Hedgehogs (Erinaceus europaeus)

Hedgehogs (Erinaceus europaeus)

Drug	Dose	Comments
Anaesthetics: Gaseous anaesthesia alone can be used in hedgehogs
Alfaxalone	2–6 mg/kg i.m. In combination with dexmedetomidine for sedation: Alfaxalone (2 mg/kg) + dexmedetomidine (0.05 mg/kg) i.m.a In combination with midazolam for deep sedation to light anaesthesia: Alfaxalone (3—5 mg/kg) + midazolam (1 mg/kg) deep s.c.	Gaseous anaesthesia can then be used for maintenance if required Reverse dexmedetomidine with atipamezole (see below) Higher doses of alfaxalone will induce light anaesthesia. Midazolam can be reversed with flumazenil 0.05 mg/kg s.c.
Diazepam	Sedation: 0.5–2 mg/kg i.m.b Anticonvulsant: 3 mg/kg i.m.b In combination with ketamine for anaesthesia: Diazepam (0.5—2 mg/kg) + ketamine (5–20 mg/kg) i.m.c,
Ketamine	10–20 mg/kg i.m.b In combination with diazepam for anaesthesia see abovec In combination with medetomidine for anaesthesia: Ketamine (5 mg/kg) + medetomidine (0.1 mg/kg) i.m.c	Sole agent – variable effects; prolonged recovery seen in some cases
Medetomidine	0.05–0.1 mg/kg i.m. for light sedation; 0.2 mg/kg i.m. for deep sedationb,c In combination with ketamine for anaesthesia see abovec	Variable effects; prolonged recovery seen in some cases Reverse with atipamezole (see below)
Atipamezole	0.25—0.5 mg/kg i.m., s.c. (equivalent to 5x dose (mg/kg) medetomidine or 10x dose (mg/kg) dexmedetomidine used)a,b,c Note: Doses up to 1 mg/kg i.m. are quoted by some authors for use in European hedgehogsc	Reversal of medetomidine: 5 times the medetomidine dose (i.e. equal volume of the 5 mg/ml atipamezole solution) Reversal of dexmedetomidine: 10 times the dexmedetomidine dose (0.5 mg/ml solution) (i.e. equal volume of the 5 mg/ml atipamezole solution when 0.5 mg/ml solution of dexmedetomidine is used)
Analgesics:
Buprenorphine	0.02–0.05 mg/kg i.m., s.c. q6–8hb,c	Opioid analgesics for moderate/severe pain
Butorphanol	0.2–0.4 mg/kg i.m., s.c. q6–8hb,c	Opioid analgesics for moderate/severe pain
Carprofen	5–10 mg/kg s.c. q24h; p.o. q12hb	Note these doses are higher than those suggested by other authors in other hedgehog speciesc but are commonly used in European hedgehogs Anti-inflammatory: the usual considerations for the careful use of NSAIDs in dehydrated, hypovolaemic or hypertensive animals, as well as those with underlying gastrointestinal disease, should be observed
Meloxicam	0.5 mg/kg s.c., p.o. q24hb
Antibiotics: Antibiotic use (both appropriate and inappropriate) imposes a powerful selection pressure on bacteria and is the primary driver of antibiotic resistance. Eliminating unnecessary use in people and animals is, therefore, essential to safeguard this invaluable resource. Prudent use is especially indicated where treated wild animals are being returned to the wild. The reader is referred to the Guide for the Responsible Use of Antibiotic, for further information (https://www.bsavalibrary.com/content/formulary/backmatter/exotic-petsguidelinesforresponsibleantibacterialuse)
Amoxicillin/clavulanate (co-amoxiclav)	30–50 mg/kg i.m., s.c. q24hb, p.o. q12hb	Broad-spectrum bactericidal Useful for infections of the respiratory tract, skin and soft tissues (including abscesses) Note these doses are higher than those suggested by other authors in other hedgehog speciesc but are commonly used in European hedgehogs
Amoxicillin LA	50–150 mg/kg s.c. q24h or q48hb	Broad-spectrum bactericidal administered every 48 hours for infections (e.g. for secondary bacterial pneumonia associated with lungworm) Higher doses (up to 150 mg/kg) and increased frequency (q24h) may, anecdotally, be effective for more severe infections
Cefalexin	25 mg/kg p.o. q8hc 30 mg/kg i.m., s.c., p.o. q12–24hb	Cephalosporins should ideally be reserved for infections where culture and sensitivity testing predict a clinical response and use of first- and second-line antimicrobials would not be considered effective Anecdotally, dosing q24h i.m. or s.c. dosing may be effective for most soft tissue infections, but more severe infections (e.g. abscesses and pyoderma) require more frequent dosing
Clindamycin	10–20 mg/kg p.o. q12hb,c	For anaerobic infections (e.g. abscesses, wound infections and dental infections) May also be useful for infections involving the bones and joints
Enrofloxacin	10–20 mg/kg i.m., s.c., p.o. q12hb	Fluroquinolones should ideally be reserved for infections where culture and sensitivity testing predict a clinical response and use of first- and second- line antimicrobials would not be considered effective Avoid use in young growing animals as potentially causes abnormalities of the cartilage
Marbofloxacin	8–10 mg/kg s.c. q24hb
Metronidazole	20–40 mg/kg p.o. q12hb,c	For anaerobic infections
Oxytetracycline	50 mg/kg i.m., s.c., p.o. q12hb	Broad-spectrum bacteriostatic
Antifungals:
Enilconazole	0.2% dilution applied topically every 3 days for 4–6 applicationsb,c	Topical antifungal treatment for ringworm applied as a wash or spray May be used as a sole agent in mild cases and concurrently with systemic antifungals in severe cases After treatment, keep hedgehogs warm to prevent hypothermia, especially in small juveniles
Itraconazole	10c–15b,d mg/kg p.o. q12h	Parenteral antifungal treatment for ringworm Treat for 2–4 weeks and then re-sample
Terbinafine	50–100 mg/kg p.o. q12h or q24hb,c,d	Parenteral antifungal treatment for ringworm Appears to be more effective than itraconazoled Treat for 2–4 weeks and then re-sample Suggested dosing frequency is q12h but, anecdotally, it is as effective when administered q24h (especially in larger animals)
Parasiticides: Parasiticide use in wildlife may reduce the development of natural resistance to parasites, as well as exerting selection pressure on organisms which can lead to drug resistance, and may risk environmental contamination. Careful selection and use of these drugs, only where there is a clinical need, and then using narrow spectrum products, is essential where treated wild animals are being returned to the wild. Reader is referred to the joint BVA, BSAVA and BVZS policy statement
Cyromazine	Topical application to wet the affected areab	Insect growth inhibitor useful for preventing hatching and development of blowfly larvae Can be used in combination with an insecticide to kill existing maggots Easy to apply, especially between the spines, if used as a spray, be aware of the cooling affect – do not use in hypothermic animals
Febendazole	100 mg/kg p.o. q24h for 5b-7e days	Useful as an in-feed treatment against nematodes and may have some effect on cestodes Has been used for 7 days to treat Capillaria spp. In wild Northern White-Breasted hedgehogs (Erinaceus roumanicus)e
Fipronil	0.25% spray used sparinglyb 7.5–15 mg/kg spot-on applicationb	Useful for treating fleas and ticks Always ensure good ventilation during and after treatment Be aware of the cooling affect – do not use in hypothermic animals
Ivermectin (injectable)	0.2c–0.5b mg/kg s.c. for most endo and ectoparasites 3.0b,g–5.0 mg/kgf s.c. for lungworm infections	Good activity against most parasites: lower doses typically used for ectoparasites; higher doses used for treatment of lungworm in European hedgehogs Repeat treatment every 7–10 days if necessary
Ivermectin (topical)	0.2–0.5 mg/kg spot-on applicationb	Useful for treating ectoparasites (e.g. fleas, ticks and mites) Repeat treatment after 10 days
Levamisole	27 mg/kg s.c. q48hb 35 mg/kg p.o q24 for 2 daysf	Dosing regimen for injectable product: 3 injections given at 48-hour intervalsb (other regimes have been described) Dosing regimen for oral product: 2 doses given at a 24hr intervalf(other regimes have been described) Lower doses (10—20 mg/kg) are suggested in other hedgehog speciesc as therapeutic margin or safety can be low Traditionally used for lungworm treatment but drug availability in the UK may be a problem, so often replaced by ivermectin
Mebendazole	50–100 mg/kg p.o. q24h for 5 daysb	Useful for treating nematodes and cestodes
Moxidectin (injectable)	5 mg/kg s.c. for lungworm infectionsf	Less effective than ivermectin in both injectable and spot-on formsf
Moxidectin (topical)	2 mg/kg topical (given as 0.2 ml/kg 1% moxidectin and 10% imidacloprid spot-on product)f	The inclusion of imidocloprid in the spot-on product raises concerns regarding environmental contamination this together with the recorded poor efficacy means there is little justification for use of combination moxidectin products
Praziquantel	10–20 mg/kg p.o. onceb 30 mg/kg spot-on applicationb	Useful for treating cestodes and trematodes
Sulfadimidine	200 mg/kg s.c. q24h for 3 daysb	Useful for treating coccidiosis
Sulfadoxine/trimethoprim	50 mg/kg i.m., s.c. q24h for 5 daysb 30 mg/kg i.m., s.c., p.o. q12c
Toltrazuril	25–50 mg/kg p.o.; repeat if necessary
Miscellaneous:
Bromhexine	1 pinch of powder p.o. q12h (3 mg/kg q24h)b	Mucolytic Aids expectoration of mucus in parasitic bronchopneumonia
Clenbuterol	1 pinch of granules p.o. q12hb	Bronchodilator Relieves bronchospasm and assists mucociliary clearance in respiratory disease
Dexamethasone	1–5 mg/kg i.v., i.m., s.c.b	Corticosteroid: lower doses are anti-inflammatory; higher doses may be useful in treating parasitic bronchopneumonia but are likely to be immunosupressive Corticosteriods should be used with caution, especially in wild animals

NSAID(s) = non-steroidal anti-inflammatory drugs

References and further reading

a Bellini L, Pagani G, Mollo A et al.(2019) Evaluation of alfaxalone and dexmedetomidine for intramuscular restraint in European hedgehogs (Erinaceus europaeus). Veterinary Record 185(5), 145

b Bexton S (2016) Hedgehogs. BSAVA Manual of Wildlife Casualties, 2nd edition, ed. E Mullineaux and E Keeble, pp. 117–136. BSAVA Publications, Gloucester

c Carpenter JW and Harms CA (2022) Exotic Animal Formulary, 6th edition. Elsevier, Oxford

d Bexton S and Nelson H (2016) Comparison of two systemic antifungal agents, itraconazole and terbinafine, for the treatment of dermatophytosis in European hedgehogs (Erinaceus europaeus). Veterinary Dermatology 27(6), 500–e133

e Alfaia F, Jota Baptista C, Lozano J et al. (2024) Efficacy of a new fenbendazole treatment protocol against Capillaria spp. in northern, white-breasted Hedgehog (Erinaceus roumanicus). Parasitologia 4, 270–278

f Van de Weyer Y, Santos MC, Williams N et al. (2023) Efficacy of levamisole, ivermectin and moxidectin against Capillaria spp. in European hedgehogs (Erinaceus europaeus). Journal of Helminthology, 97(e99), 1–9

g Barutzki D, Laubmeier E and Forstner MJ (1987) Endoparasitic infestation of wild hedgehogs and hedgehogs in human care with a contribution to therapy. Tierarztliche Praxis, 15(3), 325–331

Bexton S and Couper D (2019) Veterinary care of free-living hedgehogs. In Practice 41(9), 420–432

BSAVA Library https://www.bsavalibrary.com/

BVA, BSAVA, BVZS joint policy statement: Responsible use of parasiticides https://www.bva.co.uk/take-action/our-policies/responsible-use-of-parasiticides-for-cats-and-dogs/

The British Hedgehog Preservation Society https://www.britishhedgehogs.org.uk