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Pelligand L, Sørensen TM, Cagnardi P, Toutain PL, Allerton F. Population pharmacokinetic meta-analysis of five beta-lactams antibiotics to support dosing regimens in dogs for surgical antimicrobial prophylaxis. Vet J 2024:106136. [PMID: 38759725 DOI: 10.1016/j.tvjl.2024.106136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/13/2024] [Accepted: 05/12/2024] [Indexed: 05/19/2024]
Abstract
The Pharmacokinetic/Pharmacodynamic (PK/PD) relationship of antimicrobial drugs (AMD) for surgical prophylaxis has been poorly studied, hampering evidence-based decision making around AMD dosing and timing. Our objective is to use PK/PD principles to inform (1) the timing of administration and (2) the interval for re-administration of AMD used peri-operatively in dogs. Raw plasma concentrations of cefazolin, cefuroxime, cefalexin, amoxicillin and ampicillin were retrieved from original intravenous studies performed in dogs. E. coli and methicillin-susceptible staphylococci were identified as possible intraoperative contaminants and their epidemiological cut-offs (ECOFF) were retrieved from the EUCAST database. Individual PK data were refitted with non-linear mixed effect models (Phoenix®). We performed Monte Carlo simulation to compute i) the 95th percentile of time of peak concentration in the peripheral compartment (informing timing between administration and first incision) and ii) the duration for which at least 90% of dogs maintain a free plasma concentration above ECOFF (informing timing of re-administration: 1.5 to 4h). Cefazolin (22-25mg/kg), cefuroxime (20mg/kg), cefalexin (15mg/kg) and amoxicillin (16.7mg/kg) reached peak peripheral concentrations within 30min, but ampicillin (20mg/kg) required 82min, respectively. For methicillin-susceptible staphylococci, cefazolin and cefuroxime require re-administration every 2h, whereas cefalexin and both amoxicillin and ampicillin can be readministered every 3 and 4h, respectively. For E. coli, only cefazolin provided adequate perioperative coverage with 2-hourly administration, where cefuroxime and cefalexin failed uniformly. Alternatively, ampicillin and amoxicillin (critically ill dogs) may cover E. coli contaminations, but only if readministered every 1.5h. These PK-derived conclusions provide a rationale for perioperative AMD administration timing.
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Affiliation(s)
- L Pelligand
- Department of Comparative Biomedical Sciences and Department of Clinical Services and Sciences, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts AL9 7TA, UK.
| | - T Møller Sørensen
- Department of Veterinary Clinical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - P Cagnardi
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, Milan, Italy
| | - P-L Toutain
- Department of Comparative Biomedical Sciences and Department of Clinical Services and Sciences, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts AL9 7TA, UK; INTHEREST Université de Toulouse, INRAE, ENVT, Toulouse, France
| | - F Allerton
- Willows Veterinary Centre & Referral Service, Solihull, UK
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Sørensen TM, Scahill K, Ruperez JE, Olejnik M, Swinbourne F, Verwilghen DR, Nolff MC, Baines S, Marques C, Vilen A, Duarte EL, Dias M, Dewulf S, Wichtowska A, Valencia AC, Pelligand L, Broens EM, Toutain PL, Alishani M, Brennan ML, Weese JS, Jessen LR, Allerton F. Antimicrobial prophylaxis in companion animal surgery: A scoping review for European Network for Optimization of Antimicrobial Therapy (ENOVAT) guidelines. Vet J 2024; 304:106101. [PMID: 38490359 DOI: 10.1016/j.tvjl.2024.106101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/09/2024] [Accepted: 03/10/2024] [Indexed: 03/17/2024]
Abstract
Surgical antimicrobial prophylaxis (SAP) is widely used to reduce the risk of surgical site infections (SSI), but there is uncertainty as to what the proportion of SSI reduction is. Therefore, it is difficult for surgeons to properly weigh the costs, risks and benefits for individual patients when deciding on the use of SAP, making it challenging to promote antimicrobial stewardship in primary practice settings. The objective of this study was to map the veterinary evidence focused on assessing the effect of SAP on SSI development and in order to identify surgical procedures with some research evidence and possible knowledge gaps. In October 2021 and December 2022, Scopus, CAB Abstracts, Web of Science Core Collection, Embase and MEDLINE were systematically searched. Double blinded screening of records was performed to identify studies in companion animals that reported on the use of SAP and SSI rates. Comparative data were available from 34 out of 39123 records screened including: eight randomised controlled trials (RCT), 23 cohort studies (seven prospective and 16 retrospective) and three retrospective case series representing 12476 dogs and cats in total. Extracted data described peri- or post-operative SAP in nine, and 25 studies, respectively. In the eight RCTs evaluating SAP in companion animals, surgical procedure coverage was skewed towards orthopaedic stifle surgeries in referral settings and there was large variation in SAP protocols, SSI definitions and follow-up periods. More standardized data collection and agreement of SSI definitions is needed to build stronger evidence for optimized patient care.
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Affiliation(s)
- T M Sørensen
- Department of Veterinary Clinical Sciences, University of Copenhagen, Dyrlaegevej 16, Frederiksberg C 1870, Denmark; ESCMID Study Group for Veterinary Microbiology (ESGVM), Basel, Switzerland.
| | - K Scahill
- College of Medicine and Veterinary Medicine, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, United Kingdom; Evidensia Södra Djursjukhuset Kungens Kurva, Månskärarvägen 13, Kungens Kurva 14175, Sweden; ESCMID Study Group for Veterinary Microbiology (ESGVM), Basel, Switzerland
| | - J Espinel Ruperez
- College of Veterinary Medicine, Murdoch University, Murdoch, Perth, WA 6150, Australia
| | - M Olejnik
- Department of Fundamental and Preclinical Sciences, Nicolaus Copernicus University, Jurija Gagarina 11, Toruń 87-100, Poland
| | - F Swinbourne
- Lumbry Park Veterinary Specialists, Selborne Rd, Alton GU34 3HL, United Kingdom
| | - D R Verwilghen
- Sydney School of Veterinary Science, University of Sydney, Regimental Dr, Camperdown, NSW 2050, Australia
| | - M C Nolff
- Clinic for Small Animal Surgery, Vetsuisse Faculty, University Zürich, Winterthurerstrasse 260, TFA 01.51, Zürich 8057, Switzerland
| | - S Baines
- Willows Veterinary Centre & Referral Service, Solihull B90 4NH, United Kingdom
| | - C Marques
- Universidade Lusófona de Humanidades e Tecnologias, Campo Grande 376, Lisboa 1749-024, Portugal; Centre for Interdisciplinary Research in Animal Health (CIISA), Faculty of Veterinary Medicine, University of Lisbon, Tapada da Ajuda, Lisboa, Portugal
| | - A Vilen
- AniCura Landskrona Smådjursklinik, Föreningsgatan 165, Landskrona 261 51, Sweden
| | - E L Duarte
- Mediterranean Institute for Agriculture, Environment and Development & Departamento de Medicina Veterinária, Escola de Ciências e Tecnologia, Universidade de Évora, Universidade de Évora, Pólo da Mitra Apartado 94, Évora 7006-554, Portugal; ESCMID Study Group for Veterinary Microbiology (ESGVM), Basel, Switzerland
| | - M Dias
- Mediterranean Institute for Agriculture, Environment and Development & Departamento de Medicina Veterinária, Escola de Ciências e Tecnologia, Universidade de Évora, Universidade de Évora, Pólo da Mitra Apartado 94, Évora 7006-554, Portugal
| | - S Dewulf
- Veterinary Epidemiology Unit, Faculty of Veterinary Medicine, Ghent University, Gebouw D4, Salisburylaan 133, Merelbeke, Ghent 9820, Belgium
| | - A Wichtowska
- Department of Fundamental and Preclinical Sciences, Nicolaus Copernicus University, Jurija Gagarina 11, Toruń 87-100, Poland
| | - A Carranza Valencia
- Department of Clinical Veterinary Medicine, Vetsuisse Faculty, Bern University, Länggassstrasse 120, Bern 3012, Switzerland
| | - L Pelligand
- Dept. Comparative Biomedical Sciences, The Royal Veterinary College, University of London, 4 Royal College St, London NW1 0TU, United Kingdom; ESCMID Study Group for Veterinary Microbiology (ESGVM), Basel, Switzerland
| | - E M Broens
- Faculty of Veterinary Medicine, Utrecht University, Yalelaan 1, Utrecht 3584 CL, the Netherlands; ESCMID Study Group for Veterinary Microbiology (ESGVM), Basel, Switzerland
| | - P L Toutain
- Dept. Comparative Biomedical Sciences, The Royal Veterinary College, University of London, 4 Royal College St, London NW1 0TU, United Kingdom; INTHERES, Université de Toulouse, INRAE, ENVT, 23 Chem. des Capelles Entrée n°1, Toulouse 31300, France
| | - M Alishani
- Department of Veterinary Medicine, Faculty of Agriculture and Veterinary, University of Prishtina "Hasan Prishtina", Prishtina 10 000, Kosovo
| | - M L Brennan
- Centre for Evidence-based Veterinary Medicine, The University of Nottingham, Loughborough LE12 5RD, United Kingdom
| | - J S Weese
- Dept of Pathobiology, Ontario Veterinary College, University of Guelph, 419 Gordon St, Guelph, ON N1G 2W1, Canada
| | - L R Jessen
- Department of Veterinary Clinical Sciences, University of Copenhagen, Dyrlaegevej 16, Frederiksberg C 1870, Denmark; ESCMID Study Group for Veterinary Microbiology (ESGVM), Basel, Switzerland
| | - F Allerton
- Willows Veterinary Centre & Referral Service, Solihull B90 4NH, United Kingdom
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Krekis A, King JN, D'Arcy-Howard D, Stapleton N, Elliott J, Pelligand L. Reply to: Letter to the Editor from Malik et al.: Acute kidney injury following subcutaneous meloxicam administration. J Vet Pharmacol Ther 2024. [PMID: 38462540 DOI: 10.1111/jvp.13438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 02/25/2024] [Indexed: 03/12/2024]
Affiliation(s)
| | | | - Duncan D'Arcy-Howard
- Department of Clinical Science and Services, Beaumont Sainsbury Animal Hospital, Royal Veterinary College, University of London, London, UK
| | - Nadene Stapleton
- Department of Clinical Science and Services, Beaumont Sainsbury Animal Hospital, Royal Veterinary College, University of London, London, UK
| | - Jonathan Elliott
- Department of Comparative Biomedical Sciences, Royal Veterinary College, University of London, London, UK
| | - Ludovic Pelligand
- Department of Comparative Biomedical Sciences, Royal Veterinary College, University of London, London, UK
- Department of Clinical Science and Services, Queen Mother Hospital for Animals, Royal Veterinary College, University of London, London, UK
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Krekis A, King JN, D'Arcy-Howard D, Stapleton N, Elliott J, Pelligand L. Effect of meloxicam or robenacoxib administration timing on renal function and postoperative analgesia in cats undergoing ovariohysterectomy: A randomized, blinded, controlled clinical trial. J Vet Pharmacol Ther 2024. [PMID: 38235901 DOI: 10.1111/jvp.13427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/10/2023] [Accepted: 01/08/2024] [Indexed: 01/19/2024]
Abstract
We evaluated the effect of administration timing of meloxicam and robenacoxib on renal function, platelet cyclo-oxygenase and perioperative analgesia in 60 cats undergoing ovariohysterectomy, in a prospective randomized blinded controlled study. Twelve cats were randomly allocated to one subcutaneous treatment group: meloxicam (0.2 mg/kg) or robenacoxib (2 mg/kg) at admission (MA, RA), at induction (MI, RI) and robenacoxib at the end of surgery (RE). All cats received the same anaesthesia protocol. Plasma renin activity (PRA), plasma creatinine, drug concentrations and serum thromboxane (TxB2 ) were measured sequentially. Anaesthesia significantly increased PRA, as activity at end of the surgery was higher than 2 h later (mean ± SD: 26.6 ± 2.8 versus 10.0 ± 3.9 ng/mL/h). PRA remained higher at 2 h post-surgery in admission groups compared to induction groups (p = .01). Serum TxB2 was lower with meloxicam than robenacoxib (p = .001), and was lower in the MA than each robenacoxib group at catheter placement. Admission groups (16/24 from RA and MA groups) received earlier rescue analgesia than other groups (p = .033). In conclusion, the renin-angiotensin system was activated during anaesthesia despite cyclo-oxygenase inhibition, possibly due to hypotension or surgical stimulation. There was no effect of drug or timing on the markers of renal function but one cat receiving meloxicam at induction had suspected IRIS grade II acute kidney injury.
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Affiliation(s)
| | | | - Duncan D'Arcy-Howard
- Department of Clinical Science and Services, Beaumont Sainsbury Animal Hospital, Royal Veterinary College, University of London, London, UK
| | - Nadene Stapleton
- Department of Clinical Science and Services, Beaumont Sainsbury Animal Hospital, Royal Veterinary College, University of London, London, UK
| | - Jonathan Elliott
- Department of Comparative Biomedical Sciences, Royal Veterinary College, University of London, London, UK
| | - Ludovic Pelligand
- Department of Comparative Biomedical Sciences, Royal Veterinary College, University of London, London, UK
- Department of Clinical Science and Services, Queen Mother Hospital for Animals, Royal Veterinary College, University of London, London, UK
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Steagall PV, Pelligand L, Page S, Granick JL, Allerton F, Bęczkowski PM, Weese JS, Hrček AK, Queiroga F, Guardabassi L. The 2023 World Small Animal Veterinary Association (WSAVA): List of essential medicines for cats and dogs. J Small Anim Pract 2023; 64:731-748. [PMID: 37807906 DOI: 10.1111/jsap.13673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 10/10/2023]
Affiliation(s)
- P V Steagall
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC, Canada
- Department of Veterinary Clinical Sciences, Centre for Animal Health and Welfare, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, SAR, China
| | - L Pelligand
- The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, AL9 7TA, UK
| | - S Page
- Advanced Veterinary Therapeutics, Newtown, NSW, Australia
- Honorary Associate, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Sydney, NSW, Australia
| | - J L Granick
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN, USA
| | - F Allerton
- Willows Veterinary Centre & Referral Service, Highlands Road Shirley, Solihull, West Midlands, B90 4NH, UK
| | - P M Bęczkowski
- Department of Veterinary Clinical Sciences, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, SAR, China
| | - J S Weese
- Department of Pathobiology and Centre for Public Health and Zoonoses, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | | | - F Queiroga
- Animal and Veterinary Research Centre (CECAV), University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
- Center for the Study of Animal Sciences, CECA-ICETA, University of Porto, Porto, Portugal
| | - L Guardabassi
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark
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Lallemand EA, Bousquet-Mélou A, Chapuis L, Davis J, Ferran AA, Kukanich B, Kuroda T, Lacroix MZ, Minamijima Y, Olsén L, Pelligand L, Portugal FR, Roques BB, Santschi EM, Wilson KE, Toutain PL. Pharmacokinetic-pharmacodynamic cutoff values for benzylpenicillin in horses to support the establishment of clinical breakpoints for benzylpenicillin antimicrobial susceptibility testing in horses. Front Microbiol 2023; 14:1282949. [PMID: 37954237 PMCID: PMC10634207 DOI: 10.3389/fmicb.2023.1282949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/02/2023] [Indexed: 11/14/2023] Open
Abstract
Introduction The aim of this international project was to establish a species-specific Clinical Breakpoint for interpretation of Antimicrobial Susceptibility Testing of benzylpenicillin (BP) in horses. Methods A population pharmacokinetic model of BP disposition was developed to compute PK/PD cutoff values of BP for different formulations that are commonly used in equine medicine around the world (France, Sweden, USA and Japan). Investigated substances were potassium BP, sodium BP, procaine BP, a combination of procaine BP and benzathine BP and penethamate, a prodrug of BP. Data were collected from 40 horses that provided 63 rich profiles of BP corresponding to a total of 1022 individual BP plasma concentrations. Results A 3-compartment disposition model was selected. For each of these formulations, the PK/PD cutoff was estimated for different dosage regimens using Monte Carlo simulations. The fAUC/MIC or fT>MIC were calculated with a free BP fraction set at 0.4. For fAUC/MIC, a target value of 72 h (for a 72h treatment) was considered. For fT>MIC, efficacy was assumed when free plasma concentrations were above the explored MIC (0.0625-2 mg/L) for 30 or 40 % of the dosing interval. For continuous infusion, a fT>MIC of 90 % was considered. It was shown that a PK/PD cutoff of 0.25 mg/L can be achieved in 90 % of horses with routine regimen (typically 22,000 IU/kg or 12.4 mg/kg per day) with IM procaine BP once a day (France, Japan, Sweden but not USA1) and with IM sodium BP at 14.07 mg/kg, twice a day or IV sodium BP infusion of 12.4 mg/kg per day. In contrast, penethamate and the combination of procaine BP and benzathine BP were unable to achieve this PK/PD cutoff not even an MIC of 0.125 mg/L. Discussion The PK/PD cutoff of 0.25 mg/L is one dilution lower than the clinical breakpoint released by the CLSI (0.5 mg/ L). From our simulations, the CLSI clinical breakpoint can be achieved with IM procaine BP twice a day at 22,000 IU i.e. 12.4 mg/kg.
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Affiliation(s)
| | | | - Laura Chapuis
- INTHERES, Université de Toulouse, INRAE, ENVT, Toulouse, France
| | - Jennifer Davis
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, United States
| | - Aude A. Ferran
- INTHERES, Université de Toulouse, INRAE, ENVT, Toulouse, France
| | - Butch Kukanich
- Department of Anatomy and Physiology, Kansas State University, Manhattan, KS, United States
| | - Taisuke Kuroda
- Clinical Veterinary Medicine Division, Equine Research Institute, Japan Racing Association, Shimotsuke, Japan
| | | | - Yohei Minamijima
- Drug Analysis Department, Laboratory of Racing Chemistry, Utsunomiya, Japan
| | - Lena Olsén
- Division of Pharmacology and Toxicology, Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Ludovic Pelligand
- Department of Comparative Biomedical Sciences, The Royal Veterinary College, University of London, London, United Kingdom
| | | | | | - Elizabeth M. Santschi
- Department of Clinical Sciences, Kansas State University, Manhattan, KS, United States
| | - Katherine E. Wilson
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, United States
| | - Pierre-Louis Toutain
- INTHERES, Université de Toulouse, INRAE, ENVT, Toulouse, France
- Department of Comparative Biomedical Sciences, The Royal Veterinary College, University of London, London, United Kingdom
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Azzariti S, Mead A, Toutain PL, Bond R, Pelligand L. Time-Kill Analysis of Canine Skin Pathogens: A Comparison of Pradofloxacin and Marbofloxacin. Antibiotics (Basel) 2023; 12:1548. [PMID: 37887249 PMCID: PMC10603860 DOI: 10.3390/antibiotics12101548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023] Open
Abstract
Time-kill curves (TKCs) are more informative compared with the use of minimum inhibitory concentration (MIC) as they allow the capture of bacterial growth and the development of drug killing rates over time, which allows to compute key pharmacodynamic (PD) parameters. Our study aimed, using a semi-mechanistic mathematical model, to estimate the best pharmacokinetic/pharmacodynamic (PK/PD) indices (ƒAUC/MIC or %ƒT > MIC) for the prediction of clinical efficacy of veterinary FQs in Staphylococcus pseudintermedius, Staphylococcus aureus, and Escherichia coli collected from canine pyoderma cases with a focus on the comparison between marbofloxacin and pradofloxacin. Eight TCKs for each bacterial species (4 susceptible and 4 resistant) were analysed in duplicate. The best PK/PD index was ƒAUC24h/MIC in both staphylococci and E. coli. For staphylococci, values of 25-40 h were necessary to achieve a bactericidal effect, whereas the calculated values (25-35 h) for E. coli were lower than those predicting a positive clinical outcome (100-120 h) in murine models. Pradofloxacin showed a higher potency (lower EC50) in comparison with marbofloxacin. However, no difference in terms of a maximal possible pharmacological killing rate (Emax) was observed. Taking into account in vivo exposure at the recommended dosage regimen (3 and 2 mg/kg for pradofloxacin and marbofloxacin, respectively), the overall killing rates (Kdrug) computed were also similar in most instances.
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Affiliation(s)
- Stefano Azzariti
- Department of Comparative Biomedical Sciences, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield AL9 7TA, UK; (S.A.); (A.M.); (P.-L.T.)
| | - Andrew Mead
- Department of Comparative Biomedical Sciences, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield AL9 7TA, UK; (S.A.); (A.M.); (P.-L.T.)
| | - Pierre-Louis Toutain
- Department of Comparative Biomedical Sciences, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield AL9 7TA, UK; (S.A.); (A.M.); (P.-L.T.)
- INTHERES, Université de Toulouse, INRAE, Ecole Nationale Vétérinaire de Toulouse, 23 chemin des Capelles-BP 87614, CEDEX 03, 31076 Toulouse, France
| | - Ross Bond
- Department of Clinical Sciences and Services, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield AL9 7TA, UK;
| | - Ludovic Pelligand
- Department of Comparative Biomedical Sciences, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield AL9 7TA, UK; (S.A.); (A.M.); (P.-L.T.)
- Department of Clinical Sciences and Services, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield AL9 7TA, UK;
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Pelligand L, Baker D, Sivagurunathan A, Kovačević Z, Suemanotham N, Stair JL, Scott M, Liu F, Page SW, Guardabassi L, Steagall PV. Quality of amoxicillin/clavulanic acid oral formulations for intended veterinary use in the UK, Malaysia, Serbia and Thailand. J Small Anim Pract 2023; 64:626-634. [PMID: 37340896 DOI: 10.1111/jsap.13648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/27/2023] [Accepted: 05/24/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVES Amoxicillin/clavulanate is the most commonly used oral antimicrobial drug in companion animals. The objective of the study was to detect types and frequency of deficits in the quality of veterinary oral formulations of amoxicillin/clavulanate in various countries. MATERIALS AND METHODS In a prospective study with purposive sampling, amoxicillin/clavulanate tablet formulations for canine use were collected in four countries (wholesalers or veterinary practice) and shipped to a central bioanalytical laboratory. Twenty-four samples were collected from the UK (nine), Malaysia (nine), Serbia (four) and Thailand (two), yielding 18 different formulations (10 veterinary). Packaging inspection, tablet disintegration and content assay were conducted (validated high-performance liquid chromatography with ultra-violet detection); content was acceptable when within the 90% to 120% pre-specified range (US Pharmacopeia). RESULTS Secondary packaging was present for 13 of 24 samples and primary packaging integrity was verified for all but one sample. Amoxicillin trihydrate/potassium clavulanate label ratio was 4:1, except for three formulations (2:1). Tablet dose strength ranged from 250 to 625 mg. All formulations contained both analytes. For amoxicillin, two of 24 samples were out of specification with 72.8% (Malaysia) and 82.3% (Thailand) of labelled content. For clavulanate, four of 24 samples were out of specification with 46.9% (Serbia), 79.0% (UK), 84.3% (Serbia) and 86.5% (Thailand) of labelled content. One formulation (Thailand) failed for both analytes. CLINICAL SIGNIFICANCE Antimicrobial formulations of substandard quality have negative consequences for efficacy in patients and potentially promote antimicrobial resistance. There was evidence of substandard formulations in all countries, not only for amoxicillin but especially for clavulanate; this could compromise equitable access to acceptable quality essential veterinary medicines worldwide.
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Affiliation(s)
- L Pelligand
- Department of Clinical Services and Sciences and Department of Comparative Biomedical Sciences, Royal Veterinary College, Hatfield, UK
| | - D Baker
- Department of Clinical, Pharmaceutical & Biological Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | | | - Z Kovačević
- Department for Veterinary Medicine, Faculty of Agriculture, University of Novi Sad, Novi Sad, Serbia
| | - N Suemanotham
- Department of Pathology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - J L Stair
- Department of Clinical, Pharmaceutical & Biological Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - M Scott
- Department of Clinical, Pharmaceutical & Biological Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - F Liu
- Department of Clinical, Pharmaceutical & Biological Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - S W Page
- Veterinary Clinical Pharmacology and Toxicology, Advanced Veterinary Therapeutics, Newtown, NSW, 2042, Australia
| | - L Guardabassi
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - P V Steagall
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC, J2S 2M2, Canada
- Department of Veterinary Clinical Sciences, Centre for Animal Health and Welfare, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, China
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Mead A, Toutain PL, Richez P, Pelligand L. Targeted dosing for susceptible heteroresistant subpopulations may improve rational dosage regimen prediction for colistin in broiler chickens. Sci Rep 2023; 13:12822. [PMID: 37550398 PMCID: PMC10406827 DOI: 10.1038/s41598-023-39727-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 07/30/2023] [Indexed: 08/09/2023] Open
Abstract
The dosage of colistin for the treatment of enteric E. coli in animals necessitates considering the heteroresistant (HR) nature of the targeted inoculum, described by the presence of a major susceptible population (S1, representing 99.95% of total population) mixed with an initial minor subpopulation of less susceptible bacteria (S2). Herein, we report the 1-compartment population pharmacokinetics (PK) of colistin in chicken intestine (jejunum and ileum) and combined it with a previously established pharmacodynamic (PD) model of HR in E. coli. We then computed probabilities of target attainment (PTA) with a pharmacodynamic target (AUC24h/MIC) that achieves 50% of the maximal kill of bacterial populations (considering inoculums of pure S1, S2 or HR mixture of S1 + S2). For an MIC of 1 mg/L, PTA > 95% was achieved with the registered dose (75,000 IU/kg BW/day in drinking water) for the HR mixture of S1 + S2 E. coli, whether they harboured mcr or not. For an MIC of 2 mg/L (ECOFF), we predicted PTA > 90% against the dominant susceptible sub-population (S1) with this clinical dose given (i) over 24 h for mcr-negative isolates or (ii) over 6 h for mcr-positive isolates (pulse dosing). Colistin clinical breakpoint S ≤ 2 mg/L (EUCAST rules) should be confirmed clinically.
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Affiliation(s)
- Andrew Mead
- Comparative Biomedical Sciences, The Royal Veterinary College, London, UK.
| | - Pierre-Louis Toutain
- Comparative Biomedical Sciences, The Royal Veterinary College, London, UK
- INTHERES, Université de Toulouse, INRAE, ENVT, Toulouse, France
| | | | - Ludovic Pelligand
- Comparative Biomedical Sciences, The Royal Veterinary College, London, UK
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10
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Toutain PL, Gandia P, Pelligand L, Ferran AA, Lees P, Bousquet-Mélou A, Concordet D. Biased computation of probability of target attainment for antimicrobial drugs. CPT Pharmacometrics Syst Pharmacol 2023; 12:681-689. [PMID: 37025064 DOI: 10.1002/psp4.12929] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 11/23/2022] [Accepted: 01/19/2023] [Indexed: 04/08/2023] Open
Abstract
The medical literature is replete with articles in which there is confusion between "free concentration" and "unbound fraction" (fu ), which is the ratio of free to total plasma concentration. The lack of clarity in distinguishing between these two terms has led to biased computations, erroneous interpretations, and misleading recommendations. The problems are highlighted in this paper, taking the example of calculation of Probability of Target Attainment (PTA). This metric is used to propose pharmacokinetic/pharmacodynamic (PK/PD) breakpoints required for the interpretation of Antimicrobial Susceptibility Testing. Based on Monte Carlo simulations of the PK/PD index, area under the unbound concentration time curve/minimum inhibitory concentration (fAUC/MIC), computation of PTA from total plasma concentrations scaled by fu ineluctably leads to biased estimates. The bias is greater if the variability associated with fu is added, instead of removing it during this scaling. The explanation for the bias is that total plasma drug concentrations are intrinsically more variable than the corresponding free concentrations. This is due to the variability of antimicrobial binding for total, but not for free plasma concentrations. In consequence, the greater variability always leads to underestimation of the PK/PD cutoff (i.e., the critical MIC that is guaranteed for a given percentile of the population). A further consequence is an increase in calculated dosage required to attain the targeted quantile. This erroneous approach, of using free antimicrobial drug fraction, is not limited to the derivation of PK/PD cutoff, but may also have consequences for antimicrobials drug safety in clinical patients.
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Affiliation(s)
- Pierre-Louis Toutain
- INTHERES, Université de Toulouse, INRAE, ENVT, Toulouse, France
- The Royal Veterinary College, University of London, London, UK
| | - Peggy Gandia
- INTHERES, Université de Toulouse, INRAE, ENVT, Toulouse, France
| | | | - Aude A Ferran
- INTHERES, Université de Toulouse, INRAE, ENVT, Toulouse, France
| | - Peter Lees
- The Royal Veterinary College, University of London, London, UK
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Ho NT, Santoro F, Palacios Jimenez C, Pelligand L. Cross-sectional survey of sleep, fatigue and mental health in veterinary anaesthesia personnel. Vet Anaesth Analg 2023:S1467-2987(23)00051-X. [PMID: 37142463 DOI: 10.1016/j.vaa.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 01/27/2023] [Accepted: 03/16/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To evaluate the sleep quality, prevalence of fatigue and depressive symptoms in veterinary anaesthesia personnel. STUDY DESIGN Anonymous online voluntary survey. METHODS Sleep quality, fatigue, depressive symptoms and self-perceived burnout were scored using the Pittsburgh Sleep Quality Index (PSQI), Fatigue Severity Scale (FSS), Patient Health Questionnaire-9 (PHQ-9) and single-item burnout measure, respectively. Demographic data and questions about work-related fatigue, out-of-hours duty, transport and rest periods were included. PSQI, FSS and PHQ-9 scores were compared using Spearman rank correlation tests. RESULTS Responses from 393 participants were obtained from an estimated population of 1374 including diplomates of the American and European Colleges of Veterinary An(a)esthesia and Analgesia (43.9%), residency-trained veterinarians (15.6%), residents-in-training (13.8%) and veterinary technicians and nurses (12.0%), from 32 countries. Most were employed in clinical university teaching hospitals (54.2%) or clinical private practice (41.5%). PSQI scores > 5 were reported by 71.2% of respondents, with 52.4% reporting insufficient sleep to meet their job demands. Many showed high or borderline fatigue (56.4%), and 74.7% reported mistakes due to work-related fatigue. Major depressive symptoms (PHQ-9 score ≥ 10) were found in 42.7%, with 19.2% reporting they had thought about suicide or self-harm in the previous 2 weeks. Over half (54.8%) met the criteria for burnout and more veterinary nurses and technicians suffered from burnout than other roles, with 79.6% of this group affected (p < 0.001). Scores for PSQI and FSS [r (388) = 0.40, p < 0.001]; PSQI and PHQ-9 [r (389) = 0.23, p < 0.001]; and FSS and PHQ-9 [r (387) = 0.24, p < 0.001] were all positively correlated. CONCLUSIONS AND CLINICAL RELEVANCE This survey demonstrates a high prevalence of poor sleep, fatigue, depressive symptoms and burnout in veterinary anaesthesia personnel, and more should be done to improve the health of those in the profession.
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Affiliation(s)
- Nicola Tz Ho
- Department of Clinical Sciences and Services, Royal Veterinary College, University of London, Hatfield, UK.
| | - Francesco Santoro
- Department of Clinical Sciences and Services, Royal Veterinary College, University of London, Hatfield, UK
| | - Carolina Palacios Jimenez
- Department of Clinical Sciences and Services, Royal Veterinary College, University of London, Hatfield, UK
| | - Ludovic Pelligand
- Department of Clinical Sciences and Services, Royal Veterinary College, University of London, Hatfield, UK; Department of Comparative Biomedical Sciences, Royal Veterinary College, University of London, Hatfield, UK
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12
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Azzariti S, Bond R, Loeffler A, Zendri F, Timofte D, Chang YM, Pelligand L. Investigation of In Vitro Susceptibility and Resistance Mechanisms in Skin Pathogens: Perspectives for Fluoroquinolone Therapy in Canine Pyoderma. Antibiotics (Basel) 2022; 11:antibiotics11091204. [PMID: 36139982 PMCID: PMC9494949 DOI: 10.3390/antibiotics11091204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/02/2022] [Accepted: 09/03/2022] [Indexed: 11/16/2022] Open
Abstract
Fluoroquinolones (FQ) are commonly used in dogs with bacterial skin infections. Their use as first choice, along with the increased incidence of FQ-resistance, represents a risk to animal and public health. Our study determined minimum inhibitory (MIC) and bactericidal (MBC) concentrations of five FQs in Staphylococcus aureus, Staphylococcus pseudintermedius, and Escherichia coli, together with FQ-resistance mechanisms. MICs, efflux pump (EP) overexpression and MBCs were measured in 249 skin infection isolates following CLSI guidelines (CLSI VET01-A4, CLSI M26-A). Chromosomal and plasmid-mediated resistance genes were investigated after DNA extraction and sequencing. FQ-resistance was detected in 10% of methicillin-susceptible (MS), 90% of methicillin-resistant (MR) staphylococci and in 36% of E. coli. Bactericidal effect was observed except in 50% of MRSA/P for ciprofloxacin and in 20% of MRSPs for enrofloxacin. Highest MICs were associated with double mutation in gyrA (Ser83Leu + Asp87Asn), efflux pumps and three PMQR genes in E. coli, and grlA (Ser80Phe + Glu84Lys) in S. aureus. EP overexpression was high among E. coli (96%), low in S. aureus (1%) and absent in S. pseudintermedius. Pradofloxacin and moxifloxacin showed low MICs with bactericidal effect. Since in vitro FQ resistance was associated with MR, FQ use should be prudently guided by susceptibility testing.
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Affiliation(s)
- Stefano Azzariti
- Department of Comparative Biomedical Sciences, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield AL9 7TA, UK
| | - Ross Bond
- Department of Clinical Sciences and Services, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield AL9 7TA, UK
| | - Anette Loeffler
- Department of Clinical Sciences and Services, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield AL9 7TA, UK
| | - Flavia Zendri
- Institute of Infection, Veterinary and Ecological Sciences, Department of Veterinary Anatomy, Physiology and Pathology, Veterinary Microbiology Diagnostic, University of Liverpool Leahurst Campus, Neston CH64 7TE, UK
| | - Dorina Timofte
- Institute of Infection, Veterinary and Ecological Sciences, Department of Veterinary Anatomy, Physiology and Pathology, Veterinary Microbiology Diagnostic, University of Liverpool Leahurst Campus, Neston CH64 7TE, UK
| | - Yu-Mei Chang
- Research Support Office, Royal Veterinary College, University of London, London NW1 0TU, UK
| | - Ludovic Pelligand
- Department of Comparative Biomedical Sciences, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield AL9 7TA, UK
- Department of Clinical Sciences and Services, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield AL9 7TA, UK
- Correspondence:
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13
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Henze L, Foth S, Meller S, Twele F, Charalambous M, Kenward H, Elliott J, Pelligand L, Volk HA. Ondansetron in dogs with nausea associated with vestibular disease: A double-blinded, randomized placebo-controlled crossover study. Vet Med (Auckl) 2022; 36:1726-1732. [PMID: 35906792 PMCID: PMC9511069 DOI: 10.1111/jvim.16504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/15/2022] [Indexed: 11/26/2022]
Abstract
Background Nausea and emesis can be, among other signs, common manifestations of acute vestibular system dysfunction in dogs. Currently, antiemetic drugs, such as maropitant and metoclopramide, are used commonly, but do not appear to control nausea. A non‐placebo‐controlled preliminary study suggested good efficacy of 5‐HT3‐receptor antagonists, such as ondansetron, against nausea in dogs with vestibular syndrome. Objectives To assess and confirm the effect of ondansetron on behavior suggestive of nausea in dogs with vestibular syndrome. Animals Fourteen dogs with vestibular syndrome and clinical signs of nausea presented to a neurology service. Methods Placebo‐controlled, double‐blinded, crossover study. Behavioral assessment was performed hourly for 4 hours using an established numerical rating scale. The criteria salivation, lip licking, vocalization, restlessness, lethargy, and general nausea were scored. The occurrence of emesis was recorded. After scoring at T0 (pre‐dose) and T2 (2 hours post‐dose) either ondansetron (0.5 mg/kg) or placebo was injected IV. Two hours post‐dose, treatments were switched. Blood samples were collected to measure serum arginine vasopressin (AVP) concentration, which previously has been shown to correlate with clinical signs of nausea. Results Clinical resolution of nausea was observed 1 hour after administration of ondansetron, whereas serum AVP concentration decreased 4 hours after ondansetron administration. Conclusion and Clinical Importance Administration of ondansetron IV is beneficial for dogs with nausea secondary to acute vestibular syndrome. Ondansetron substantially and rapidly decreased clinical signs of nausea behavior and stopped emesis.
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Affiliation(s)
- Lea Henze
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Sarah Foth
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Sebastian Meller
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Friederike Twele
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Marios Charalambous
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Hannah Kenward
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, Hertfordshire, UK
| | - Jonathan Elliott
- Department of Comparative Biomedical Sciences, Royal Veterinary College, Hatfield, Hertfordshire, UK
| | - Ludovic Pelligand
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, Hertfordshire, UK
| | - Holger A Volk
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
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14
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Stathopoulou T, Light J, Lamas LP, Pierce SE, Pelligand L. A Protocol for Prolonged Surgical Anaesthesia with Recovery in Fire Salamanders Using Tricaine Mesylate (MS-222): A Case Series. Lab Anim 2022; 56:540-549. [PMID: 35850552 DOI: 10.1177/00236772221103706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study was to describe prolonged surgical anaesthesia and recovery in fire salamanders (Salamandra salamandra) using tricaine methanesulfonate (MS-222). A total of 14 salamanders were anaesthetised for electromyography wire implantation. Sodium bicarbonate buffered solutions (0.5-4 g l-1) of MS-222 were prepared (adjusted to pH 7.0). Anaesthesia was induced by partial immersion in pre-oxygenated 3 g l-1 solution for 20 min. Buprenorphine (0.5 mg kg-1) was administered subcutaneously. During microsurgery, heart rate (HR), solution pH and temperature were recorded. Reflectance pulse oximeter (SpO2) (Masimo Rad-57) was recorded in two salamanders. Anaesthetic plane and MS-222 pH stability (pH 7.6) were maintained by renewing administration of oxygenated MS-222 solution (0.5-3 g l-1) onto swabs that partially covered the body. Recovery started at the end of surgery (MS-222 0 g l-1). Postoperatively, salamanders were given oral meloxicam (0.2 mg kg-1). Mean time for loss of righting reflex during induction was 13.7 ± 2.2 min. Duration of anaesthesia and time to recovery were 111 ± 24.2 and 31 ± 10.3 min, respectively. Due to complications, two salamanders did not recover. Baseline HR was 67.4 ± 34.5 beats/min, and it decreased significantly until recovery (p ≤ 0.0001). In two salamanders, baseline SpO2 was 85.5% ± 14.5, SpO2 during surgery was 61% ± 6.4, improving to 80.5% ± 2.1 on recovery.In conclusion, prolonged recovery anaesthesia is achievable with MS-222 dilutions in salamander. Reflectance SpO2 could prove valuable during immersion anaesthesia.
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Affiliation(s)
- T Stathopoulou
- Department of Clinical Services and Sciences, Royal Veterinary College, London, UK
| | - J Light
- Department of Clinical Services and Sciences, Royal Veterinary College, London, UK
| | - L P Lamas
- Faculdade de Medicina Veterinária, Departamento de Clínica, Pólo Universitário do Alto da Ajuda, Lisbon, Portugal
| | - S E Pierce
- Museum of Comparative Zoology and Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA 02139, USA
| | - L Pelligand
- Department of Clinical Services and Sciences, Royal Veterinary College, London, UK.,Department of Comparative Biomedical Sciences, Royal Veterinary College, London, UK
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15
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Lees P, Toutain PL, Elliott J, Giraudel JM, Pelligand L, King JN. Pharmacology, safety, efficacy and clinical uses of the COX-2 inhibitor robenacoxib. J Vet Pharmacol Ther 2022; 45:325-351. [PMID: 35460083 PMCID: PMC9541287 DOI: 10.1111/jvp.13052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 02/23/2022] [Accepted: 03/06/2022] [Indexed: 12/14/2022]
Abstract
Robenacoxib is a veterinary‐approved non‐steroidal anti‐inflammatory drug (NSAID) of the coxib group. It possesses anti‐hyperalgesic, anti‐inflammatory and anti‐pyretic properties. Robenacoxib inhibits the cyclooxygenase (COX)‐2 isoform of COX selectively (in vitro IC50 ratios COX‐1:COX‐2, 129:1 in dogs, 32:1 in cats). At registered dosages (2 mg/kg subcutaneously in dogs and cats, 1–4 mg/kg orally in dogs and 1–2.4 mg/kg orally in cats), robenacoxib produces significant inhibition of COX‐2 whilst sparing COX‐1. The pharmacokinetic (PK) profile of robenacoxib is characterized by a high degree of binding to plasma proteins (>98%) and moderate volume of distribution (at steady state, 240 ml/kg in dogs and 190 ml/kg in cats). In consequence, the terminal half‐life in blood (<2 h) is short, despite moderate body clearance (0.81 L/kg/h) in dogs and low clearance (0.44 L/kg/h) in cats. Excretion is principally in the bile (65% in dogs and 72% in cats). Robenacoxib concentrates in inflamed tissues, and clinical efficacy is achieved with once‐daily dosing, despite the short blood terminal half‐life. In dogs, no relevant breed differences in robenacoxib PK have been detected. Robenacoxib has a wide safety margin; in healthy laboratory animals daily oral doses 20‐fold (dog, 1 month), eight‐fold (cat, 6 weeks) and five‐fold (dog, 6 months) higher than recommended clinical doses were well tolerated. Clinical efficacy and safety have been demonstrated in orthopaedic and soft tissue surgery, and in musculoskeletal disorders in dogs and cats.
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Affiliation(s)
- Peter Lees
- Royal Veterinary College, University of London, London, UK
| | - Pierre-Louis Toutain
- Royal Veterinary College, University of London, London, UK.,INTHERES, INRA, ENVT, Université de Toulouse, Toulouse, France
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16
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Vegas Cómitre MD, Cortellini S, Cherlet M, Devreese M, Roques BB, Bousquet-Melou A, Toutain PL, Pelligand L. Population Pharmacokinetics of Intravenous Amoxicillin Combined With Clavulanic Acid in Healthy and Critically Ill Dogs. Front Vet Sci 2021; 8:770202. [PMID: 34869739 PMCID: PMC8636140 DOI: 10.3389/fvets.2021.770202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/18/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Data regarding antimicrobial pharmacokinetics (PK) in critically ill dogs are lacking and likely differ from those of healthy dogs. The aim of this work is to describe a population PK model for intravenous (IV) amoxicillin–clavulanic acid (AMC) in both healthy and sick dogs and to simulate a range of clinical dosing scenarios to compute PK/PD cutoffs for both populations. Methods: This study used a prospective clinical trial in normal and critically ill dogs. Twelve client-owned dogs hospitalized in the intensive care unit (ICU) received IV AMC 20 mg/kg every 8 h (0.5-h infusion) during at least 48 h. Eight blood samples were collected at predetermined times, including four trough samples before the next administration. Clinical covariates and outcome were recorded, including survival to discharge and bacteriologic clinical failure. Satellite PK data were obtained de novo from a group of 12 healthy research dogs that were dosed with a single AMC 20 mg/kg IV. Non-linear mixed-effects model was used to estimate the PK parameters (and the effect of health upon them) together with variability within and between subjects. Monte Carlo simulations were performed with seven dosage regimens (standard and increased doses). The correlation between model-derived drug exposure and clinical covariates was tested with Spearman's non-parametric correlation analysis. Outcome was recorded including survival to discharge and bacteriologic clinical failure. Results: A total of 218 amoxicillin concentrations in plasma were available for healthy and sick dogs. A tricompartmental model best described the data. Amoxicillin clearance was reduced by 56% in sick dogs (0.147 L/kg/h) compared with healthy dogs (0.336 L/kg/h); intercompartmental clearance was also decreased (p <0.01). None of the clinical data covariates were significantly correlated with individual exposure. Monte Carlo simulations showed that higher PK/PD cutoff values of 8 mg/L could be reached in sick dogs by extending the infusion to 3 h or doubling the dose. Conclusions: The PK of AMC is profoundly different in critically ill dogs compared with normal dogs, with much higher interindividual variability and a lower systemic clearance. Our study allows to generate hypotheses with regard to higher AMC exposure in clinical dogs and provides supporting data to revise current AMC clinical breakpoint for IV administration.
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Affiliation(s)
- Maria D Vegas Cómitre
- Department of Clinical Science and Services, The Royal Veterinary College, Hatfield, United Kingdom
| | - Stefano Cortellini
- Department of Clinical Science and Services, The Royal Veterinary College, Hatfield, United Kingdom
| | - Marc Cherlet
- Department of Pharmacology, Toxicology and Biochemistry, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Mathias Devreese
- Department of Pharmacology, Toxicology and Biochemistry, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | | | | | - Pierre-Louis Toutain
- INTHERES, Université de Toulouse, INRAE, ENVT, Toulouse, France.,Department of Comparative Biomedical Science, The Royal Veterinary College, Hatfield, United Kingdom
| | - Ludovic Pelligand
- Department of Clinical Science and Services, The Royal Veterinary College, Hatfield, United Kingdom.,Department of Comparative Biomedical Science, The Royal Veterinary College, Hatfield, United Kingdom
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17
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Quesada N, Pelligand L, Doig M, Sanchis‐Mora S. Suspected local anaesthetic systemic toxicity (LAST) after several bupivacaine injections through an epidural catheter in a cat. Vet Record Case Reports 2021. [DOI: 10.1002/vrc2.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Nuria Quesada
- Clinical Science and Services Royal Veterinary College London UK
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18
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Mead A, Gillard N, Robert C, Pierret G, Henrottin J, Richez P, Pelligand L. Determination of colistin in luminal and parietal intestinal matrices of chicken by ultra-high-performance liquid chromatography-tandem mass spectrometry. J Vet Pharmacol Ther 2021; 44:982-985. [PMID: 34614207 PMCID: PMC9293311 DOI: 10.1111/jvp.13022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/15/2021] [Accepted: 09/27/2021] [Indexed: 11/16/2022]
Abstract
Justification for continued use of colistin in veterinary medicine, for example medicated water, relies on pharmacokinetic/pharmacodynamic (PK/PD) studies that require accurate measurement of colistin content in the digestive tract. A method for the detection and quantification of colistin in poultry intestinal material was developed and validated. Colistin is not absorbed after oral administration, and the biophase is the gastrointestinal tract. Extraction of colistin from the matrix was achieved using solid‐phase extraction with a methanol:water (1:2; v/v) solution. Polymyxin B was used as an internal standard. Colistin A and colistin B, the main components of colistin, were separated, detected and measured using ultra‐high‐performance liquid chromatography coupled with tandem mass spectrometry (UHPLC‐MS/MS). The method was validated for linearity/quadraticity between 1.1 (LOQ) and 56.7 mg/kg. Mean accuracy was between 82.7% and 107.7% with inter‐ and intra‐day precision lower than 13.3% and 15% respectively. Freeze–thaw, long‐term and bench storage were validated. Incurred samples following colistin treatment in poultry at the approved clinical dose of 75,000 IU/kg in drinking water and oral gavage were quantifiable and in line with expected intestinal transit times. The method is considered appropriately accurate and precise for the purposes of pharmacokinetic analysis in the gastrointestinal tract.
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19
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Tikhomirov M, Antończyk A, Śniegocki T, Jajor P, Świtała M, Skrzypczak P, Kiełbowicz Z, Posyniak A, Pelligand L, Pozniak B. Intravenous lipid emulsion as a treatment in buprenorphine overdose - pharmacokinetic and pharmacodynamic evaluation in the rabbit model. Toxicol Lett 2021. [DOI: 10.1016/s0378-4274(21)00436-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Sadouki Z, McHugh TD, Aarnoutse R, Ortiz Canseco J, Darlow C, Hope W, van Ingen J, Longshaw C, Manissero D, Mead A, Pelligand L, Phee L, Readman J, Ruth MM, Standing JF, Stone N, Wey EQ, Kloprogge F. Application of the hollow fibre infection model (HFIM) in antimicrobial development: a systematic review and recommendations of reporting. J Antimicrob Chemother 2021; 76:2252-2259. [PMID: 34179966 PMCID: PMC8361333 DOI: 10.1093/jac/dkab160] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/21/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This systematic review focuses on the use of the in vitro hollow fibre infection model (HFIM) for microbial culture. We summarize the direction of the field to date and propose best-practice principles for reporting of the applications. METHODS Searches in six databases (MEDLINE®, EMBASE®, PubMed®, BIOSIS®, SCOPUS® and Cochrane®) up to January 2020 identified 129 studies meeting our inclusion criteria. Two reviewers independently assessed and extracted data from each publication. The quality of reporting of microbiological and technical parameters was analysed. RESULTS Forty-seven out of 129 (36.4%) studies did not report the minimum pharmacokinetic parameters required in order to replicate the pharmacokinetic profile of HFIM experiments. Fifty-three out of 129 (41.1%) publications did not report the medium used in the HFIM. The overwhelming majority of publications did not perform any technical repeats [107/129 (82.9%)] or biological repeats [97/129 (75.2%)]. CONCLUSIONS This review demonstrates that most publications provide insufficient data to allow for results to be evaluated, thus impairing the reproducibility of HFIM experiments. Therefore, there is a clear need for the development of laboratory standardization and improved reporting of HFIM experiments.
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Affiliation(s)
- Zahra Sadouki
- Institute for Global Health, University College London, London, UK.,Centre of Clinical Microbiology, University College London, London, UK
| | - Timothy D McHugh
- Centre of Clinical Microbiology, University College London, London, UK
| | - Rob Aarnoutse
- Department of Internal Medicine, Radboud Center of Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Christopher Darlow
- Antimicrobial Pharmacodynamics and Therapeutics, University of Liverpool, Liverpool, UK
| | - William Hope
- Antimicrobial Pharmacodynamics and Therapeutics, University of Liverpool, Liverpool, UK
| | - Jakko van Ingen
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Davide Manissero
- Medical Affairs for Infection and Immune Diagnostics, QIAGEN, London, UK
| | - Andrew Mead
- Department of Comparative Biological Sciences, The Royal Veterinary College, London, UK
| | - Ludovic Pelligand
- Department of Comparative Biological Sciences, The Royal Veterinary College, London, UK
| | - Lynette Phee
- Antimicrobial Research Group, Barts and The London School of Medicine and Dentistry, Queen Mary University London, London, UK
| | - John Readman
- Infection, Immunity, Inflammation Section, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Mike M Ruth
- Department of Internal Medicine, Radboud Center of Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Joseph F Standing
- Infection, Immunity, Inflammation Section, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Neil Stone
- Department of Microbiology, University College London Hospitals, London, UK
| | | | - Frank Kloprogge
- Institute for Global Health, University College London, London, UK
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21
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Mead A, Richez P, Azzariti S, Pelligand L. Pharmacokinetics of Colistin in the Gastrointestinal Tract of Poultry Following Dosing via Drinking Water and Its Bactericidal Impact on Enteric Escherichia coli. Front Vet Sci 2021; 8:698135. [PMID: 34250071 PMCID: PMC8264055 DOI: 10.3389/fvets.2021.698135] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/18/2021] [Indexed: 11/13/2022] Open
Abstract
Colistin, a last-line antibiotic of major importance in veterinary medicine and of critical importance in human medicine, is authorized to treat gastrointestinal (enteric) infections caused by non-invasive Escherichia coli in multiple veterinary species including poultry. Its use in veterinary medicine has been implicated in the widespread prevalence of mobilized colistin resistance. The objectives of this study were to determine the intestinal content reached in broiler chickens during 72-h treatment with colistin, to evaluate the associated impact on intestinal E. coli density, and to select less susceptible E. coli populations. In this study, 94 broiler chickens were administered a dose of 75,000 IU/kg/day via drinking water. Intestinal samples were collected pre-, during-, and post-dosing. Luminal intestinal content was assessed for colistin content by ultra-high-performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS), and E. coli were isolated and enumerated on UriSelect agar™. Minimum inhibitory concentration (MIC, for eight isolates per intestine per animal) was determined, and when higher than the epidemiological cutoff (ECOFF 2 mg/l), isolates were screened for mobilized colistin resistance (mcr)-1 to 5. Colistin content increased during treatment to a maximum of 5.09 mg/kg. During this time, the total population of E. coli showed an almost 1,000-fold reduction. An apparent increase in the relative abundance of E. coli with an MIC ≥ ECOFF, either mcr-negative (6.25–10.94%) or mcr-1-positive (4.16–31.25%) was observed, although this susceptibility shift was not maintained post-treatment. Indeed, following cessation of dosing, colistin was eliminated from the intestine, and content was below the limit of quantification (LOQ, 1.1 mg/kg) within 4 h, and the median MIC of E. coli isolates returned below baseline thereafter. Few isolates with a lower susceptibility (mcr-1-positive or negative) were however observed at the end of the study period, indicating maintained sub-populations in the chicken gut. The results of this study show a limited impact on long-term maintenance of less susceptible E. coli populations as a direct result of colistin treatment in individual birds.
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Affiliation(s)
- Andrew Mead
- Comparative Biomedical Sciences, The Royal Veterinary College, London, United Kingdom
| | | | - Stefano Azzariti
- Comparative Biomedical Sciences, The Royal Veterinary College, London, United Kingdom
| | - Ludovic Pelligand
- Comparative Biomedical Sciences, The Royal Veterinary College, London, United Kingdom
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Foth S, Meller S, Kenward H, Elliott J, Pelligand L, Volk HA. The use of ondansetron for the treatment of nausea in dogs with vestibular syndrome. BMC Vet Res 2021; 17:222. [PMID: 34154584 PMCID: PMC8218477 DOI: 10.1186/s12917-021-02931-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/07/2021] [Indexed: 12/12/2022] Open
Abstract
Background Vestibular syndrome is often accompanied by nausea. Drugs currently approved for its treatment have been developed to stop vomiting but not nausea. The efficacy of 5-HT3 receptor antagonists to reduce nausea has been described for chemotherapy, but not for nausea secondary to vestibular disorders. Methods Sixteen dogs with vestibular syndrome-associated nausea were included in the open-label, multicentre study. The intensity of nausea-like behaviour was analysed before ondansetron administration (0.5 mg/kg i.v.) and 2 h afterwards, using a validated 5-point-scale. The occurrence and frequency of salivation, lip licking, restlessness, vocalisation, lethargy, and vomiting were assessed. Results All dogs initially showed signs of nausea, whereas only 31% showed vomitus. The intensity of nausea was significantly reduced in all dogs (p ≤ 0.0001) 2 h after ondansetron administration, including the clinical signs of nausea analysed in 11 dogs (salivation [p = 0.0078], lip licking [p = 0.0078], restlessness [p = 0.0039], and lethargy [p = 0.0078]) except for vocalisation (p > 0.9999). Conclusions The results provide preliminary evidence of the potential benefit of ondansetron in the treatment of nausea, which was present in all examined dogs. Vomiting was only observed in 5 dogs indicating that nausea can occur separately and should not be perceived only as a preceding stimulation of the vomiting centre. Supplementary Information The online version contains supplementary material available at 10.1186/s12917-021-02931-9.
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Affiliation(s)
- S Foth
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
| | - S Meller
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
| | - H Kenward
- Department of Clinical Science and Services, Royal Veterinary College, Hertfordshire, Hatfield, UK
| | - J Elliott
- Department of Comparative Biomedical Sciences, Royal Veterinary College, Hertfordshire, Hatfield, UK
| | - L Pelligand
- Department of Clinical Science and Services, Royal Veterinary College, Hertfordshire, Hatfield, UK
| | - H A Volk
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany.
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Temmerman R, Pelligand L, Schelstraete W, Antonissen G, Garmyn A, Devreese M. Enrofloxacin Dose Optimization for the Treatment of Colibacillosis in Broiler Chickens Using a Drinking Behaviour Pharmacokinetic Model. Antibiotics (Basel) 2021; 10:antibiotics10050604. [PMID: 34069540 PMCID: PMC8161238 DOI: 10.3390/antibiotics10050604] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/13/2021] [Accepted: 05/17/2021] [Indexed: 12/03/2022] Open
Abstract
Enrofloxacin is frequently administered via drinking water for the treatment of colibacillosis in broiler chickens. However, the EMA/CVMP has urged to re-evaluate historically approved doses, especially for antimicrobials administered via drinking water. In response, the objectives of this study were two-fold. First, to evaluate the pharmacokinetics (PK) of enrofloxacin following IV, PO and drinking water administration. Second, to predict the efficacy of a range of doses in the drinking water for the treatment of APEC infections. For the first objective, PK parameters were estimated by fitting a one-compartmental model with a zero-order IV infusion and an oral absorption lag function to the simultaneously modelled IV and PO data. After fixing these parameter values, a drinking behaviour pharmacokinetic (DBPK) model was developed for the description and prediction of drinking water PK profiles by adding three model improvements (different diurnal and nocturnal drinking rates, inter-animal variability in water consumption and taking account of dose non-proportionality). The subsequent simulations and probability of target attainment (PTA) analysis predicted that a dose of 12.5 mg/kg/24 h is efficacious in treating colibacillosis with an MIC up to 0.125 μg/mL (ECOFF), whereas the currently registered dose (10 mg/kg/24 h) reaches a PTA of 66% at ECOFF.
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Affiliation(s)
- Robin Temmerman
- Department of Pharmacology, Toxicology and Biochemistry, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium; (R.T.); (W.S.); (G.A.)
| | - Ludovic Pelligand
- Department of Clinical Sciences and Services, Royal Veterinary College, University of London, Hawkshead Lane, Hatfield AL9 7TA, UK;
| | - Wim Schelstraete
- Department of Pharmacology, Toxicology and Biochemistry, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium; (R.T.); (W.S.); (G.A.)
| | - Gunther Antonissen
- Department of Pharmacology, Toxicology and Biochemistry, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium; (R.T.); (W.S.); (G.A.)
- Department of Pathology, Bacteriology and Poultry Diseases, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium;
| | - An Garmyn
- Department of Pathology, Bacteriology and Poultry Diseases, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium;
| | - Mathias Devreese
- Department of Pharmacology, Toxicology and Biochemistry, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium; (R.T.); (W.S.); (G.A.)
- Correspondence: ; Tel.: +32-(0)9-264-73-47
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24
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Lees P, Pelligand L, Giraud E, Toutain PL. A history of antimicrobial drugs in animals: Evolution and revolution. J Vet Pharmacol Ther 2021; 44:137-171. [PMID: 32725687 DOI: 10.1111/jvp.12895] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 06/08/2020] [Accepted: 07/06/2020] [Indexed: 12/17/2022]
Abstract
The evolutionary process of antimicrobial drug (AMD) uses in animals over a mere eight decades (1940-2020) has led to a revolutionary outcome, and both evolution and revolution are ongoing, with reports on a range of uses, misuses and abuses escalating logarithmically. As well as veterinary therapeutic perspectives (efficacy, safety, host toxicity, residues, selection of drug, determination of dose and measurement of outcome in treating animal diseases), there are also broader, nontherapeutic uses, some of which have been abandoned, whilst others hopefully will soon be discontinued, at least in more developed countries. Although AMD uses for treatment of animal diseases will continue, it must: (a) be sustainable within the One Health paradigm; and (b) devolve into more prudent, rationally based therapeutic uses. As this review on AMDs is published in a Journal of Pharmacology and Therapeutics, its scope has been made broader than most recent reviews in this field. Many reviews have focused on negative aspects of AMD actions and uses, especially on the question of antimicrobial resistance. This review recognizes these concerns but also emphasizes the many positive aspects deriving from the use of AMDs, including the major research-based advances underlying both the prudent and rational use of AMDs. It is structured in seven sections: (1) Introduction; (2) Sulfonamide history; (3) Nontherapeutic and empirical uses of AMDs (roles of agronomists and veterinarians); (4) Rational uses of AMDs (roles of pharmacologists, clinicians, industry and regulatory controls); (5) Prudent use (residue monitoring, antimicrobial resistance); (6) International and inter-disciplinary actions; and (7) Conclusions.
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Affiliation(s)
- Peter Lees
- The Royal Veterinary College, University of London, London, UK
| | | | - Etienne Giraud
- INTHERES, INRA, ENVT, Université de Toulouse, Toulouse, France
| | - Pierre-Louis Toutain
- The Royal Veterinary College, University of London, London, UK
- INTHERES, INRA, ENVT, Université de Toulouse, Toulouse, France
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25
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Berk BA, Packer RMA, Law TH, Wessmann A, Bathen-Nöthen A, Jokinen TS, Knebel A, Tipold A, Pelligand L, Volk HA. Medium-chain triglycerides dietary supplement improves cognitive abilities in canine epilepsy. Epilepsy Behav 2021; 114:107608. [PMID: 33268017 DOI: 10.1016/j.yebeh.2020.107608] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/08/2020] [Accepted: 10/27/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Cognitive impairments (CI) have recently been identified in canine epilepsy patients. A medium-chain triglyceride (MCT) enriched diet has been demonstrated to improve cognition in aged dogs and seizure control in canine epilepsy. This study evaluates the short-term effects of MCT-oil consumption on cognitive abilities in dogs with epilepsy, a naturally occurring animal model. METHODS A 6-month multicenter, prospective, randomized, double-blinded, controlled cross-over diet trial was conducted comparing dietary supplementation (DS) of MCT oil to a control oil. Allocation to dietary oil supplements, consisting of 9% total caloric intake, was block-randomized and supplemented into each dogs' diet for 3 months followed by a respective switch of DS-oil for a further 3 months. Noninvasive cognitive tests and a validated psychometric tool were utilized to evaluate cognitive function and perturbations associated with dietary intervention. RESULTS Twenty-nine dogs completed the trial, of which 18 completed noninvasive cognitive testing. Spatial-working memory (P = 0.008), problem-solving ability (P = 0.048), and owner-reported trainability (P = 0.041) were significantly improved during MCT-oil supplementation compared to control-DS. SIGNIFICANCE MCT-oil DS improves cognition in dogs with epilepsy when compared to a control-DS. MCT supplementation may represent a promising option to address CI associated with epilepsy.
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Affiliation(s)
- Benjamin Andreas Berk
- Royal Veterinary College, Department of Clinical Science and Services, Hatfield, United Kingdom; BrainCheck.Pet - Tierärztliche Praxis für Epilepsie, Sachsenstraße, Mannheim, Germany.
| | - Rowena Mary Anne Packer
- Royal Veterinary College, Department of Clinical Science and Services, Hatfield, United Kingdom
| | - Tsz Hong Law
- Royal Veterinary College, Department of Clinical Science and Services, Hatfield, United Kingdom
| | - Annette Wessmann
- Pride Veterinary Centre, Riverside Road, Pride Park, Derby, United Kingdom
| | | | - Tarja Susanna Jokinen
- Faculty of Veterinary Medicine, Dep. of Equine and Small Animal Medicine, Helsinki, Finland
| | - Anna Knebel
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hannover, Germany
| | - Andrea Tipold
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hannover, Germany
| | - Ludovic Pelligand
- Royal Veterinary College, Department of Comparative Biomedical Sciences, Hatfield, United Kingdom
| | - Holger Andreas Volk
- Royal Veterinary College, Department of Clinical Science and Services, Hatfield, United Kingdom; Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hannover, Germany
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26
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Castineiras D, Armitage L, Lamas LP, De Baere S, Croubels S, Pelligand L. Perioperative pharmacokinetics and pharmacodynamics of meloxicam in emus (Dromaius novaehollandiae) of different age groups using nonlinear mixed effect modelling. J Vet Pharmacol Ther 2020; 44:603-618. [PMID: 33141479 DOI: 10.1111/jvp.12923] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/08/2020] [Accepted: 10/07/2020] [Indexed: 01/19/2023]
Abstract
Meloxicam is a widely used nonsteroidal anti-inflammatory drug in avian species. However, variability in pharmacokinetic (PK) and pharmacodynamic (PD) parameters in birds warrants species-specific studies for dose and dosing interval optimization. We performed a perioperative PK study of meloxicam (0.5 mg/kg, intravenously) on emus of three different age groups: 3 chicks (5 weeks old, 3.5 kg), 4 juveniles (26 weeks old, 18.8 kg) and 6 adults (66 weeks old, 38.8 kg). A two-compartment population PK model including weight as a significant covariate on clearance and central volume of distribution (V1) best fitted the data. The typical values (20 kg bird) for clearance and V1 were 0.54 L/kg/h and 0.095 L/kg. Both parameters significantly decreased with increasing weight/age. Meloxicam potency and selectivity for COX-1 and COX-2 were measured in whole blood assays (TxB2 production endpoint). Meloxicam was partially selective in emus (IC50 COX-1:COX-2 = 9.1:1). At the current empirical dose (0.5 mg/kg/24 hr), plasma meloxicam concentration is above IC50 of COX-2 for only 2 hr. PK/PD predicted dose required for 80% COX-2 inhibition over 24 hr were 3.4, 1.4 and 0.95 L/kg/day in chicks, juveniles and adult emus, respectively. The safety, therapeutic efficacy and practicality of modifying the daily dose or dose interval should be considered for dose recommendations in emus.
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Affiliation(s)
- Diego Castineiras
- Department of Clinical Services and Sciences, Royal Veterinary College, London, UK
| | - Lucy Armitage
- Department of Clinical Services and Sciences, Royal Veterinary College, London, UK
| | - Luís Pardon Lamas
- Structure & Motion Laboratory, Department of Comparative Biomedical Sciences, Royal Veterinary College, London, UK
| | - Siegrid De Baere
- Department of Pharmacology, Toxicology and Biochemistry, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Siska Croubels
- Department of Pharmacology, Toxicology and Biochemistry, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Ludovic Pelligand
- Department of Clinical Services and Sciences, Royal Veterinary College, London, UK.,Department of Comparative Biomedical Sciences, Royal Veterinary College, London, UK
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27
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Toutain PL, Pelligand L, Lees P, Bousquet-Mélou A, Ferran AA, Turnidge JD. The pharmacokinetic/pharmacodynamic paradigm for antimicrobial drugs in veterinary medicine: Recent advances and critical appraisal. J Vet Pharmacol Ther 2020; 44:172-200. [PMID: 33089523 DOI: 10.1111/jvp.12917] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 08/16/2020] [Accepted: 09/22/2020] [Indexed: 12/12/2022]
Abstract
Pharmacokinetic/pharmacodynamic (PK/PD) modelling is the initial step in the semi-mechanistic approach for optimizing dosage regimens for systemically acting antimicrobial drugs (AMDs). Numerical values of PK/PD indices are used to predict dose and dosing interval on a rational basis followed by confirmation in clinical trials. The value of PK/PD indices lies in their universal applicability amongst animal species. Two PK/PD indices are routinely used in veterinary medicine, the ratio of the area under the curve of the free drug plasma concentration to the minimum inhibitory concentration (MIC) (fAUC/MIC) and the time that free plasma concentration exceeds the MIC over the dosing interval (fT > MIC). The basic concepts of PK/PD modelling of AMDs were established some 20 years ago. Earlier studies have been reviewed previously and are not reconsidered in this review. This review describes and provides a critical appraisal of more recent, advanced PK/PD approaches, with particular reference to their application in veterinary medicine. Also discussed are some hypotheses and new areas for future developments.First, a brief overview of PK/PD principles is presented as the basis for then reviewing more advanced mechanistic considerations on the precise nature of selected indices. Then, several new approaches to selecting PK/PD indices and establishing their numerical values are reviewed, including (a) the modelling of time-kill curves and (b) the use of population PK investigations. PK/PD indices can be used for dose determination, and they are required to establish clinical breakpoints for antimicrobial susceptibility testing. A particular consideration is given to the precise nature of MIC, because it is pivotal in establishing PK/PD indices, explaining that it is not a "pharmacodynamic parameter" in the usual sense of this term.
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Affiliation(s)
- Pierre-Louis Toutain
- INTHERES, INRA, ENVT, Université de Toulouse, Toulouse, France.,Royal Veterinary College, University of London, London, UK
| | | | - Peter Lees
- Royal Veterinary College, University of London, London, UK
| | | | - Aude A Ferran
- INTHERES, INRA, ENVT, Université de Toulouse, Toulouse, France
| | - John D Turnidge
- School of Biological Sciences, University of Adelaide, Adelaide, SA, Australia
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28
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Steagall PV, Pelligand L, Page SW, Bourgeois M, Weese S, Manigot G, Dublin D, Ferreira JP, Guardabassi L. The World Small Animal Veterinary Association (WSAVA): List of Essential Medicines for Cats and Dogs. J Small Anim Pract 2020; 61:E162-E176. [PMID: 32543704 DOI: 10.1111/jsap.13135] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- P V Steagall
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, 3200 rue Sicotte, Saint-Hyacinthe, QC, J2S 0G8, Canada
| | - L Pelligand
- Department of Clinical Services and Sciences, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, AL9 7TA, United Kingdom
| | - S W Page
- Veterinary Clinical Pharmacology and Toxicology, Advanced Veterinary Therapeutics, Newtown, NSW, 2042, Australia
| | - M Bourgeois
- Merck Animal Health, Madison, NJ, 07940, United States
| | - S Weese
- Dept of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - G Manigot
- Dermlink Buenos Aires, Veterinary Dermatology Service, C1426, Buenos Aires, Argentina
| | - D Dublin
- Global Education Leadership, Department of International Relations, Hokkaido University of Education, 1-15-55 Shiroyama, Kushiro, Hokkaido, 085-0821, Japan
| | - J P Ferreira
- Antimicrobial Resistance and Veterinary Products Department, World Organisation for Animal Health [OIE], 12 Rue de Prony, 75004, Paris, France
| | - L Guardabassi
- Department of Veterinary and Animal Sciences, University of Copenhagen, Stigbøjlen 4, 1870, Frederiksberg C, Denmark
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D'Anselme O, Pelligand L, Veres-Nyeki K, Zaccagnini A, Zilberstein L. Analysis of teaching methods in anaesthesia in the undergraduate curriculum of four veterinary universities. Vet Anaesth Analg 2020; 47:657-666. [PMID: 32792273 DOI: 10.1016/j.vaa.2020.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 01/25/2020] [Accepted: 02/15/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To design a holistic audit tool to assess the effectiveness of anaesthesia teaching strategies, and thereby to study veterinary undergraduate teaching methods in different geographical areas. STUDY DESIGN Qualitative study using interviews of university staff and students to identify common themes and differences in teaching veterinary anaesthesia. METHODS An audit was performed using an audit tool in four veterinary universities (École Nationale Vétérinaire d'Alfort, France; Royal Veterinary College, UK; University of Buenos Aires, Argentina; and Alma mater studiorum - Università di Bologna, Italy). First, an open-question interview of anaesthesia head of service (60-90 minutes) identified the pedagogical strategies in order to conceive a subsequent semi-directive interview formulated as a SWOT analysis (Strength/Weaknesses/Opportunity/Threats). Second, the SWOT reflection was conducted by a second staff member and focussed on: 1) general organization; 2) topics for pre-rotation teaching; 3) teaching methods for clinical rotation; and 4) assessment methods. Qualitative analysis of the interview responses was performed with semi-structured interviews. Finally, the students evaluated their teaching through a students' questionnaire generated from the output of both interviews. RESULTS A group of nine lecturers and 106 students participated in the study at four different sites. Preclinical teaching ranged from 13 to 24 hours (median 15 hours). Clinical teaching ranged from 4 to 80 hours (median 60 hours). Overall, all faculties perceived time as a limitation and attempted to design strategies to achieve the curriculum expectations and optimize teaching using more time-efficient exercises. Large animal anaesthesia teaching was found to be a common area of weakness. Internal feedback was delivered to each university, whereas generalized results were shared globally. CONCLUSIONS This preliminary study proved the generalizability of the protocol used. Recruiting a larger pool of universities would help to identify and promote efficient teaching strategies and innovations for training competent new graduates in an ever-expanding curriculum.
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Affiliation(s)
- Olivia D'Anselme
- Department of Anesthesia, School of Veterinary Medicine, École Nationale Vétérinaire d'Alfort, Paris, France.
| | - Ludovic Pelligand
- Department of Anaesthesia, School of Veterinary Medicine, Royal Veterinary College, London, UK
| | - Kata Veres-Nyeki
- Department of Anaesthesia, School of Veterinary Medicine, Royal Veterinary College, London, UK
| | - Andrea Zaccagnini
- Department of Anesthesia, School of Veterinary Medicine, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Luca Zilberstein
- Department of Anesthesia, School of Veterinary Medicine, École Nationale Vétérinaire d'Alfort, Paris, France
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30
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Pierce SE, Lamas LP, Pelligand L, Schilling N, Hutchinson JR. Patterns of Limb and Epaxial Muscle Activity During Walking in the Fire Salamander, Salamandra salamandra. Integr Org Biol 2020; 2:obaa015. [PMID: 33791558 PMCID: PMC7671131 DOI: 10.1093/iob/obaa015] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Salamanders and newts (urodeles) are often used as a model system to elucidate the evolution of tetrapod locomotion. Studies range from detailed descriptions of musculoskeletal anatomy and segment kinematics, to bone loading mechanics and inferring central pattern generators. A further area of interest has been in vivo muscle activity patterns, measured through electromyography (EMG). However, most prior EMG work has primarily focused on muscles of the forelimb or hindlimb in specific species or the axial system in others. Here we present data on forelimb, hindlimb, and epaxial muscle activity patterns in one species, Salamandra salamandra, during steady state walking. The data are calibrated to limb stride cycle events (stance phase, swing phase), allowing direct comparisons to homologous muscle activation patterns recorded for other walking tetrapods (e.g., lizards, alligators, turtles, mammals). Results demonstrate that Salamandra has similar walking kinematics and muscle activity patterns to other urodele species, but that interspecies variation does exist. In the forelimb, both the m. dorsalis scapulae and m. latissimus dorsi are active for 80% of the forelimb swing phase, while the m. anconaeus humeralis lateralis is active at the swing–stance phase transition and continues through 86% of the stance phase. In the hindlimb, both the m. puboischiofemoralis internus and m. extensor iliotibialis anterior are active for 30% of the hindlimb swing phase, while the m. caudofemoralis is active 65% through the swing phase and remains active for most of the stance phase. With respect to the axial system, both the anterior and posterior m. dorsalis trunci display two activation bursts, a pattern consistent with stabilization and rotation of the pectoral and pelvic girdles. In support of previous assertions, comparison of Salamandra muscle activity timings to other walking tetrapods revealed broad-scale similarities, potentially indicating conservation of some aspects of neuromuscular function across tetrapods. Our data provide the foundation for building and testing dynamic simulations of fire salamander locomotor biomechanics to better understand musculoskeletal function. They could also be applied to future musculoskeletal simulations of extinct species to explore the evolution of tetrapod locomotion across deep-time.
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Affiliation(s)
- S E Pierce
- Museum of Comparative Zoology and Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA 02139, USA
| | - L P Lamas
- Departamento de Clinica, Faculdade de Medicina Veterinária, Universidade de Lisboa, Av. da Universidade Técnica, 1300-345, Lisboa, Portugal
| | - L Pelligand
- Department of Comparative Biomedical Sciences, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, AL9 7TA, UK
| | - N Schilling
- Institute of Zoology and Evolutionary Research, Friedrich-Schiller-University Jena, Erbertstr. 1, Jena, 07743, Germany
| | - J R Hutchinson
- Structure and Motion Laboratory, Department of Comparative Biomedical Sciences, The Royal Veterinary College, Hawkshead Lane, Hatfield, AL9 7TA, UK
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Pelligand L, Guillot E, Geneteau A, Guyonnet J, Magnier R, Elliott J, Peyrou M, Jacobs M. Population Pharmacokinetics and Pharmacodynamics Modeling of Torasemide and Furosemide After Oral Repeated Administration in Healthy Dogs. Front Vet Sci 2020; 7:151. [PMID: 32411731 PMCID: PMC7199743 DOI: 10.3389/fvets.2020.00151] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/02/2020] [Indexed: 12/16/2022] Open
Abstract
Torasemide is a loop diuretic licensed in dogs for cardiogenic pulmonary oedema. The aim of this pharmacokinetic-pharmacodynamic (PK/PD) study was to define an optimally effective dosage regimen based on preclinical data. In a first study, 5 dogs received once-daily oral torasemide (0, 0.1, 0.2, 0.4, 0.8 mg/kg/day) for 14 days. A second study compared once-daily oral torasemide (0, 0.1, 0.2, 0.3, 0.4 mg/kg/day) to twice-daily furosemide (1, 2, 4, 8 mg/kg/day). For all doses of the second study, 11 dogs received a first day of treatment, followed by a 3 day washout and resumed daily treatment for 10 days (until Day 14). Blood and urine were collected to measure urinary torasemide excretion and plasma torasemide concentrations and daily diuresis and natriuresis. Torasemide PK was linear. After rapid absorption (Tmax 0.5–1 h), 61% of the bioavailable torasemide was eliminated unchanged in urine. Diuresis and natriuresis observed with torasemide were similar to the ones obtained after furosemide (daily dose-ratios: 1/20 to 1/10). The average diuresis increased from baseline (220 ± 53 mL/day for 10 kg dogs) to 730 ±120 mL after the first torasemide administration and up to 1150 ± 252 mL after 10 administrations at the highest dose. At higher doses (≥0.3 mg/kg/day), daily diureses after 10 diuretic treatment-days were higher than Day 1 and variable between dogs; in contrast, diureses remained constant over time and less variable for doses up to 0.2 mg/kg/day. Natriuresis peaked after the first day and decreased dramatically after the 2nd treatment-day then stabilized to a value close to baseline, except for 0.4 mg/kg/day. Urinary torasemide excretion predicted pharmacodynamics better than plasma concentrations. The decrease in natriuresis observed was successfully modeled using a resistance mechanism; this is likely due to a reabsorption of sodium which did not seem however to affect the volume of urine excreted. For a daily target diuresis of 460 mL/dog/day in severe pulmonary oedema (net fluid loss 240 mL/dog/day), a computed dose of 0.26 mg/kg/day (3.5 mg/kg/day furosemide-equivalent) was selected for clinical studies. Due to high inter-individual variability in diureses at doses ≥0.3 mg/kg, higher doses should be limited to 3–5 days to avoid supra-clinical effects in high responders.
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Affiliation(s)
- Ludovic Pelligand
- Department of Comparative Biological Sciences, The Royal Veterinary College, London, United Kingdom
| | - Emilie Guillot
- Companion Animal Franchise, Ceva Santé Animale, Libourne, France
| | | | | | | | - Jonathan Elliott
- Department of Comparative Biological Sciences, The Royal Veterinary College, London, United Kingdom
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Berk BA, Law TH, Packer RMA, Wessmann A, Bathen-Nöthen A, Jokinen TS, Knebel A, Tipold A, Pelligand L, Meads Z, Volk HA. A multicenter randomized controlled trial of medium-chain triglyceride dietary supplementation on epilepsy in dogs. J Vet Intern Med 2020; 34:1248-1259. [PMID: 32293065 PMCID: PMC7255680 DOI: 10.1111/jvim.15756] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 03/12/2020] [Indexed: 12/11/2022] Open
Abstract
Background Medium‐chain triglyceride (MCT) enriched diet has a positive effect on seizure control and behavior in some dogs with idiopathic epilepsy (IE). Objective To evaluate the short‐term efficacy of MCTs administered as an add‐on dietary supplement (DS) to a variable base diet to assess seizure control and antiseizure drug's (ASD) adverse effect profiles. Animals Twenty‐eight dogs with International Veterinary Epilepsy Task Force Tier II (IVETF) level diagnosis of treated IE with 3 or more seizures in the last 3 months were used. Methods A 6‐month multicenter, prospective, randomized, double‐blinded, placebo‐controlled crossover trial was completed, comparing an MCT‐DS with a control‐DS. A 9% metabolic energy‐based amount of MCT or control oil was supplemented to the dogs' diet for 3 months, followed by a control oil or MCT for another 3 months, respectively. Dogs enrolled in this study satisfied most requirements of IE diagnosis stated by the IVETF II level. If they received an oil DS or drugs that could influence the metabolism of the investigated DS or chronic ASD, the chronic ASD medication was adjusted, or other causes of epilepsy were found, the dogs were excluded from the study. Results Seizure frequency (median 2.51/month [0‐6.67] versus 2.67/month [0‐10.45]; P = .02) and seizure‐day frequency were significantly (1.68/month [0‐5.60] versus 1.99/month [0‐7.42], P = .01) lower when dogs were fed MCT‐DS in comparison with the control‐DS. Two dogs were free of seizures, 3 had ≥50% and 12 had <50% reductions in seizure frequency, and 11 dogs showed no change or an increase in seizure frequency. Conclusions and Clinical Importance These data show antiseizure properties of an MCT‐DS compared to a control oil and support former evidence for the efficacy of MCTs as a nutritive, management option for a subpopulation of drug‐resistant dogs with epilepsy.
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Affiliation(s)
- Benjamin A Berk
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, UK.,BrainCheck.Pet, Mannheim, Germany
| | - Tsz H Law
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, UK
| | - Rowena M A Packer
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, UK
| | | | | | - Tarja S Jokinen
- Faculty of Veterinary Medicine, Department of Equine and Small Animal Medicine, Helsinki, Finland
| | - Anna Knebel
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hanover, Germany
| | - Andrea Tipold
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hanover, Germany
| | - Ludovic Pelligand
- Department of Comparative Biomedical Sciences, Royal Veterinary College, Hatfield, UK
| | - Zoe Meads
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, UK
| | - Holger A Volk
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, UK.,Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hanover, Germany
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Cehrs E, Pelligand L, Weller R. Faculty's Perception of a Research Project Embedded in the Undergraduate Veterinary Curriculum. J Vet Med Educ 2020; 47:170-176. [PMID: 31009275 DOI: 10.3138/jvme.0318-028r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In this article, we describe faculty's perception of a research project embedded in the final year of the undergraduate veterinary curriculum and look at factors associated with overall perceptions of the project. We hypothesized that faculty would have a dichotomous attitude toward the research project, with faculty viewing it either positively or negatively, and that this opinion of the project would be largely influenced by the background of the faculty member-in particular, her or his role at the Royal Veterinary College. We explored this hypothesis via a questionnaire consisting of 26 questions in categorical format, Likert-scale format, and ranking format. The questions addressed faculty demographics, faculty's perceptions of the project, and generic skills. Faculty had an overall positive view of the project and found it to be a useful part of the undergraduate curriculum (83.3% found it to be useful or very useful). Faculty's perception of the project was influenced by their role at the college (p = .017), the species with which they primarily work (p = .05), and their opinion on the time spent supervising the final-year project (p = .003). We concluded that faculty view research as an important and useful part of the undergraduate veterinary curriculum.
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Affiliation(s)
- Emily Cehrs
- Bachelor of Veterinary Medicine Student, Royal Veterinary College
| | - Ludovic Pelligand
- Veterinary Anaesthesia and Clinical Pharmacology, Department of Veterinary Clinical Sciences, The Royal Veterinary College
| | - Renate Weller
- Department of Veterinary Clinical Sciences, The Royal Veterinary College
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McKenna M, Pelligand L, Elliott J, Cotter D, Jepson R. Relationship between serum iohexol clearance, serum SDMA concentration, and serum creatinine concentration in non-azotemic dogs. J Vet Intern Med 2019; 34:186-194. [PMID: 31725186 PMCID: PMC6979102 DOI: 10.1111/jvim.15659] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 10/23/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Serum creatinine and symmetric dimethylarginine (SDMA) are used as surrogate markers of glomerular filtration rate (GFR) in clinical practice. Data pertaining to the correlations between GFR, SDMA, and serum creatinine in client-owned dogs are limited. OBJECTIVES To describe the relationship between GFR, SDMA, and serum creatinine in a population of client-owned dogs, and to compare clinical utility of SDMA to GFR estimation for detecting pre-azotemic chronic kidney disease. ANIMALS Medical records of 119 dogs that had GFR estimation performed via serum iohexol clearance between 2012 and 2017. METHODS Prospective study using archived samples. GFR, SDMA, and serum creatinine results were reviewed and submitting practices contacted for outcome data. All dogs included in the study population were non-azotemic. Correlations between GFR, SDMA, and serum creatinine were determined by regression analysis. Sensitivity, specificity, and positive and negative likelihood ratios of different cutoffs for SDMA and serum creatinine for detecting decreased GFR were calculated, using a 95% confidence interval. RESULTS Serum creatinine and SDMA were moderately correlated with GFR (R2 = 0.52 and 0.27, respectively, P < .0001) and with each other (R2 = 0.33, P < .0001). SDMA >14 μg/dL was sensitive (90%) but nonspecific (50%) for detecting a ≥40% decrease in GFR. Optimal SDMA concentration cutoff for detecting a ≥40% GFR decrease was >18 μg/dL (sensitivity 90%, specificity 83%). CONCLUSIONS AND CLINICAL IMPORTANCE In non-azotemic dogs being screened for decreased renal function, using a cutoff of >18 μg/dL rather than >14 μg/dL increases the specificity of SDMA, without compromising sensitivity.
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Affiliation(s)
- Myles McKenna
- Department of Clinical Science and Services, Royal Veterinary College, London, United Kingdom
| | - Ludovic Pelligand
- Department of Clinical Science and Services, Royal Veterinary College, London, United Kingdom
| | - Jonathan Elliott
- Department of Comparative Biomedical Sciences, Royal Veterinary College, London, United Kingdom
| | - Daniel Cotter
- Department of Clinical Science and Services, Royal Veterinary College, London, United Kingdom
| | - Rosanne Jepson
- Department of Clinical Science and Services, Royal Veterinary College, London, United Kingdom
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Gozalo-Marcilla M, Moreira da Silva R, Pacca Loureiro Luna S, Rodrigues de Oliveira A, Werneck Fonseca M, Peporine Lopes N, Taylor PM, Pelligand L. A possible solution to model nonlinearity in elimination and distributional clearances with α 2 -adrenergic receptor agonists: Example of the intravenous detomidine and methadone combination in sedated horses. J Vet Pharmacol Ther 2019; 42:738-744. [PMID: 31584710 DOI: 10.1111/jvp.12815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 08/22/2019] [Accepted: 08/30/2019] [Indexed: 12/28/2022]
Abstract
The alpha(α)2 -agonist detomidine is used for equine sedation with opioids such as methadone. We retrieved the data from two randomized, crossover studies where detomidine and methadone were given intravenously alone or combined as boli (STUDY 1) (Gozalo-Marcilla et al., 2017, Veterinary Anaesthesia and Analgesia, 2017, 44, 1116) or as 2-hr constant rate infusions (STUDY 2) (Gozalo-Marcilla et al., 2019, Equine Veterinary Journal, 51, 530). Plasma drug concentrations were measured with a validated tandem Mass Spectrometry assay. We used nonlinear mixed effect modelling and took pharmacokinetic (PK) data from both studies to fit simultaneously both drugs and explore their nonlinear kinetics. Two significant improvements over the classical mammillary two-compartment model were identified. First, the inclusion of an effect of detomidine plasma concentration on the elimination clearances (Cls) of both drugs improved the fit of detomidine (Objective Function Value [OFV]: -160) and methadone (OFV: -132) submodels. Second, a detomidine concentration-dependent reduction of distributional Cls of each drug further improved detomidine (OFV: -60) and methadone (OFV: -52) submodel fits. Using the PK data from both studies (a) helped exploring hypotheses on the nonlinearity of the elimination and distributional Cls and (b) allowed inclusion of dynamic effects of detomidine plasma concentration in the model which are compatible with the pharmacology of detomidine (vasoconstriction and reduction in cardiac output).
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Affiliation(s)
- Miguel Gozalo-Marcilla
- The Royal (Dick) School of Veterinary Studies and the Roslin Institute, The University of Edinburgh, Midlothian, UK
| | - Rodrigo Moreira da Silva
- Núcleo de Pesquisas em Produtos Naturais e Sintéticos (NPPNS), School of Pharmaceutical Sciences, University of São Paulo (USP), Ribeirão Preto, Brazil
| | | | | | - Mariana Werneck Fonseca
- São Paulo State University (UNESP), School of Veterinary Medicine and Animal Science, Botucatu, Brazil
| | - Norberto Peporine Lopes
- Núcleo de Pesquisas em Produtos Naturais e Sintéticos (NPPNS), School of Pharmaceutical Sciences, University of São Paulo (USP), Ribeirão Preto, Brazil
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McKenna M, Pelligand L, Elliott J, Walker D, Jepson R. Clinical utility of estimation of glomerular filtration rate in dogs. J Vet Intern Med 2019; 34:195-205. [PMID: 31373414 PMCID: PMC6979109 DOI: 10.1111/jvim.15561] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 07/01/2019] [Indexed: 01/20/2023] Open
Abstract
Background Glomerular filtration rate (GFR) estimation is the gold standard for assessment of renal function, although the clinical utility of this test is unclear. Objectives To describe the clinical utility of GFR estimation in dogs. Animals Medical records of 132 dogs that had serum iohexol clearance measured between 2012 and 2017. Methods Iohexol clearance and clinical records were reviewed and submitting practices contacted to obtain outcome data. Dogs were classified into 4 groups based on the reason for performing GFR estimation: A1 (screening for pre‐azotemic chronic kidney disease [CKD], n = 105), A2 (confirmation of azotemic CKD, n = 3), B (screening for pre‐azotemic acute kidney injury, n = 19), and C (miscellaneous causes, n = 5). Descriptive review of the clinical utility of GFR estimation is provided. Results For dogs in Group A1, renal disease was diagnosed in 9/9 dogs with a GFR ≥40% decreased below the mean GFR of their body weight category, in 5/6 dogs with a ≥30% but <40% reduction in GFR and in 7/9 dogs with a ≥20% but <30% reduction in GFR. Conclusions and Clinical Importance Glomerular filtration rate estimation is useful for the diagnosis of CKD before the onset of azotemia.
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Affiliation(s)
- Myles McKenna
- Department of Clinical Science and Services, Royal Veterinary College, London, United Kingdom
| | - Ludovic Pelligand
- Department of Clinical Science and Services, Royal Veterinary College, London, United Kingdom
| | - Jonathan Elliott
- Department of Comparative Biomedical Sciences, Royal Veterinary College, London, United Kingdom
| | - David Walker
- Anderson Moores Veterinary Specialists, Winchester, United Kingdom
| | - Rosanne Jepson
- Department of Clinical Science and Services, Royal Veterinary College, London, United Kingdom
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Toutain PL, Sidhu PK, Lees P, Rassouli A, Pelligand L. VetCAST Method for Determination of the Pharmacokinetic-Pharmacodynamic Cut-Off Values of a Long-Acting Formulation of Florfenicol to Support Clinical Breakpoints for Florfenicol Antimicrobial Susceptibility Testing in Cattle. Front Microbiol 2019; 10:1310. [PMID: 31244816 PMCID: PMC6581757 DOI: 10.3389/fmicb.2019.01310] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 05/27/2019] [Indexed: 11/13/2022] Open
Abstract
The PK/PD cut-off (PK/PDCO) value of florfenicol for calf pathogens was determined for long acting formulations (MSD Nuflor® and a bioequivalent generic product). PK/PDCO is one of the three MICs considered by VetCAST, a sub-committee of the European Committee on Susceptibility Testing (EUCAST), to establish a Clinical Breakpoint for interpreting Antimicrobial Susceptibility Testing (AST). A population model was built by pooling three pharmacokinetic data sets, obtained from 50 richly sampled calves, receiving one of two formulations (the pioneer product and a generic formulation). A virtual population of 5,000 florfenicol disposition curves was generated by Monte Carlo Simulations (MCS) over the 96 h of the assumed duration of action of the formulations. From this population, the maximum predicted MIC, for which 90% of calves can achieve some a priori selected critical value for two PK/PD indices, AUC/MIC and T>MIC, was established. Numerical values were established for two bacterial species of the bovine respiratory disease (BRD) complex, Pasteurella multocida and Mannheimia haemolytica. It was concluded that the PK/PDCO of florfenicol for both AUC/MIC and T>MIC was 1 mg/L.
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Affiliation(s)
- Pierre-Louis Toutain
- École Nationale Vétérinaire de Toulouse, UMR 1436 Intheres INRA, Toulouse, France
- The Royal Veterinary College, Hawkshead Campus, Hatfield, United Kingdom
| | - Pritam Kaur Sidhu
- The Royal Veterinary College, Hawkshead Campus, Hatfield, United Kingdom
- Institute of Computational Comparative Medicine, College of Veterinary Medicine, Kansas State University, Manhattan, KS, United States
| | - Peter Lees
- The Royal Veterinary College, Hawkshead Campus, Hatfield, United Kingdom
| | - Ali Rassouli
- The Royal Veterinary College, Hawkshead Campus, Hatfield, United Kingdom
- Department of Comparative Biosciences, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Ludovic Pelligand
- The Royal Veterinary College, Hawkshead Campus, Hatfield, United Kingdom
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Pelligand L, Lees P, Sidhu PK, Toutain PL. Semi-Mechanistic Modeling of Florfenicol Time-Kill Curves and in silico Dose Fractionation for Calf Respiratory Pathogens. Front Microbiol 2019; 10:1237. [PMID: 31244793 PMCID: PMC6579883 DOI: 10.3389/fmicb.2019.01237] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 05/17/2019] [Indexed: 11/17/2022] Open
Abstract
An important application of time-kill curve (TKC) assays is determination of the nature of the best PK/PD index (fAUC/MIC or fT% > MIC) and its target value for predicting clinical efficacy in vivo. VetCAST (the veterinary subcommittee of EUCAST) herein presents semi-mechanistic TKC modeling for florfenicol, a long acting (96 h) veterinary antimicrobial drug licensed against calf pneumonia organisms (Pasteurella multocida and Mannheimia haemolytica) to support justification of its PK/PDbreakpoint and clinical breakpoint. Individual TKC assays were performed with 6 field strains of each pathogen (initial inoculum 107 CFU/mL with sampling at times at 0, 1, 2, 4, 8, and 24 h). Semi-mechanistic modeling (Phoenix NLME) allowed precise estimation of bacteria growth system (KGROWTH, natural growth rate; KDEATH, death rate; BMAX, maximum possible culture size) and florfenicol pharmacodynamic parameters (EMAX, efficacy additive to KDEATH; EC50, potency; Gamma, sensitivity). PK/PD simulations (using the present TKC model and parameters of a florfenicol population pharmacokinetic model) predicted the time-course of bacterial counts under different exposures. Of two licensed dosage regimens, 40 mg/kg administered once was predicted to be superior to 20 mg/kg administered at 48 h intervals. Furthermore, we performed in silico dose fractionation with doses 0 - 80 mg/kg administered in 1, 2 or 4 administrations over 96 h and for MICs of 0.5, 1, 2, 4 mg/L with 2 inoculum sizes 105 and 107 CFU/mL. Regression analysis (Imax model) demonstrated that i) fAUC/MIC outperformed fT% > MIC as PK/PD index and ii) maximum efficacy (IC90%) was obtained when the average free plasma concentration over 96 h was equal to 1.2 to 1.4 times the MIC of Pasteurella multocida and Mannheimia haemolytica, respectively.
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Affiliation(s)
- Ludovic Pelligand
- Royal Veterinary College, Department of Comparative Biomedical Sciences, Hawkshead Campus, Hatfield, United Kingdom
| | - Peter Lees
- Royal Veterinary College, Department of Comparative Biomedical Sciences, Hawkshead Campus, Hatfield, United Kingdom
| | - Pritam Kaur Sidhu
- Institute of Computational Comparative Medicine, College of Veterinary Medicine, Kansas State University, Manhattan, KS, United States
| | - Pierre-Louis Toutain
- Royal Veterinary College, Department of Comparative Biomedical Sciences, Hawkshead Campus, Hatfield, United Kingdom
- École Nationale Vétérinaire de Toulouse, Toulouse, France
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Elkholly DA, O'Neill D, Wright AK, Mwacalimba K, Nolan LS, Pavlock A, Pelligand L, Church D, Brodbelt DC. Systemic glucocorticoid usage in dogs under primary veterinary care in the UK: prevalence and risk factors. Vet Rec 2019; 185:108. [PMID: 31076520 DOI: 10.1136/vr.105220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 02/28/2019] [Accepted: 04/22/2019] [Indexed: 11/03/2022]
Abstract
Glucocorticoids are widely used in primary care veterinary practices. The study aimed to quantify the usage of systemic glucocorticoids (SGC) in dogs in the UK using primary care treatment records recorded during 2013 in the VetCompass Programme. From a study population of 455 557 dogs, 28 472 dogs (6.2 per cent, 95 per cent CI 6.2 to 6.3) received a total of 50 971 SGC therapy events in 2013. Prednisolone represented the most frequently used oral preparation (27 362 events, 90.0 per cent of oral events). Dexamethasone sodium phosphate was the most commonly used injectable agent (12 796 events, 62.7 per cent of injectable events). The most common breed treated was Staffordshire Bull Terriers (2236/28 472 dogs, 7.9 per cent, 95 per cent CI 7.5 to 8.2) and within-breed prevalence of SGC usage was 2236/32 635, 6.9 per cent, 95 per cent CI 6.6 to 7.1. The most commonly treated age group was dogs older than eight years (8931/28472, 31.4 per cent) and the most commonly treated bodyweight group was 10.01-20.0 kg (7918/28 472, 27.8 per cent). Dexamethasone and prednisolone were the most commonly prescribed SGC. Short-acting and intermediate-acting injectable SGC were more commonly used compared with long-acting injectable SGC. Older and medium size dogs were most likely to receive SGC and certain breeds appeared predisposed. These data can provide a useful benchmark for glucocorticoid usage and highlight the benefits from 'Big Data' analyses.
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Affiliation(s)
- Doaa A Elkholly
- Pathobiology and Population Science, Royal Veterinary College, Hatfield, UK
| | - Dan O'Neill
- Veterinary Clinical Sciences, Royal Veterinary College, Hatfield, UK
| | | | | | | | | | | | | | - David C Brodbelt
- Veterinary Clinical Sciences, Royal Veterinary College, Hatfield, UK
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Gozalo-Marcilla M, de Oliveira AR, Fonseca MW, Possebon FS, Pelligand L, Taylor PM, Luna SPL. Sedative and antinociceptive effects of different detomidine constant rate infusions, with or without methadone in standing horses. Equine Vet J 2018; 51:530-536. [PMID: 30485499 DOI: 10.1111/evj.13054] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 11/19/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Standing surgery avoids the risks of general anaesthesia in horses. OBJECTIVES To assess sedation, antinociception and gastrointestinal motility in standing horses after a detomidine loading dose and 2-h constant rate intravenous (i.v.) infusion, with or without methadone. STUDY DESIGN Blinded, randomised, crossover with seven healthy adult cross-bred horses, three geldings and four females (404 ± 22 kg). METHODS Five i.v. treatments were administered to all horses with 1-week washout period: saline (SAL), detomidine low (2.5 μg/kg bwt + 6.25 μg/kg bwt/h) (DL) and high doses (5 μg/kg bwt + 12.5 μg/kg bwt/h) (DH) alone or combined with methadone (0.2 mg/kg bwt + 0.05 mg/kg bwt/h), (DLM) and (DHM), respectively. Height of head above the ground (HHAG), electrical (ET), thermal (TT) and mechanical (MT) nociceptive thresholds and gastrointestinal motility were evaluated at predetermined times between 5 and 240 min. A mixed effect model and Kruskal-Wallis test were used to analyse normally and non-normally distributed data, respectively. RESULTS Sedation (<50% basal HHAG) was achieved for the duration of the infusion, and for an additional 15 min in DH and DHM groups. Nociceptive thresholds were higher than baseline, to the greatest degree and the longest duration, with DHM (ET and TT for 135 min and MT for 150 min). After DH, TT was significantly higher than baseline from 30 to 120 min and MT from 15 to 135 min. After DLM, ET was increased at 90 min, TT at 30 min and MT for 120 min. Gastrointestinal motility was reduced for up to 135 min after DL, 150 min after DLM and 210 min after DH and DHM. MAIN LIMITATIONS Nociceptive thresholds are not equivalent to surgical stimuli. CONCLUSION Methadone with the highest detomidine dose (DHM) may provide sufficient sedation and analgesia for standing surgical procedures and warrants further investigation.
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Affiliation(s)
- M Gozalo-Marcilla
- São Paulo State University (UNESP), School of Veterinary Medicine and Animal Science, Botucatu, São Paulo, Brazil.,The Royal (Dick) School of Veterinary Studies and the Roslin Institute, The University of Edinburgh, Midlothian, UK
| | - A R de Oliveira
- São Paulo State University (UNESP), School of Veterinary Medicine and Animal Science, Botucatu, São Paulo, Brazil
| | - M W Fonseca
- São Paulo State University (UNESP), School of Veterinary Medicine and Animal Science, Botucatu, São Paulo, Brazil
| | - F S Possebon
- São Paulo State University (UNESP), School of Veterinary Medicine and Animal Science, Botucatu, São Paulo, Brazil
| | - L Pelligand
- Royal Veterinary College, North Mymms, Hatfield, Hertfordshire, UK
| | | | - S P L Luna
- São Paulo State University (UNESP), School of Veterinary Medicine and Animal Science, Botucatu, São Paulo, Brazil
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Gozalo-Marcilla M, Luna SPL, Moreira da Silva R, Crosignani N, Lopes NP, Taylor PM, Pelligand L. Characterisation of the in vivo interactions between detomidine and methadone in horses: Pharmacokinetic and pharmacodynamic modelling. Equine Vet J 2018; 51:517-529. [PMID: 30298682 DOI: 10.1111/evj.13031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 09/24/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pharmacokinetic (PK)/pharmacodynamic (PD) modelling offers new insights to design protocols for sedation and analgesia in standing horses. OBJECTIVES To evaluate the parameters and interactions between detomidine and methadone when given alone or combined in standing horses. STUDY DESIGN Randomised, placebo-controlled, blinded, crossover. METHODS Eight adult healthy horses were given six treatments intravenously: saline (SAL); detomidine (5 μg/kg bwt; DET); methadone (0.2 mg/kg bwt; MET) alone or combined with detomidine (2.5 [MLD], 5 [MMD] or 10 [MHD] μg/kg bwt). Venous blood samples were obtained at predetermined times between 0 and 360 min after drug administration. Plasma detomidine and methadone were measured using a single, liquid/liquid extraction technique by liquid chromatography coupled with a triple quadrupole mass spectrometer (LC-MS/MS). Sequential PK/PD modelling compared rival models, with and without PK and PD interaction between drugs, to fit the PD data including height of the head above the ground (HHAG), a visual analogue scale for sedation (VAS), electrical (ET), thermal (TT) and mechanical (MT) nociceptive thresholds and gastrointestinal motility (GIM) [1]. RESULTS Two and three compartment models best described the PK of detomidine and methadone, respectively. Detomidine decreased its own clearance as well as the clearance of methadone. The interaction of methadone on the effect of detomidine revealed an infra-additive (partial antagonism) effect for HHAG (α = -1.33), VAS (α = -0.98) and GIM (α = -1.05), a positive potentiation for ET (pot = 0.0041) and TT (pot = 0.133) and a synergistic to additive effect for MT (α = 0.78). MAIN LIMITATIONS This is a small experimental study. CONCLUSIONS Different PK/PD interactions were demonstrated for each PD parameter and could be modelled in vivo. The modelling of our data will allow us to simulate and predict the effect of constant rate infusions of both drugs for future investigations.
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Affiliation(s)
- M Gozalo-Marcilla
- Department of Veterinary Surgery and Anaesthesiology, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - S P L Luna
- Department of Veterinary Surgery and Anaesthesiology, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - R Moreira da Silva
- Núcleo de Pesquisas em Produtos Naturais e Sintéticos (NPPNS), School of Pharmaceutical Sciences, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - N Crosignani
- Department of Veterinary Surgery and Anaesthesiology, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - N P Lopes
- Núcleo de Pesquisas em Produtos Naturais e Sintéticos (NPPNS), School of Pharmaceutical Sciences, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | | | - L Pelligand
- Department of Clinical Services and Sciences and Comparative Biomedical Sciences, Royal Veterinary College, Hatfield, Hertfordshire, UK
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Mead A, Lees P, Mitchell J, Rycroft A, Standing JF, Toutain PL, Pelligand L. Differential susceptibility to tetracycline, oxytetracycline and doxycycline of the calf pathogens Mannheimia haemolytica and Pasteurella multocida in three growth media. J Vet Pharmacol Ther 2018; 42:52-59. [PMID: 30267412 DOI: 10.1111/jvp.12719] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/03/2018] [Accepted: 09/01/2018] [Indexed: 11/28/2022]
Abstract
For clinical isolates of bovine Mannheimia haemolytica and Pasteurella multocida, this study reports minimum inhibitory concentration (MIC) differences for tetracycline, oxytetracycline and doxycycline between cation-adjusted Mueller-Hinton broth (CAMHB), foetal bovine serum (FBS) and Roswell Park Memorial Institute (RPMI) medium. MICs were determined according to CLSI standards and additionally using five overlapping sets of twofold dilutions. Matrix effect: (a) free drug MICs and minimum bactericidal concentrations (MBC) for all drugs were significantly higher in FBS than in CAMHB for both pathogens (p < 0.001); (b) MICs and MBCs were higher for CAMHB and FBS compared to RPMI for P. multocida only. Net growth rate for P. multocida in CAMHB was significantly slower than in FBS and higher than in RPMI, correlating to MIC and MBC ranking. Drug effect: doxycycline MICs and MBCs were significantly lower (p < 0.001) in both CAMHB and FBS than tetracycline and oxytetracycline for both pathogens. Only for M. haemolytica were oxytetracycline MIC and MBC significantly lower than tetracycline, precluding the use of tetracycline to predict oxytetracycline susceptibility in this species. Determining potencies of tetracyclines in a physiological medium, such as FBS, is proposed, when the objective is correlation with pharmacokinetic data for dosage determination.
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Affiliation(s)
- Andrew Mead
- Department of Comparative Biomedical Sciences, Royal Veterinary College, Hatfield, Herts, UK
| | - Peter Lees
- Department of Comparative Biomedical Sciences, Royal Veterinary College, Hatfield, Herts, UK
| | - John Mitchell
- Veterinary Medicines Directorate, Addlestone, Surrey, UK
| | - Andrew Rycroft
- Department of Pathobiology and Population Science, Royal Veterinary College, Hatfield, Herts, UK
| | - Joseph F Standing
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Pierre-Louis Toutain
- Department of Comparative Biomedical Sciences, Royal Veterinary College, Hatfield, Herts, UK
| | - Ludovic Pelligand
- Department of Comparative Biomedical Sciences, Royal Veterinary College, Hatfield, Herts, UK
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Martinez MN, Gehring R, Mochel JP, Pade D, Pelligand L. Population variability in animal health: Influence on dose-exposure-response relationships: Part II: Modelling and simulation. J Vet Pharmacol Ther 2018; 41:E68-E76. [PMID: 29806231 DOI: 10.1111/jvp.12666] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 04/15/2018] [Indexed: 11/29/2022]
Abstract
During the 2017 Biennial meeting, the American Academy of Veterinary Pharmacology and Therapeutics hosted a 1-day session on the influence of population variability on dose-exposure-response relationships. In Part I, we highlighted some of the sources of population variability. Part II provides a summary of discussions on modelling and simulation tools that utilize existing pharmacokinetic data, can integrate drug physicochemical characteristics with species physiological characteristics and dosing information or that combine observed with predicted and in vitro information to explore and describe sources of variability that may influence the safe and effective use of veterinary pharmaceuticals.
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Affiliation(s)
- Marilyn N Martinez
- Center for Veterinary Medicine, US Food and Drug Administration, Rockville, Maryland
| | - Ronette Gehring
- Utrecht Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Jonathan P Mochel
- Department of Biomedical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa
| | | | - Ludovic Pelligand
- Department of Clinical Services and Sciences and Department of Comparative Biomedical Sciences, The Royal Veterinary College, Hatfield, UK
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Bon C, Toutain PL, Concordet D, Gehring R, Martin-Jimenez T, Smith J, Pelligand L, Martinez M, Whittem T, Riviere JE, Mochel JP. Mathematical modeling and simulation in animal health. Part III: Using nonlinear mixed-effects to characterize and quantify variability in drug pharmacokinetics. J Vet Pharmacol Ther 2018; 41:171-183. [PMID: 29226975 DOI: 10.1111/jvp.12473] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 11/16/2017] [Indexed: 01/12/2023]
Abstract
A common feature of human and veterinary pharmacokinetics is the importance of identifying and quantifying the key determinants of between-patient variability in drug disposition and effects. Some of these attributes are already well known to the field of human pharmacology such as bodyweight, age, or sex, while others are more specific to veterinary medicine, such as species, breed, and social behavior. Identification of these attributes has the potential to allow a better and more tailored use of therapeutic drugs both in companion and food-producing animals. Nonlinear mixed effects (NLME) have been purposely designed to characterize the sources of variability in drug disposition and response. The NLME approach can be used to explore the impact of population-associated variables on the relationship between drug administration, systemic exposure, and the levels of drug residues in tissues. The latter, while different from the method used by the US Food and Drug Administration for setting official withdrawal times (WT) can also be beneficial for estimating WT of approved animal drug products when used in an extralabel manner. Finally, NLME can also prove useful to optimize dosing schedules, or to analyze sparse data collected in situations where intensive blood collection is technically challenging, as in small animal species presenting limited blood volume such as poultry and fish.
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Affiliation(s)
- C Bon
- Roche Pharmaceutical Research and Early Development, Roche Innovation Center, Basel, Switzerland
| | - P L Toutain
- Department of Veterinary Basic Sciences, Royal Veterinary College, Hatfield, UK
| | - D Concordet
- Toxalim, Research Centre in Food Toxicology, Toulouse, France
- Université de Toulouse, ENVT, INP, Toxalim, Toulouse, France
- Laboratoire de Physiologie et Thérapeutique, École Nationale Vétérinaire de Toulouse INRA, UMR 1331, Toulouse, France
| | - R Gehring
- Department of Anatomy and Physiology, College of Veterinary Medicine, Institute of Computational Comparative Medicine (ICCM), Kansas State University, Manhattan, KS, USA
| | - T Martin-Jimenez
- Department of Comparative Medicine, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, USA
| | - J Smith
- Veterinary Diagnostic and Production Animal Medicine, Iowa State University College of Veterinary Medicine, Ames, IA, USA
| | - L Pelligand
- Department of Veterinary Basic Sciences, Royal Veterinary College, Hatfield, UK
| | - M Martinez
- Center for Veterinary Medicine, US Food and Drug Administration, Rockville, MD, USA
| | - T Whittem
- Translational Research and Animal Clinical Trials (TRACTs) Group, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Werribee, Vic., Australia
| | - J E Riviere
- Department of Anatomy and Physiology, College of Veterinary Medicine, Institute of Computational Comparative Medicine (ICCM), Kansas State University, Manhattan, KS, USA
| | - J P Mochel
- Biomedical Sciences, Iowa State University College of Veterinary Medicine, Ames, IA, USA
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Bijsmans ES, Doig M, Jepson RE, Syme HM, Elliott J, Pelligand L. Factors Influencing the Relationship Between the Dose of Amlodipine Required for Blood Pressure Control and Change in Blood Pressure in Hypertensive Cats. J Vet Intern Med 2018; 30:1630-1636. [PMID: 27717190 PMCID: PMC5032874 DOI: 10.1111/jvim.14562] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 07/02/2016] [Accepted: 07/18/2016] [Indexed: 11/30/2022] Open
Abstract
Background Hypertension is a common problem in elderly cats. In most cats, systolic blood pressure (SBP) of <160 mmHg is achieved in response to amlodipine besylate at either 0.625 or 1.25 mg q24h. The individual cat factors determining dose requirement dose have not been explored. Aims To determine whether individual cat factors influence the dose of amlodipine required to achieve adequate blood pressure control and to determine whether factors other than the prescribed dose of drug alter the achieved plasma amlodipine concentrations. Methods Fifty‐nine hypertensive cats that required 0.625 mg (A) and 41 cats that required 1.25 mg (B) amlodipine to reach a target SBP of <160 mmHg were identified, and plasma amlodipine concentrations were determined. Comparisons were made between groups, and multivariable linear regression models were performed to investigate predictors of antihypertensive response. Results Cats that required a greater dose of amlodipine had significantly higher SBP at diagnosis of hypertension (A: (median [25th, 75th percentile]) 182 [175,192] mmHg; B: 207 [194,217] mmHg, P < .001), but comparable blood pressure was achieved after treatment. Plasma amlodipine concentrations were directly related to the dose of amlodipine administered. At diagnosis, cats in group B had significantly lower plasma potassium concentration (A: 4.1 [3.8,4.5]; B: 3.8 [3.6,4.2] mEq/L, P < .01). Weight did not differ between groups. The decrease in SBP was directly and independently associated with the SBP at diagnosis and the plasma amlodipine concentration. Conclusions and Clinical Importance Cats with higher blood pressure at diagnosis might require a greater dose of amlodipine to control their blood pressure adequately. Differences in amlodipine pharmacokinetics between cats do not seem to play a role in the antihypertensive response.
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Affiliation(s)
- E S Bijsmans
- Department of Comparative Biomedical Sciences, Royal Veterinary College, University of London, London, UK.
| | - M Doig
- ABS Laboratories Ltd, Welwyn Garden City, Hertfordshire, UK
| | - R E Jepson
- Department of Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, Hertfordshire, UK
| | - H M Syme
- Department of Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, Hertfordshire, UK
| | - J Elliott
- Department of Comparative Biomedical Sciences, Royal Veterinary College, University of London, London, UK
| | - L Pelligand
- Department of Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, Hertfordshire, UK
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Norgate DJ, Pelligand L. Emergency intraoperative transcutaneous pacing in a dog undergoing a high‐pressure balloon inflation to relieve severe subaortic stenosis. Vet rec case rep 2018. [DOI: 10.1136/vetreccr-2017-000451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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47
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Toutain PL, Bousquet-Mélou A, Damborg P, Ferran AA, Mevius D, Pelligand L, Veldman KT, Lees P. En Route towards European Clinical Breakpoints for Veterinary Antimicrobial Susceptibility Testing: A Position Paper Explaining the VetCAST Approach. Front Microbiol 2017; 8:2344. [PMID: 29326661 PMCID: PMC5736858 DOI: 10.3389/fmicb.2017.02344] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 11/15/2017] [Indexed: 01/05/2023] Open
Abstract
VetCAST is the EUCAST sub-committee for Veterinary Antimicrobial Susceptibility Testing. Its remit is to define clinical breakpoints (CBPs) for antimicrobial drugs (AMDs) used in veterinary medicine in Europe. This position paper outlines the procedures and reviews scientific options to solve challenges for the determination of specific CBPs for animal species, drug substances and disease conditions. VetCAST will adopt EUCAST approaches: the initial step will be data assessment; then procedures for decisions on the CBP; and finally the release of recommendations for CBP implementation. The principal challenges anticipated by VetCAST are those associated with the differing modalities of AMD administration, including mass medication, specific long-acting product formulations or local administration. Specific challenges comprise mastitis treatment in dairy cattle, the range of species and within species breed considerations and several other variable factors not relevant to human medicine. Each CBP will be based on consideration of: (i) an epidemiological cut-off value (ECOFF) - the highest MIC that defines the upper end of the wild-type MIC distribution; (ii) a PK/PD breakpoint obtained from pre-clinical pharmacokinetic data [this PK/PD break-point is the highest possible MIC for which a given percentage of animals in the target population achieves a critical value for the selected PK/PD index (fAUC/MIC or fT > MIC)] and (iii) when possible, a clinical cut-off, that is the relationship between MIC and clinical cure. For the latter, VetCAST acknowledges the paucity of such data in veterinary medicine. When a CBP cannot be established, VetCAST will recommend use of ECOFF as surrogate. For decision steps, VetCAST will follow EUCAST procedures involving transparency, consensus and independence. VetCAST will ensure freely available dissemination of information, concerning standards, guidelines, ECOFF, PK/PD breakpoints, CBPs and other relevant information for AST implementation. Finally, after establishing a CBP, VetCAST will promulgate expert comments and/or recommendations associated with CBPs to facilitate their sound implementation in a clinical setting.
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Affiliation(s)
- Pierre-Louis Toutain
- UMR 1331 Toxalim, INRA, ENVT, Toulouse, France
- The Royal Veterinary College, University of London, London, United Kingdom
| | | | - Peter Damborg
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark
| | | | - Dik Mevius
- Wageningen Bioveterinary Research, Lelystad, Netherlands
| | - Ludovic Pelligand
- The Royal Veterinary College, University of London, London, United Kingdom
| | - Kees T. Veldman
- National Reference Laboratory on Antimicrobial Resistance in Animals, Lelystad, Netherlands
| | - Peter Lees
- The Royal Veterinary College, University of London, London, United Kingdom
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Whitehead M, Chambers D, Lees P, Pelligand L, Toutain PL, Whiting M. The authors of 'Comparison of veterinary drugs and veterinary homeopathy: part 1 and 2', respond. Vet Rec 2017; 181:457-458. [PMID: 29074799 DOI: 10.1136/vr.j4914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Martin Whitehead
- Chipping Norton Veterinary Hospital, Banbury Road, Chipping Norton, Oxon OX7 5SY
| | - Danny Chambers
- Langford Vets, University of Bristol, Langford, North Somerset BS40 5DU
| | - Peter Lees
- Royal Veterinary College, Hawkshead Campus, Hatfield, Hertfordshire AL9 7TA
| | - Ludovic Pelligand
- Royal Veterinary College, Hawkshead Campus, Hatfield, Hertfordshire AL9 7TA
| | | | - Martin Whiting
- Royal Veterinary College, Hawkshead Campus, Hatfield, Hertfordshire AL9 7TA
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Gozalo-Marcilla M, Luna SPL, Crosignani N, Puoli Filho JNP, Pelligand L, Taylor PM. The importance of measuring skin resistance for electrical nociceptive stimulation in standing horses. Equine Vet J 2017; 49:836. [DOI: 10.1111/evj.12700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- M. Gozalo-Marcilla
- Department of Veterinary Surgery and Anaesthesiology; Faculty of Veterinary Medicine and Animal Science; UNESP - Univ. Estadual Paulista; Botucatu Sao Paulo Brazil
| | - S. P. L. Luna
- Department of Veterinary Surgery and Anaesthesiology; Faculty of Veterinary Medicine and Animal Science; UNESP - Univ. Estadual Paulista; Botucatu Sao Paulo Brazil
| | - N. Crosignani
- Department of Veterinary Surgery and Anaesthesiology; Faculty of Veterinary Medicine and Animal Science; UNESP - Univ. Estadual Paulista; Botucatu Sao Paulo Brazil
| | - J. N. P. Puoli Filho
- Department of Veterinary Surgery and Anaesthesiology; Faculty of Veterinary Medicine and Animal Science; UNESP - Univ. Estadual Paulista; Botucatu Sao Paulo Brazil
| | - L. Pelligand
- Departments of Clinical Services and Sciences and Comparative Biomedical Sciences; Royal Veterinary College; North Mymms, Hatfield Hertfordshire UK
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Stathopoulou TR, Kouki M, Pypendop BH, Johnston A, Papadimitriou S, Pelligand L. Evaluation of analgesic effect and absorption of buprenorphine after buccal administration in cats with oral disease. J Feline Med Surg 2017; 20:704-710. [DOI: 10.1177/1098612x17727234] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objectives The objective of this study was to evaluate the analgesic effect and absorption of buprenorphine after buccal administration in cats with oral disease. Methods Six adult client-owned cats with chronic gingivostomatitis (weighing 5.1 ± 1.1 kg) were recruited for a randomised, prospective, blinded, saline-controlled, crossover study. Pain scores, dental examination, stomatitis score and buccal pH measurement were conducted on day 1 under sedation in all cats. On day 2, animals were randomised into two groups and administered one of the two treatments buccally (group A received buprenorphine 0.02 mg/kg and group B received 0.9% saline) and vice versa on day 3. Pain scores and food consumption were measured at 30, 90 and 360 mins after the administration of buprenorphine. Blood samples were taken at the same time and plasma buprenorphine concentration was measured by liquid chromatography–mass spectrometry. Data were statistically analysed as non-parametric and the level of significance was set as P <0.05. Results There were no major side effects after buprenorphine administration. Buccal pH values ranged between 8.5 and 9.1 and the stomatitis disease activity index between 10 and 22 (17.8 ± 4.5), with the scale ranging from 0–30. The maximum buprenorphine plasma concentration (14.8 ng/ml) was observed 30 mins after administration and there was low inter-individual variability. There was a significant difference between baseline pain scores compared with pain scores after buprenorphine ( P <0.05), and between the saline and buprenorphine group at 30 mins ( P = 0.04) and 90 mins ( P = 0.04). There was also a significant effect of the stomatitis index on the pain score. Regarding the pharmacokinetic parameters, cats with stomatitis showed lower bioavailability and shorter absorption half-life after buccal administration of buprenorphine compared with normal cats in previous studies. Conclusions and relevance Buccal administration of buprenorphine in cats with gingivostomatitis produces an analgesic effect and low inter-individual variability in plasma concentration, and it can be incorporated in their multimodal analgesia plan.
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Affiliation(s)
| | - Maria Kouki
- Aristotle University of Thessaloniki School of Veterinary Medicine, Thessaloniki, Greece
| | - Bruno H Pypendop
- Surgical and Radiological Science, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Atholl Johnston
- Queen Mary University of London and Analytical Services International, St George’s, University of London, London, UK
| | - Serafeim Papadimitriou
- Aristotle University of Thessaloniki School of Veterinary Medicine, Thessaloniki, Greece
| | - Ludovic Pelligand
- Clinical Services and Sciences, Royal Veterinary College, Hatfield, UK
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