread, processed sugar treats and general acid forming foods nothing like their natural diet, dairy, 'beef', 'pork', cooked bones and generally poor quality 'food', every single day. They end up malnourished, dehydrated and anaemic.
Add to this if they get a slight injury, their 'immune systems' aren’t as strong as people think. A minor injury or infection can really badly affect a wild fox, and they’re so resilient and masters at masking conditions and pain that you won’t notice a decline until its very advance and they’re struggling because they are masters of masking pain, vulnerability and health conditions until often it’s too late or touch and go.
Which brings me onto anaemia. Urban foxes moreso, particularly injured ones and definitely mange patients, are very often anaemic. On haematology blood results it will present on a number of markers. It’s important to investigate the cause and type of anaemia as just the word anaemia is a blanket term and each type requires different treatment.
If it is nutrition based anaemia then often a specific and regular balance diet in conjunction with medical care over the period of a couple of months is sufficient albeit bloods should be taken before, possibly during, and definitely after to ensure it has been put under control, sorted, and hasn’t lead to other conditions. Adrenal function, spleen and bone related markers may be worth checking in case of issues that may affect iron levels and usage.
If it is, as one example immune mediated haemolytic anaemia (IMHA) then a vet may suggest steroids with caution of other conditions the fox may have, and other medications so a vet must be worked with in these cases for anyone who isn’t a veterinary professional and I want other rescues and rehabbers to be very aware and mindful of that, because you cannot simply give a fox steroids for example if they’re taking a non-steroidal anti inflammatory drug (NSAID) and I am very mindful that there are fox places and indeed rehabbers who give medication as a precaution out of habit or incorrectly without consulting vets, anti-inflammatories such as meloxicam, antibiotics and pain medication in particular. IMHA is also an issue if the fox happens to be affected by Neospora Caninum (neosporosis) or Toxoplasma Gondii (toxoplasmosis) because steroids are shown to potentially be detrimental in these cases. And again, I’m very well aware there are rehabbers and rescues and fox organisations in the UK at least who assume toxoplasmosis purely due to 'friendliness' or assuming any 'neurological' issue equals toxoplasmosis (which is a serious problem in the fox rescue world) without actually confirming with serology blood results and give medication (usually clindamycin) as a 'precaution' which is a very dangerous and negligent problem.
I am seeing too many occurrences of foxes not getting the proper medical treatment through places assuming that a fox can only get mange, a limp or toxoplasmosis and the truth is they can and do get hundreds of conditions. It only seems to happen in the fox community and it has stemmed from misinformation or lack of sufficient information whereby fox rescues when first starting out gained their knowledge from the internet by googling conditions and stuck with that basic level gained from the minimal info or misinformation source in the past which has spiralled. Members of the public repeating misinformation to such a huge degree on social media to the point where it seems to most to be fact now is also a problem. Enough people saying the same incorrect fact leads people to assume its correct. This is prevalent in fox fan groupls on facebook and it is so far out of control now its difficult to correct it. Even members of the public with zero fox experience will now argue with an experienced rehabber over it. I hope to try to correct that as difficult a task as it is.
My advice to all fox rescues, rehabbers and organisations - if you get any fox in with any skin condition, fur loss, emaciation, deterioration, weakness, limp with no obvious reason, generally looking tatty or if any confirm mange or dermatitis (including ringworm/dermatophytosis) - run a blood profile for haematology and biochemistry. You will without doubt find an issue that needs addressing, and learn properly about the lymphatic system and how the various organs and eliminatory routes of the body work, then how to alkalise the body from acidosis. This will put you on the right track to figuring out root causes instead of relying solely on vets prescribing drugs or getting by on basic knowledge. Remember, these are medical patients with medical conditions. Medical and healing knowledge is required.
For those with actual mange, 2 weeks of treatment is nowhere near enough and it is negligent. They require 8 weeks to confirm that all mites are gone (see study sources below), and also should not be released without having addressed the conditions they always have with mange including clinical dehydration, anaemia and whatever caused their immune system to get them to the stage of suffering with mites in the first place since mange is always a secondary condition in adult foxes. It is never the primary health concern concern with the exception of neonatal cubs suckling from an already infected mother, who then also get the malnutrition and health issues or toxins via the milk and then usually cubs do not survive beyond 12-16 weeks if untreated.
What is Mange?
The most common mites found on foxes malnourished and declined systemically enough for mites to develop and infest are usually Sarcoptes Scabiei (also sometimes referred to as Scabies), but Demodectic (Demodex) and Otodectes sometimes occur - there are also many other types of mites that lead to mange and mange-like symptoms in other species include but are not limited to Sarcoptic, Demodectic, Chorioptic, Psorergatic, Psoroptic, Notoedric, Knemidokoptes, Cheyletiella spp, Trixacarus spp, Chorioptes. Most common sarcoptiform (round-bodied) mites resemble one another and are often misidentified by rescues/rehabbers and even times vets due to their similarity, important characteristics for correct identification of these common mites can be the length and segmentation of the stalk (pedicle) connecting a terminal sucker or claw to the leg, for example in Sarcoptes Scabiei the stalk is long and unjointed whereas in Psoroptes spp mites have a long, jointed pedicle. Sarcoptes have pointes scales, Notoedres have rounded scales. Also, the legs on which the stalks are vary between genus. Most common mite infestations are diagnosed by deep or superficial skin scrapings. With regards to Sarcoptes, the mites burrow into the top layer of skin, where the females lay eggs which hatch in 3-4 days and develop into adult mites in 7-14 days. Symptoms usually begin around 4-6 weeks after initial infestation where the patient develops an adverse reaction to the presence of the mite proteins and faeces in the scabies burrow causing intense rash and itch. This can lead to inoculation of the skin with bacteria leading to impetigo (skin sores). Scabies-associated skin infection is known to be a common risk factor for kidney disease and there is data to show evidence of acute renal failure in around 10% of scabies infested patients. this is another reason why it is vital to heed the warnings above regarding delay of toxic chemical based treatments and instead focus on clearing the lymphatic system, kidneys, liver and colon (the eliminatory paths for toxins and cellular waste) first so not to cause further damage to the kidneys from the ingredients of ivermectin based medication, or medication such as bravecto, advocate, nexguard, simparica, stronghold, etc. It has also been shown to persist beyond the treatment unless the patients are treated to heal the kidneys, adrenal glands, liver, lymphatic system and gut during their overall treatment - this is also a reason why the current attitude to treatment by virtually all of the current main well known fox rescues in the UK at least is insufficient since many/most only give treatment for the mites and release the patients within 2-4 weeks, still with alopecia and having not addressed any of the internal or systemic associated issues, which is nowhere near sufficient as previously mentioned in this article. So while the mites may be assumed to be eradicated, the reality is they are not entirely at the stage of release, no measure taken to ensure confirmation of eradication by way of skin scrape confirmations at week 8 (or around day 28 and 58 which are common test schedules among all of the well known laboratory tests for the most common pharmaceutical treatments). This means the potential for reinfestation upon release is very high, but more importantly the risk of the patient declining or dying (albeit with a nicer skin condition or new hair growth) following release is a distinct possibility, whether within a few days, weeks or sometimes months that may to the rescue then seem unrelated through a simple lack of full understanding of all mentioned above. The purpose of saying all this is as a learning opportunity for rescues, rehabbers and sanctuaries, and not in any way meant to single anyone out. So you can hopefully now see why we usually keep in mange patients for extended periods of 3 to 6 months in some case and they do indeed tolerate it well despite some rehabbers and veterinary professionals being under the incorrect assumption that foxes don't do well in captivity provided the right calming environment and having sufficient experience with foxes to understand their behaviour, body language and the individual's boundaries is provided.
Anomalies with medication resistance and mite removal, including toxicosis
While we cannot 'technically' advise on treatment officially, we can share some clinical data that we have personally found in that we do have patients show some resistance to ivermectin-containing medication (such as ivermectin, noromectin, ivomec, panomec, noromec, from time to time in that mites persist despite treatment. I mention ivermectin more than other medications as it is the most common used for Sarcoptes Scabiei mites, although other products such as Fluralaner (e.g. Bravecto), imidacloprid/moxidectin (e.g. Advocate, Simparica, etc) or Afoxolaner (e.g. Nexgard Spectra) are known to also disrupt the nervous system of the mites causing their death, however the principle remains the same in the details given below. With regards to the ivermectin resistance, there is the possibility that this may at times be linked to moulting periods of mites. In one of the studies linked below, there was evidence found that during the moulting period when exposed to ivermectin, one third of the moulting mites survived whereas all active mites died suggesting that mites may survive after two doses of ivermectin 7 days apart due to the resistance of mites during the moulting process. The life cycle of Sarcoptes mites is around 10-13 days on average and Sarcoptes mites undergo three moult periods in their lifetime, the average moulting period is around 2 days each and in some cases over 30 hours, from larvae to protonymph, from protonymph to tritonymph and from tritonympth to adult. It was found that this might be attributed to the outer cuticle offering protection to the mite during this process. There is also the issue that it is not ovicidal, meaning it does not affect eggs so the central nervous system of the mites needs to be mature enough to be disrupted further showing a shorter window to eradicate mites. These are reasons why the common practice of the main fox rescues in the UK providing 2 to 3 treatments of ivermectin is insufficient (whether 'in the field' or inpatients) and in the case of captured inpatients, releasing back to the wild after just 2 to 4 weeks on average is negligent (notwithstanding the issue that some wildlife hospitals and rescues are illegally sending these medications in the post to untrained individuals for 'in the field' treatment indiscriminately). This is not only based on mite eradication and the resistance problem but also in failure to treat or heal, or even understand the more serious health concerns they have (lymphatic system, mitochondria, renal, hepatic and general systemic issues they have once at this stage of having mites due to the overall malnutrition, deficiencies and health concerns which led to eventual development or contracting infestation of mange-causing mites which as previously stated are almost always a final symptom after all else and only ever a primary issue, in neonatals of an already infested mother.) While the BSAVA Formulary Part A states treatment schedule to be every 14 days for 6-8 weeks, we have found (as confirmed in studies - sources linked below) that a more effective schedule is day 1, 2, 8, 9 and 15 in all cases followed by day 22 and day 29 in more serious cases particularly once crust develops. Due to the above notes on moulting process resistance, skin scrapings should be done on approximately day 1, 28 and 58 on multiple infection/lesion sites on the body for actual confirmation of a lack of mites or eggs and to ensure no ivermectin resistance or efficacy of medication such as advocate or bravecto since even in their own studies they do not have a 100% efficacy. Particularly with Sarcoptes Scabiei suspicion, we usually do several slides of around 2 to 3 slides per lesion area to give a much higher chance of finding any stage of the mite life cycle, and will usually do a clear tape lift onto slides in addition to skin scrapes as a further confirmation attempt. Faecal samples are also useful as mites are often found on faecal flotations due to ingestion during grooming, female mites are approximately 400µm and males approximately 250µm in size. We have personally found that a minimum of 90 days, but usually 120-180 days is required for successful treatment of patients with chronic or acute mange due to the internal organ and systemic problems taking that long to rectify and heal properly. Again, this is because mange in foxes is not a simple case of only mites, it is more often than not, a serious systemic issue often with mitochondria dysfunction, deficiencies and other subsequent internal issues, none of which are visible to the eye and don't always show up on blood results, however by symptoms alone once one understands the workings of the body, it becomes obvious, particularly to those qualified as Naturopathic Doctors. We have found during treatment, it has been helpful to provide remedies that help to heal the systemic problems which are listed above in this article under "Schedule".
Important note on toxicosis
Although the standard listed dose for Sarcoptes Scabiei in dogs is 200µg/kg to 400µg/kg (or 0.02ml to 0.04ml/kg), toxicosis has been reported in kittens exposed to as little as 300 to 400 μg/kg SC (sub-cutaneous injection). Younger animals do not have a fully developed blood-brain barrier and as a result may be more susceptible to ivermectin toxicity so extreme caution should be used in cubs which is a problem since cubs who develop mange usually do so from exposure during nursing from their new mother and as such are often between 4-16 weeks of age when they come in, this caution also still applies to other medication since they are usually too small for medication such as bravecto due to bodyweight and only once above 2kg are they potentially on paper able to have something like advocate administered although be advised these are toxic compounds even for healthy animals, and based on the above information they may still cause a severe or fatal reaction in cubs, so this is something to be very aware of. The focus should be on details as listed above, namely strengthening their entire system first, before mite medication since as mentioned enough times in this article, the mites are a lower priority than the root cause systemic concerns in most causes. High doses of ivermectin have been shown to alter haematological parameters causing anaemia so particular attention should be paid to this since foxes who come in with mange mites are virtually always already anaemic due to malnutrition mostly. Although foxes are of course canid species, and therefore technically in the canine/dog family, there are times we have found that foxes exhibit adverse reactions with pharmaceutical medication associated with felines not canines according to those listed in the BSAVA Formulary for Small Animals Part A. One such example is Enrofloxacin, which we at The Fox Hospital personally have banned from use in red foxes due to severe and fatal reactions in 3 patients within a couple of weeks of each other following veterinary prescription. So even though in most cases medication is prescribed as if for dogs, observations should always be done with reference to the listed reactions an contraindications for cats since foxes do indeed share some feline-like traits and anatomical similarities (eyes being the most obvious). While we are on the topic of ivermectin here, with regards to pharmacokinetics;
"Ivermectin is absorbed rapidly when administered either subcutaneously or orally. Gastrointestinal (GI) absorption is the more rapid, about 95% is absorbed, and peak plasma concentrations are achieved within 2 to 4 hours after oral administration. Ivermectin is metabolised via oxidation in the liver and excreted in the bile to the faeces; less than 5% is excreted in the urine. Its half-life in dogs is approximately 2 days."
Recovery Environment
Another issue found is rescues, rehabilitators or sanctuaries keeping mange patients during treatment in outdoor enclosures, or 'natural environment' housings on grass, hay/straw or shaving type bedding assuming they would feel more at ease but this does not have the desired effect realistically and psychologically but more pertinent, does not provide a disinfection capable environment and since mites can survive for a very long time away from hosts in the environment, the risk of reinfecting the current or future patients in the same environment prior to release is high and essentially this is (albeit accidental) negligent care even though obviously not intended. Mange patients must be allowed to recover in a veterinary infection controllable environment such as a stainless steel or polypropylene veterinary kennel that can be disinfected multiple times per day and have disposable bedding/incontinence pads used because the environment also needs treating.
Sources or related studies of interest (more are added periodically as they are found or produced, this is not an exhaustive list and there will inevitably be many not listed. If there are any of particular interest that you do not see here, feel free to reach out with link or description for it to be potentially added to help others). These sources are not intended as a source for members of the public to start treating foxes without sufficient experience or knowledge of contraindications, indications and adverse reactions and the biology and anatomy of the body.
Ivermectin Schedule
Ivermectin liver toxicity
Mange still present at 45 & 60 days with ivermectin, selamectin.
Adverse reactions of ivermectin
BSAVA British Small Animal Veterinary Association Formulary
Ivermectin efficacy during sarcoptes scabiei molting process
Small Animal Critical Care Medicine