Pet health: Paws for thought

With 12 million households owning at least one pet there is a huge opportunity for pharmacy to provide these customers with the advice and medicines they need to keep their animals healthy.

Learning objectives

After reading this feature you will know how to:

  • Prevent, detect and treat parasitic infections in animals
  • Advise customers about the risks of their pets contracting lungworm and rabies
  • Capitalise on the pharmacy animal health category, in particular flea and worm treatments

In national pet month (May), a pet census by the veterinary charity, PDSA, found that up to one in five dog and cat owners do not regularly treat their pets for fleas and worms.

“There is a poor understanding among pet owners about what protection is needed and which products to choose,” says Andrea Tarr, a pharmacist and founder of Veterinary Prescriber magazine. “One of the most important roles community pharmacies can play is in advising pet owners about disease prevention, particularly parasite control.”


Cats and dogs should be wormed regularly for round worms, tapeworms and lungworm to prevent infestations, as they will pick them up repeatedly throughout life. Worm infestations in pets can be asymptomatic and may only be diagnosed through a faecal exam carried out by a vet. Symptoms can include:
• Visible worms or eggs in faeces or visible worms in fur
• Bloated stomach
• Constant hunger and weight loss
• Vomiting with visible worms
• Weakness
• Diarrhoea (particularly with blood in it)
• Signs of itchiness around the anus.

Pets that hunt other animals or eat raw meat will pick up more worms and are classified as higher risk. Puppies and kittens should be wormed more often as they are often born with worms and can become re-infected through their mother’s milk.

Some worms such as roundworm (Toxocara canis) can affect humans as well. They are spread through contact with dog or cat faeces, so it is important to encourage good hand hygiene by pet owners. Worms can prove particularly dangerous for children and pregnant women, sometimes causing blindness and birth defects, so pets in households with these groups of people would be classified as higher risk.

“Veterinary surgeons will typically recommend that a pet is comprehensively wormed no fewer than four times a year, but pets at higher risk may require monthly worming,” says PDSA vet, Olivia Anderson-Nathan.


Ticks globally rank second only to mosquitoes in terms of infectious disease spread to both pets and people. They lurk in grassy areas and look for hosts to latch onto, such as a passing cat or dog. Ticks in the UK can carry Lyme disease, caused by bacteria which affect both muscle and nerve cells.

The Kennel Club says that, while the number of human cases of Lyme disease is rising, it is a difficult disease to diagnose in dogs as they have only occasional signs of sudden arthritis – which is why prevention against ticks is of vital importance. These parasites are oval, flat and small, the size of a sesame seed when unfed, but when completely engorged with blood, they grow to the size and shape of a coffee bean and will cause a pet to itch.

There are many safe and effective products on the market to prevent ticks – from spot-ons and sprays, to special collars impregnated with substances that infiltrate into the fatty layer of the dog’s skin, killing ticks when they attempt to feed.

Pet owners who enjoy walks in the countryside, parks and woodlands should be advised to wear long trousers and always tuck trousers into socks to help prevent ticks latching onto skin. In the spring and autumn, when ticks are particularly active, pet owners should always check themselves and their pets for ticks when returning home.

If a tick is found on a pet it should be removed slowly and carefully with a tick removal tool to ensure all the mouth parts are extracted.


All pets are at risk of fleas, even animals that only live indoors, and it is important they are treated regularly to ensure they have continuous cover against these parasites. “Customers should not wait until they see fleas or a family member is bitten,” says Joanne Carey, a pharmacist working on behalf of Drontal and Advantage.

“Some animals will show no signs of being infected, while others may groom more, have a dull coat, regularly change resting spots, and have changes in appetite and bowel movements.”

Most products require monthly administration, says Olivia Anderson-Nathan, although a few have longer durations of action. “Some flea treatments only kill adult fleas; others kill adult fleas and stop eggs developing. Some products also treat other parasites such as ticks, ear mites or biting flies.”

Check the datasheets for durations and indications, she says, and never use flea treatments for dogs on cats as they contain permethrin, which can be fatal to cats. Pharmacy teams should always recommend a flea treatment specifically for cats and check all household flea sprays for permethrin before recommending them for use around cats.

Other preventive advice includes regularly washing pets’ bedding on a hot wash to get rid of any flea eggs that might be lurking there and using a household spray regularly.

If a pet has fleas it is likely to:
• Be itching, chewing or licking more than normal
• Have red and inflamed skin
• Have fleas or flea faeces (small, dark flecks) on its fur and skin.

Key facts

  • Up to one in five cat and dog owners do not regularly treat their pets for fleas and worms
  • Owning a pet improves older people’s health and wellbeing
  • British pet owners spend £4.5bn on the care of their pets every year

Managing a flea infestation in the home

When the home is infested with fleas, just treating a pet isn’t enough as the vast majority of the flea population lives in the environment, then jumps onto an animal to feed on its blood and start laying eggs. To get rid of an infestation:

• Treat all pets in the household to make sure fleas don’t pass from one pet to another
• Because of their six-week life cycle and potential to lay in dormant stages for nearly a year, it is important to continue ongoing treatment or the problem will return
• Vacuum the home thoroughly to get rid of any fleas or eggs
in furniture and carpets. Pay special attention to places where the pet spends a lot of time, such as the sofa or bed, as well as around fires and radiators – fleas love these warm areas

• Treat the home with a household flea spray to kill both fleas and flea eggs. There are many suitable products but some have a longer period of efficacy (e.g. a year rather than a month) and may be more effective at preventing a recurrence of fleas
• Fleas are a problem all year round but especially during the warmer months. It is much easier to prevent an infestation than treat one, so advise pet owners to regularly use a preventive treatment.


Lungworm is a parasite whose larvae is carried by slugs and snails. This parasite can cause serious health problems in dogs and can be fatal if not diagnosed and treated. Cases in the UK have more than trebled in the past four years and the parasite is now endemic in many parts of the country.

Dogs can be infected when they eat slugs and snails either accidentally or deliberately while rummaging through undergrowth, eating grass or drinking from puddles or outdoor water bowls. Signs of lungworm are:

• Changes in behaviour such as lethargy, depression and also seizures
• Breathing problems/coughing and tiring easily
• General sickness including weight loss, diarrhoea, vomiting and not wanting to eat
• Poor blood clotting, which causes bleeding into the eye, nose bleeds and pale gums.

If an owner reports any of these symptoms in their pet they should be advised to visit the vet immediately.

“Pharmacists can help by raising awareness of the parasite and advising on how pets can become infected,” says Olivia Anderson-Nathan. “Not every wormer will cover against lungworm so it is important to know which products are licensed for this use.

Typically, monthly treatment with a product containing milbemycin oxime or imidacloprid/moxidectin is preventive and these products also have the benefit of treating or preventing several other parasites.”


The risk of rabies is very low in the UK – only four cases of rabies in humans have been identified since 2000, all of which were acquired by those infected from dog bites abroad. Rabies is invariably fatal once symptoms develop but a timely course of rabies vaccination before travel can prevent infection and death.

Pet owners wishing to take their pet abroad will need to get it vaccinated against rabies as part of the process of acquiring a pet passport.

Making the most of the category

“I believe there is a huge potential for pharmacies to develop the pet care category,” says Andrea Tarr, “but, to make the most of it, they need to really understand the products they sell because pet owners will welcome the availability of impartial advice on pet healthcare and product choice in an environment where there is specialist knowledge about medicines.”

Rebecca Thomas of Celesio says awareness of the availability of pet care products and medicines in community pharmacy is currently low among customers. “Pharmacy teams could adopt a ‘family medicine’ approach and explain how customers can pick up medicines from their local pharmacy for all family members, including their pets,” she says.

“There are some easy ways to educate and inform consumers that their pharmacy sells pet medicines and their pharmacist can help advise them. The first step is to ensure in-store signposting is clear for customers and to try awareness tactics such as pharmacy bag stuffers.

Make sure you create a display that is easy to understand and navigate, giving basic information about how to use the products. This makes the shopper feel comfortable with making a decision in-store. You could also consider cross-category links where pet medicines have relevance, such as allergy preparations and children’s medicines.”

Rob Morris, veterinary pharmacy consultant at Roma Consulting and chair of the RPS Veterinary Pharmacy Forum, says it is important all members of the pharmacy team have the relevant education and training. Manufacturers of animal medicines can be a good source of educational material, he says, and the newly established Veterinary Pharmacy Association, which he has helped to launch, will soon be running courses for pharmacy teams in association with Harper Adams University, providing CPD sessions and newsletters.

Products for preventing and treating parasitic infections will be the main sellers, but Rob Morris suggests there are many other additional pet care products that can be sold in the pharmacy. Special diets for pets with conditions such as stiff joints, diabetes, pancreatitis, digestive or skin sensitivity and liver disorders often sell very well, he says.

“It is very important to establish a rapport with pet owners. Pets need regular treatment for parasites, so once you start persuading people to buy these products from the pharmacy, you will find they are very loyal
and could end up being customers for life.”

Cat owners in the dark over feline health...

A recent survey from Bayer has revealed that almost half (45 per cent) of owners are unable to detect signs of a parasitic infection in their cat, placing greater emphasis on the role of pharmacy staff to educate unsuspecting pet owners.

Currently, 40 per cent of cat owners admit they do not regularly use a flea preventative product. Also 4 per cent of cat owning households admit to only treating for fleas when a family member is bitten or they physically see fleas.

Joanne Carey, director of Evolve Health Solutions, said: “The health of pets can often have a direct impact on their human owners, especially with the risk of zoonotic diseases spread from common parasites such as fleas and worms. Pharmacy staff can play an influential role in ensuring the health and well-being of pets and their owners by educating them on how to spot the signs of a parasite infestation and recommending a treatment plan that keeps their pet, family and home protected.”

Cats, in particular, are masters at hiding their signs of illness and in most cases, the only clue pointing to a flea infestation that the majority of cat owners could spot was ‘scratching’. Indeed, cats often show no signs at all. Nine out of 10 owners also admitted they do not recognise that depressive behaviour or lack of appetite could also be signs.

However, pharmacists have the platform to educate cat owners on the signs to look out for including: excessive grooming; regularly changing resting spots; changes in appetite; changes in toilet habits such as diarrhoea and other gastrointestinal signs and symptoms; and a dull coat.

To help educate pet owners Bayer, manufacturer of Drontal and Advantage, has launched an education campaign called Instinctively Close, which helps owners understand their cats’ behaviour and what it means for their health. The report can be requested from the Drontal and Advantage Facebook page www.facebook.com/drontalUK.

Health benefits of pet ownership in older people

Pets can have a beneficial effect on their owners’ health and wellbeing, particularly when they are elderly, says Age UK. A study at Cambridge University found that owning a pet can improve an owner’s general health in less than a month, with pet owners reporting fewer minor ailments such as headaches, coughs and colds.

According to the Pet Health Council, simply stroking a pet or watching fish swim can help people to relax, thus reducing their heart rate and lowering blood pressure. Other studies indicate that owning a pet can lower cholesterol, reducing the risk of heart attack – and one US study found that people who do suffer a heart attack have a better chance of survival if they have a pet.

In addition, pets can help to lift depression and reduce loneliness and isolation. Walking a dog, for example, not only helps the owner to keep fit but can provide opportunities to meet new people while they are out and about.

  • An e-learning resource from Frontline for pharmacy teams on tackling fleas and ticks can be accessed by clicking here.


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