Head-to-Head Comparison of 2 Paclitaxel-Coated Balloons for Femoropopliteal Lesions

BACKGROUND

There is a scarcity of published head-to-head comparisons between different paclitaxel-coated angioplasty balloons. More prospective safety data to support the health care economic reimbursement processes are needed.

OBJECTIVES

The aim of this study was to report the safety and efficacy of the Passeo-18 Lux drug-coated balloon (DCB) (Biotronik AG) for the treatment of symptomatic peripheral artery disease caused by stenosis, restenosis, or occlusion of the femoral and/or popliteal arteries.

METHODS

A total of 302 patients were randomized 1:1 and assigned to the Passeo-18 Lux DCB (study device) group or the IN.PACT Admiral DCB (control device, Medtronic Vascular) group for testing of noninferiority. The primary efficacy endpoint was freedom from clinically driven target lesion revascularization at 12 months. The primary safety endpoint was a composite of freedom from device-/procedure-related death through 30 days postindex procedure, major target limb amputation, and clinically driven target vessel revascularization at 12 months.

RESULTS

At 12 months, 130 of 134 patients in the IN.PACT Admiral group had freedom from clinically driven target lesion revascularization (97.0%) compared with 137 of 141 patients in the Passeo-18 Lux group (97.2%). The primary safety endpoint showed 96.3% in the control group vs 95.7% in the study device group. The null hypothesis of inferiority on both efficacy and safety was rejected. The Kaplan-Meier estimate of primary patency at 1 year was 88.7% in the control arm vs 91.5% in the study device arm.

CONCLUSIONS

The Passeo-18 Lux and the IN.PACT Admiral DCBs demonstrate comparable results with excellent effectiveness and safety through 12 months for femoropopliteal interventions.

Qualitative risk assessment of homogeneity, stability, and residual concentrations of antimicrobials in medicated feed and drinking water in pig rearing

BACKGROUND

Despite the common use of oral group treatment in pig rearing, the magnitude of the factors influencing the homogeneity and stability of antimicrobial drugs in medicated feed and medicated drinking water are largely unknown, as well as the residual concentrations of the drugs after the end of the treatment.

RESULTS

This study presents a qualitative risk assessment to estimate the magnitude of the risks for reduced homogeneity and stability, and increased residual concentrations of antimicrobial drugs in medicated feed and drinking water on the farm. Risk assessment was done using a questionnaire and farm visits (n = 52), combined with a second questionnaire, and concentrations of amoxicillin and doxycycline measured in medicated feed and water samples, each collected on 10 farms. For medicated feed, the duration of storage in the silo did not show to influence the concentration levels in a consistent trend, while the treatment duration had a low to negligible effect. A moderate to high risk was found caused by human error when preparing the medicated feed on the farm. Purchased medicated feed greatly reduces the risk of human error and drugs remain stable during the duration of treatment, while the risk of residual concentrations after the end of the treatment was estimated to be low to moderate. The feed intake variability was identified as a moderate to high risk factor. For medicated drinking water, the type of dosing pump, age of pre-solution, and human errors during the preparation of the pre-solution present a moderate to high risk on homogeneity and stability. Precipitation of the active substance in the absence of a stirrer in a drinking water tank was shown to be a low to moderate risk factor for residues after treatment. Waterline length had a weak correlation with the concentrations of the antimicrobials, while a moderate to high influence was detected for the water intake by the pigs.

CONCLUSIONS

A considerable variation in drug concentration in both medicated feed and medicated drinking water was detected depending on their preparation. Therefore, it is important to know which factors influence the homogeneity and stability, and the residual concentrations after treatment.

Oral group medication in pig production: characterising medicated feed and drinking water systems

Despite common use of oral group medication in pig rearing, the homogeneity, stability and carry-over of frequently used medicinal products in feed and drinking water are largely unknown. Therefore, a field study was performed on 52 Belgian pig farms, characterising preparation and administration of medicinal products via these systems, and farmers' user experiences with medicated feed and medicated drinking water. The study showed that medicated drinking water is more commonly used than medicated feed, since 90.4 per cent of the farms sometimes use medicated drinking water and 69.2 per cent of the farms sometimes use medicated feed. The drinking water quality is evaluated at least once a year on only 30.7 per cent of the farms. Separate pipelines for medicated and non-medicated circuits were not present in any of the farms using medicated feed and in 27.7 per cent of the farms using medicated drinking water. With drinking water medication, 63.5 per cent of the farmers reported encountering practical problems, often related to solubility issues and precipitation of the active compounds. In contrast, medicated feed is bought ready-to-use from the feed manufacturer in 68.2 per cent of the cases, thus reducing the number of practical problems experienced by the farmer. This study shows room for improvement of oral group treatment, developing appropriate pharmaceutical formulations for drinking water medication, quality control of drinking water, using separate pipeline circuits, and cleaning and disinfecting protocols.

The impact of antimicrobial use guidelines on prescription habits in fourteen Flemish small animal practices

A prospective study was performed to explore the prescription habits in fourteen first-line, small animal practices during first consultations of cats and dogs. Consultations one month prior to the implementation of antimicrobial use guidelines and at least 20 days thereafter were examined. Differences in the proportion of consultations during which antimicrobials were prescribed, were assessed. Additionally, changes in the choice of active substance were critically evaluated against the introduced antimicrobial use guidelines. The proportion of consultations where antimicrobials were prescribed decreased in cats and dogs (both –12%) after the introduction of the antimicrobial use guidelines. There was an increase of consultations of cats (+13%) and dogs (+10%) where veterinarians handled according to those guidelines. However, an increase in the prescription of third-choice antimicrobials and highest priority critically important antimicrobials was noticed both in cats (+8% and +12%, respectively) and dogs (both +5%). This unexpected increase invites to create extra awareness amongst prescribers.

Vraag & Antwoord

Streptokokkeninfecties bij biggen Het gebruik van Cefovecin bij reptielen, vogels, kleine herbivoren en fretten 

Postoperatieve infectie met een multiresistente Staphylococcus aureus (MRSA) bij een Berner sennenhond met een ruptuur van de voorste kruisband

Een vrouwelijke Berner sennenhond van 5,5 jaar oud werd aangeboden met een septische artritis van de linkerknie na een exploratieve artrotomie. De pathogene kiem was een multiresistente Staphylococcus aureus (MRSA). De knie werd opnieuw chirurgisch geëxploreerd en gespoeld. De hond werd vervolgens subcutaan behandeld met meropenem (Meronem®, NV AstraZeneca SA, Brussel, België) gedurende acht weken. Tijdens deze periode trad een scheur van de voorste gekruiste band op in het betrokken kniegewricht, waarvoor een behandeling met een “tuberositas tibiae advancement”-techniek (TTA Rapid) werd uitgevoerd. Ondanks de infectie, de erge symptomen en de bijkomende kruisbandruptuur herstelde de hond volledig. Multiresistente kiemen zijn moeilijk te behandelen en vragen een zorgvuldige aanpak van de dierenarts, een grote inzet van de eigenaar, waarbij volgens antibiogram werkzame antibiotica van het type ‘laatste redmiddel’ uitzonderlijk gebruikt worden. In deze casus wordt aangetoond dat ook ernstige gevallen van postoperatieve infectie met MRSA kunnen genezen indien een correcte behandeling uitgevoerd wordt.