Compounding,extralabel drug use,and other pharmaceutical quagmires in avian and exotics practice

The lack of Federal Drug Administration-approved drug products in the United States for avian and exotic animals creates daily challenges for the practitioner. The day-to-day practice of avian and exotic animal medicine requires us to meet these challenges in many ways, including by: extralabel use of domestic human and animal products; simple compounding or other manipulations in the clinical setting; using a pharmacy compounding service; using medicated feeds; and using imported pharmaceutical products. These may present legal and ethical issues to the practitioner that he or she may not be aware of. This paper will discuss some of practical and legal implications of these methods (based on U.S. laws), with an emphasis on compounding and extralabel use.     

Mathematical modeling and simulation in animal health. Part III: Using nonlinear mixed‐effects to characterize and quantify variability in drug pharmacokinetics

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.     

Pharmacologic considerations in the management of peripartum conditions in the cow.

As is true with the use of drugs in veterinary medicine in general, there are many controversial issues in the management of peripartum conditions in the cow. For example, the use of PG versus antibacterial drugs in the management of postpartum uterine infections has advocates for the use of either approach. Intrauterine versus systemic administration of antibacterial drugs for the prophylaxis or treatment of postpartum metritis is another area of debate. Clearly, more research is needed in this area. Equally clearly, however, the research results that are available are being disregarded on a daily basis. In considering this discussion of the use of drugs in the peripartum period, one is struck by the frequency that optimum drug therapy of a condition relies on the extralabel use of nonapproved preparations. What guidelines are available to the practitioner in this regard? One example is lack of availability of appropriate dosage regimens or withdrawal times for food derived from treated animals. Unfortunately, pharmacokinetic and residue studies that would aid in establishing guidelines generally are not available and, in most instances, are not forthcoming. Extrapolation of data from other species to the ruminant or extrapolation of information from one drug to a related compound (such as prediction of residue and withdrawal data from an approved aminoglycoside, dihydrostreptomycin, to another unapproved drug, gentamicin) is fraught with difficulties. The need for research in this area is obvious, and lack of such information is one of the major dilemmas in trying to establish rational drug therapy in the food-producing animal. Recent developments in drug therapy have led to innovative approaches for the management of peripartum and other diseases in cattle. The use of PG in the treatment of reproductive disorders, so commonplace and widely accepted in contemporary veterinary practice, is a relatively recent approach that continues to be refined with the development of new, more potent, more specific PG analogs. What will be the role of ceftiofur, a potent, third-generation cephalosporin that currently is approved only for the treatment of respiratory infections in cattle, in the management of reproductive tract infections? The fluoroquinolones, which represent a novel approach to the control of infectious diseases, are being increasingly used in veterinary and human medicine, and one may predict that these powerful antimicrobial drugs will find application in bovine practice, including for the treatment of peripartum infections. Pharmacologic manipulation of immune and defense mechanisms also is an approach with some promise.(ABSTRACT TRUNCATED AT 400 WORDS)     

Current status of food animal antidotes.

The availability of antidotes in veterinary medicine has been an issue for more than a decade. Antidotes are available for food animals through extralabel use, regulatory discretion, and compounding. There is little economic incentive for pharmaceutical companies to pursue approval of antidotes and other drug products that have a small market. In addition, human food safety concerns must be addressed when approving antidotes for use in food animals. This article provides a brief history of antidote availability, current mechanisms for procuring food animal antidotes, and availability of specific antidotes for use in food animals.     

"抗菌新兽药对与人类健康相关细菌微生物学影响的安全性评价"指导原则简介

在食品动物使用抗菌药,可能导致耐药菌产生,耐药菌在人畜间的传递导致产生交叉耐药性.FDA对此制定了安全性评价指导原则.本文简要介绍了抗菌新兽药对与人类健康相关细菌微生物学影响的安全性评价指导原则.该指导原则主要内容包括:释放评价、暴露评价、后果评价、危险评估及危险管理措施制定等.毫无疑问,这一指导原则对我国抗菌新兽药管理和食品安全管理会有所启迪.     

动物性食品中磺胺类药物残留检测方法的研究进展

动物性食品中兽药和饲料添加剂残留对人体健康所造成的危害,已经引起世界范围的广泛关注,成为人类亟待解决的问题之一。磺胺类药物特别是磺胺嘧啶、磺胺甲基嘧啶、磺胺二甲氧嘧啶、磺胺甲基异口恶唑等作为饲料添加剂或动物疫病治疗药物被广泛应用,然而不合理的用药导致磺胺类药物在动物性食品中残留,影响食品安全,进而危害人类健康。作者对目前动物性食品中磺胺类药物（SAs）残留的主要检测方法进行介绍,主要包括微生物检测法、分光光度计法、免疫分析法、色谱法及色/质联用技术等,重点介绍了免疫分析法和色谱法,并对各种检测方法做出评价及其发展趋势进行了展望。     

Developing new regulatory approaches to antimicrobial safety

Resistance to antimicrobial agents is of concern to public health officials worldwide. In industrialized countries, a significant source of antimicrobial-resistant food-borne infections in humans is the acquisition of resistant bacteria originating from animals. The US Food and Drug Administration (FDA) is committed to resolving the public health impact arising from the use of antimicrobial drugs in food-producing animals. The FDAs goal is to ensure that significant human antimicrobial therapies are not compromised or lost while providing for the safe use of antimicrobials in food animals. Recently the FDA published a guidance document titled 'Evaluating the Safety of Antimicrobial New Animal Drugs with Regard to their Microbiological Effects on Bacteria of Human Health Concern' (US Food and Drug Administration, Center for Veterinary Medicine, 2003). This document outlines a pathway drug sponsors can use to address concerns about antimicrobial resistance prior to approval of their drug. The process uses a qualitative risk assessment approach to assess the potential of the intended use of a product to develop resistance in bacteria that may harm humans. The level of risk determines the level of risk management that is required for the drug to be used. The Food and Drug Administration (FDA) always has the option of not approving a drug if the risk of a public health consequence is too high.     

Cost-effective antimicrobial drug selection for the management and control of respiratory disease in European cattle

Respiratory disease in growing cattle has both animal welfare and economic implications, but the use of antimicrobial drugs to treat and control it is under public scrutiny owing to concerns that their use in food-producing animals may be detrimental to human health. This paper outlines criteria for the selection of appropriate and cost-effective drugs, based on good dinical practice and sound economic principles. It also suggests that these principles should be integrated into quality assurance schemes, and that the monitoring of antimicrobial resistance patterns among known bacterial respiratory pathogens should be improved.     

Immunomodulators for prevention and treatment of infectious diseases in food-producing animals.

The goal of immunomodulation in food-producing animals is to regulate immunity for the benefit of the animal and production efficiency. Immunomodulators are substances that exert this control and include cytokines, pharmaceuticals, microbial products, nutraceuticals, and traditional medicinal plants. Although treatment and prevention of infectious diseases are the most common reasons to use immunomodulators, other conditions, such as amelioration of stress-induced immunosuppression, maturation of the neonate's developing immune response, and strategies to reduce the metabolic cost of eliciting an immune response also are well suited for immunomodulation. Continued discovery of new immune regulators and increased understanding of immunity in food-producing animals will ensure new opportunities for the use of immunomodulators in food-producing animals.     

The regulatory status of xylazine for use in food-producing animals in the United States

Xylazine is commonly used in veterinary medicine as a tranquillizer or adjunct to surgical anaesthesia. Although its use is approved in companion animals and certain species of deer, xylazine remains unapproved for use in food-producing animals in the United States. This paper reviews existing toxicological and residue chemistry information on xylazine in food animals, particularly cattle, and discusses the regulatory status of the drug in the US, as well as the conclusions reached by the Joint FAO/WHO Expert Committee on Food Additives in its recent evaluation of xylazine.     

An integrated experimental and physiologically based pharmacokinetic modeling study of penicillin G in heavy sows

Penicillin G is widely used in food‐producing animals at extralabel doses and is one of the most frequently identified violative drug residues in animal‐derived food products. In this study, the plasma pharmacokinetics and tissue residue depletion of penicillin G in heavy sows after repeated intramuscular administrations at label (6.5 mg/kg) and 5 × label (32.5 mg/kg) doses were determined. Plasma, urine, and environmental samples were tested as potential antemortem markers for penicillin G residues. The collected new data and other available data from the literature were used to develop a population physiologically based pharmacokinetic (PBPK) model for penicillin G in heavy sows. The results showed that antemortem testing of urine provided potential correlation with tissue residue levels. Based on the United States Department of Agriculture Food Safety and Inspection Service action limit of 25 ng/g, the model estimated a withdrawal interval of 38 days for penicillin G in heavy sows after 3 repeated intramuscular injections at 5 × label dose. This study improves our understanding of penicillin G pharmacokinetics and tissue residue depletion in heavy sows and provides a tool to predict proper withdrawal intervals after extralabel use of penicillin G in heavy sows, thereby helping safety assessment of sow‐derived meat products.     

Distribution of chloramphenicol in the genital tract of postpartum cows

Chloramphenicol was administered by constant IV infusion to 7 healthy postpartum cows at rates predicted to approach a steady-state plasma concentration of 5 micrograms/ml. After 8 hours of constant IV infusion, uterine tissues were removed surgically and were assayed for chloramphenicol concentrations. Mean plasma-to-tissue ratios of chloramphenicol concentrations were 3.05, 3.63 (6 cows only), and 3.22 for caruncles, endometrium, and uterine wall, respectively. Plasma-to-tissue ratios of the 3 tissues were not significantly different (P greater than 0.10). Intrauterine (IU) injections of chloramphenicol (20 mg/kg of body weight) were administered to 3 healthy post-partum cows. The mean value of the fraction of the drug absorbed from the uteri of these cows was 0.40. Mean concentrations of chloramphenicol were 43.8 micrograms/g in caruncles, 34.6 micrograms/g in endometrium, 2.8 micrograms/g in uterine wall, and 2.9 micrograms/ml in plasma 8 hours after IU injections. Chloramphenicol has now been banned for use in food-producing animals in the United States because of its potential for causing toxicosis in human beings. It is illegal to use chloramphenicol in food-producing animals in the United States and in some other countries as well. This includes use by the IU route of administration because chloramphenicol and most drugs are absorbed from the uterus into the bloodstream and are distributed to milk and tissues.     

兽药环境风险评估研究进展

随着畜禽集约化养殖数量增加,兽药被广泛用于治疗疾病或作为促生长剂添加到动物饲料中,中国2010-2017年兽用抗菌药的销售量从31 500 t增长到56 800 t。兽药的不合理使用、畜禽养殖过程中废弃物处理不当以及药物经过动物机体代谢后以原形药或代谢物随粪尿排出体外是兽药造成环境污染的主要原因。兽药进入环境后发生迁移转化造成了严重危害,包括抗生素耐药菌或耐药基因的产生、兽药在动植物源性食品和饮用水中的暴露间接影响人类健康、对非靶标动物的生态毒性等。作者就兽药在环境中的暴露、转归及对生态环境的主要影响进行了论述,并对药物的环境风险评估的重要性进行了阐述,针对降低兽药环境风险的措施提出了建议,以引起人们对兽药环境风险评估的关注和重视。     

Population pharmacokinetics in veterinary medicine: Potential use for therapeutic drug monitoring and prediction of tissue residues

Population pharmacokinetics can be defined as a study of the basic features of drug disposition in a population, accounting for the influence of diverse pathophysiological factors on pharmacokinetics, and explicitly estimating the magnitude of the interindividual and intraindividual variability. It is used to identify subpopulations of individuals that may present with differences in drug kinetics or in kinetic/dynamic responses. Rooted in procedures used in engineering systems, population pharmacokinetics methods were conceived as a means to determine the pharmacokinetic profile in populations in which a sparse number of samples were obtained per individual, such as those in late stage human clinical trials. This is the situation commonly encountered in all aspects of veterinary medicine. The exploratory nature of this technique allows one to probe relationships between clinical factors (such as age, gender, renal function, etc.) and drug disposition and/or effect. Similarly, the utilization of these techniques in the clinical research phases of drug development optimize the determination of efficacy and safety of drugs. Given the observational nature of most studies published so far, statistical methods to validate the population models are necessary. Simulation studies may be conducted to explore data collection designs that maximize information yield with a minimum expenditure of resources. The breadth of this approach has allowed population studies to be more commonly employed in all areas of drug therapy and clinical research. Finally, in veterinary medicine, there is an additional field in which population studies are potentially ideally suited: the application of this methodology to the study of tissue drug depletion and drug residues in production animals, and the establishment of withdrawal times tailored to the clinical or production conditions of populations or individuals. Such application would provide a major step toward assuring a safe food supply under a wide variety of dose and off-label clinical uses. Population pharmacokinetics is an ideal method for generating data in support of the implementation of flexible labelling policies and extralabel drug use recently approved under AMDUCA (Animal Medicinal Drug Use Clarification Act. 21 CFR Part 530).     

New drugs for horses and production animals in 2010

In 2010, three new active pharmaceutical ingredients were released on the German market for horses and food-producing animals. These were gamithromycin (Zactran?), a new macrolide antibiotic, Monepantel (Zolvix?), a broad spectrum anthelmintic with a novel mechanism, and Pergolide (Prascend?), the first dopamine receptor agonist for animals. Two substances have been approved for additional species. The tetracycline antibiotic doxycycline is now also authorized for turkeys and the nonsteroidal anti-inflammatory drug firocoxib from the group of cyclo-oxygenase-2 (COX-2) inhibitors is now available for horses. Furthermore, four new preparations with an interesting new pharmaceutical form, one drug with a new formulation and two drugs, which are interesting because of other criteria, were added to the market for horses and food producing animals.     

Use of bone morphogenetic proteins for augmentation of bone regeneration

A large body of preclinical and clinical data now documents that recombinant BMPs can be used for skeletal regeneration in humans and animals. Recombinant human BMP-2 and BMP-7 have been approved for use in human patients with long-bone fractures and nonunions and in patients undergoing lumbar fusion or various maxillofacial and dental regenerative procedures. These products have also been made available for veterinary use.     

Factors that affect drug disposition in food-producing animals during maturation.

Drugs administered to neonatal food-producing animals (cattle, sheep, goats, swine) may exhibit significantly different pharmacokinetic/disposition characteristics than they do in adult animals of the same species. Undesirable consequences such as suboptimum therapeutic concentrations, toxic effects, and violative tissue residues may result if adult dosage regimens are employed in young animals. Using selected drugs as examples, this paper reviews factors that contribute to differences in drug disposition in newborn vs adult animals. Immaturity of mechanisms involved in drug absorption, especially from gastrointestinal and parenteral sites of administration, and of drug distribution to sites such as plasma proteins, adipose tissue, and fluid compartments are considered. The role of developmental changes in drug biotransformation in the liver and other tissues and the maturation of excretory mechanisms, primarily from the kidney, in the increased rate of drug clearance during maturation is described. Pharmacokinetic studies with specific drugs in the target species are an important approach to establishing rational drug use in immature food-producing animals.     

Pharmacological treatments and risks for the food chain

Veterinarians play a pivotal role in public health control, in particular in the management of risks deriving from pharmacological treatments of food-producing animals. Veterinary medicinal products can represent a risk for animal health and welfare (side effects, decreased efficacy), for farmers and practitioners administering the drug, for consumers of food of animal origin (presence of residues, occurrence of antibiotic resistance) and for the environment. According to pending European guidelines, risk management starts from marketing authorisation that must be based on risk evaluation and can be denied when the risk/benefit ratio is not favourable considering the advantages for animal health and welfare and for safety of consumers. Veterinarians can prevent and control risks by using correct pharmacological criteria to choose and administer medicinal products and undertaking risk-based inspection of residues of drugs in food of animal origin. Moreover, a major tool for veterinarians to prevent and control drug-borne risk is "pharmacovigilance". Risks for the environment are usually assessed during the pre-marketing approval process, however veterinarians, as risk managers, should educate farmers about correct drug handling and disposal, and periodically verify that suggested measures are applied.