Principles of chemotherapy safety procedures

With the ever-increasing demand in veterinary medicine to administer chemotherapy agents, it is imperative for the practitioner as well as the support staff to follow strict guidelines for the administration and disposal of cytotoxic drugs. Because of the possible reproductive risks associated with hazardous drugs, all employees who may be pregnant or trying to become pregnant should be excluded from the process. The long-term occupational effects of these agents are not known; therefore, a standard operating procedure including storage of chemotherapy drugs, protective attire, drug preparation, administration, waste disposal/management, hazardous drug spills, and emergency measures for personal contamination should be carefully implemented and documented.     

Advantages of and guidelines for using neuromuscular blocking agents.

Neuromuscular blocking agents, although not commonly used in veterinary practice, should be considered when muscle relaxation is needed to facilitate surgical exposure and minimize tissue trauma. These drugs should be administered only once respiration has been controlled and anesthetic agents have been administered to induce unconsciousness and analgesia. Following administration of neuromuscular blocking drugs, neuromuscular and cardiovascular function must be monitored.     

Emergency treatments for police dogs used for illicit drug detection

The key to saving police dogs that have been exposed to large quantities of illicit substances is rapid action. Removal from the gastrointestinal tract, adsorption, and catharsis are the first steps. Some of these measures can be instituted on site by the attending officer. In case of accidental drug exposures of a dog during a search, police officers should have on hand apomorphine, syringes for administration of the drug and rinsing of the conjunctival sac, activated charcoal, a saline cathartic such as sodium sulfate (not needed if the activated charcoal product contains sorbitol), a resuscitator bag, and a well-fitting canine face mask. If bags of drugs are ingested intact, immediate surgery by a veterinarian may be required to remove the bag and prevent an obstruction or rapid absorption of a lethal dose. Injectible medications to antagonize the effects of the drugs should be reserved for administration by a readily available veterinarian upon arrival of the dog at the veterinary hospital. Pharmacologic antagonistic agents may have adverse side effects, especially if used in the treatment of a drug exposure against which they are not specifically indicated. Proper dosage and route of administration are additional important factors with such treatment. The veterinarian must instruct the police officers on the proper use, dosages, and methods of administration of the detoxifying agents as well as the proper procedures for using the face mask and resuscitator bag before an emergency arises. The officer should also be aware of the clinical signs likely to be produced following exposure to the agents for which these dogs search.(ABSTRACT TRUNCATED AT 250 WORDS)     

加强兽药国际交流与合作的思考

随着全球一体化的加速，总结和梳理我国兽药国际合作相关工作显得愈发迫切。简要介绍了目前主要的兽医药品国际组织及其工作程序，概述了我国兽药国际交流合作现状，并就该项工作中存在的问题和困难进行了分析思考，从健全制度、完善机制等方面提出了建议。     

ACVIM small animal consensus statement on safe use of cytotoxic chemotherapeutics in veterinary practice

The purpose of this report is to offer a consensus opinion of ACVIM oncology diplomates and technicians on the safe use of cytotoxic chemotherapeutics in veterinary practice. The focus is on minimizing harm to the personnel exposed to the drugs: veterinary practitioners, veterinary technicians, veterinary staff, and pet owners. The safety of the patient receiving these drugs is also of paramount importance, but is not addressed in this statement. Much of the information presented is based on national recommendations by Occupational Safety and Health Administration, National Institute for Occupational Safety and Health, United States Pharmacopeia, and other published regulations. These directives reflect an abundance of caution to minimize exposure to medical personnel, but large‐scale studies about the consequences of long‐term occupational exposure are not available in veterinary medicine. Challenges in the delivery of optimal treatment safely and economically to veterinary patients in general practice without access to a veterinary oncologist or other specialist, because of costs or proximity, remain.     

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。     

The use of intravenous lipid emulsion as an antidote in veterinary toxicology

Objective – To review the use of IV lipid emulsion (ILE) for the treatment of toxicities related to fat‐soluble agents; evaluate current human and veterinary literature; and to provide proposed guidelines for the use of this emerging therapy in veterinary medicine and toxicology. Data Sources – Human and veterinary medical literature. Human Data Synthesis – Human data are composed mostly of case reports describing the response to treatment with ILE as variant from mild improvement to complete resolution of clinical signs, which is suspected to be due to the variability of lipid solubility of the drugs. The use of ILE therapy has been advocated as an antidote in cases of local anesthetic and other lipophilic drug toxicoses, particularly in the face of cardiopulmonary arrest and unsuccessful cardiopulmonary cerebral resuscitation. Veterinary Data Synthesis – The use of ILE therapy in veterinary medicine has recently been advocated by animal poison control centers for toxicoses associated with fat‐soluble agents, but there are only few clinical reports documenting successful use of this therapy. Evidence for the use of ILE in both human and veterinary medicine is composed primarily from experimental animal data. Conclusions – The use of ILE appears to be a safe therapy for the poisoned animal patient, but is warranted only with certain toxicoses. Adverse events associated with ILE in veterinary medicine are rare and anecdotal. Standard resuscitation protocols should be exhausted before considering this therapy and the potential side effects should be evaluated before administration of ILE as a potential antidote in cases of lipophilic drug toxicoses. Further research is waranted.     

9种抗菌药物对大肠埃希菌最小抑菌浓度的测定

畜禽养殖中会用到一些抗菌药物,而药物选用需要进行药物敏感性试验,目前市售的药敏纸片多为人用抗菌药物,为了制备兽用抗菌药物的药敏纸片,需要对药物的最小抑菌浓度(MIC)进行测定。该研究筛选了国家兽用药物名录中规定的、兽医临床上常用6类共9种抗菌药物(头孢噻呋钠、硫酸链霉素、强力霉素、土霉素、氨苄西林、氟苯尼考、替米考星、硫酸新霉素、青霉素),以大肠埃希菌为指标菌,通过微量肉汤稀释法分别测定了9种常用抗菌药物的最小抑菌浓度(MIC)。结果表明,头孢噻呋钠、硫酸链霉素、强力霉素、土霉素、氨苄西林、氟苯尼考、替米考星、硫酸新霉素、青霉素对指标菌的MIC值分别为为2、4、4、16、8、16、64、32、250μg/mL。研究结果为这些药物的临床应用和药敏纸片的研制提供了基础资料。     

兽药GMP检查验收中的常见问题分析

兽药GMP认证工作主要是对相关人员、硬件与软件三大要素和验证、规程与记录三项重点工作进行考核与检查。其中,硬件是根本,软件是重点,人员是关键。记录是实施GMP认证的基础性工作,必须真实、详细;规程是兽药生产的规范性文件和行动指南,必须规范、合理,可操作性强;而验证则是GMP检查验收工作的精髓和重中之重,各项规程及标准等都必须通过验证。     

中国与欧盟兽药管理之比较

从兽药管理法规、兽药监督管理部门、新兽药的研制、兽药注册管理、兽药生产许可证和GMP、兽药经营许可与GSP、进口兽药管理和兽药分类管理等八个方面,分别列举和比较了中国与欧盟的法律法规、行政设置和管理规定.     

Newer neuromuscular blockers. Is the practitioner ready for muscle relaxants?

Current research on the development of new neuromuscular blocking agents is directed towards producing agents that have a rapid onset of action and predictable duration of action and recovery times, with minimal hemodynamic effects. For the veterinary practitioner, these newer agents should be considered when muscle relaxation is required for certain surgical procedures. Care must be taken to monitor paralyzed patients appropriately to ensure adequate ventilation and anesthetic depth. Vigilant monitoring should exist during the recovery period for the development of muscle weakness from residual blockade and the ability to reverse the effects of neuromuscular blockade. The use of neuromuscular blocking agents in veterinary patients should continue to increase as newer drugs and better monitoring techniques are developed.     

Hendra virus in Queensland,Australia, during the winter of 2011: Veterinarians on the path to better management strategies

Following the emergence of Hendra virus (HeV), private veterinarians have had to adopt additional infection control strategies to manage this zoonosis. Between 1994 and 2010, seven people became infected with HeV, four fatally. All infected people were at a higher risk of exposure from contact with horses as they were either veterinary personnel, assisting veterinarians, or working in the horse industry. The management of emerging zoonoses is best approached from a One Health perspective as it benefits biosecurity as well as a public health, including the health of those most at risk, in this case private veterinarians. In 2011 we conducted a cross-sectional study of private veterinarians registered in Queensland and providing veterinary services to horses. The aim of this study was to gauge if participants had adopted recommendations for improved infection control, including the use of personal protective equipment (PPE), and the development of HeV specific management strategies during the winter of 2011. A majority of participants worked in practices that had a formal HeV management plan, mostly based on the perusal of official guidelines and an HeV field kit. The use of PPE increased as the health status of an equine patient decreased, demonstrating that many participants evaluated the risk of exposure to HeV appropriately; while others remained at risk of HeV infection by not using the appropriate PPE even when attending a sick horse. This study took place after Biosecurity Queensland had sent a comprehensive package about HeV management to all private veterinarians working in Queensland. However, those who had previous HeV experience through the management of suspected cases or had attended a HeV specific professional education programme in the previous 12 months were more likely to use PPE than those who had not. This may indicate that for private veterinarians in Queensland personal experience and face-to-face professional education sessions may be more effective in the improvement of HeV management than passive education via information packages. The role of different education pathways in the sustainable adoption of veterinary infection control measures should be further investigated.     

Swiss veterinary drug compendium as a tool for reconversions

The new Swiss ordinance on veterinary drugs poses a new challenge to the veterinarians, specially those working with farm animals. A complete overview about the registered veterinary drugs and immunobiologicals is absolutely necessary to cope with these new tasks: the internet version of the Swiss Veterinary Drug Compendium is a versatile tool to satisfy this needs (http://www.tierarzneimittel.ch). Due to the frequent updates and powerful search possibilities, this database is a reliable and comprehensive information system regarding Swiss veterinary drugs. We will demonstrate how this system can be used as a valuable help in the case of reconversions of drugs (e.g. use of small animal drugs in farm animals).     

规模养殖场兽用抗菌药物使用减量化养殖模式初探

兽用抗菌药物减量化三年试点工作落下帷幕,上海市6家养殖场顺利通过评价,先后被列入兽用抗菌药使用减量化行动试点达标养殖场名单。本文以试点养殖场为调研对象,从制度建设、环境控制、疫病防控、饲养管理、替抗方案等五个方面总结了各养殖场在抗菌药物减量化试点工作中取得的经验及减抗成效,以期为养殖场在开展兽用抗菌药物使用减量化行动过程中提供可复制、可操作的经验,推动建立兽用抗菌药使用减量化管理长效机制。     

Animal health in organic agriculture: new guidelines and perspectives for food animal practitioners

In the last decade, the organic agriculture in Switzerland has been substantially increased due to the interest of consumer and financial incentives of the federation. Ruminants take directly or indirectly the largest part from grassland used within the organic managed surfaces. As the contacts between veterinary practice and organic agriculture has increased, the potential for veterinary activity in this area has developed considerably. The organic agriculture guidelines stipulate that all the preventive measures should be taken in feeding, keeping and breeding to insure animal health safety. This requires veterinary services for herd management. The organic status of a farm affects veterinary practice also in the form of alternative therapy/drugs administration and measures like dehorning and tail-docking. An important point in organic managed herds requests that treatment of animals should depend on alternative medical preparations or procedures based on veterinarian's experience and also on the therapeutic effect on the animal species concerned as well as on the disease. However, there are no restrictions on the veterinarian to use registered drugs as long as no alternative therapy, according to experience and possible success, is available to treat the animals. The prophylactic administration of allopathic veterinary drugs is not permissible. Further features in organic farms regarding the use of drugs are the keeping of withholding/withdrawal time, the documentation and the treatment frequency tolerated by organic marketing. Despite the above measures, the animal health has a priority regardless of its organic status. Although management of organic farms represent a unique responsibility, there are still obvious deficits in the education of veterinary practitioners for this new situation. However, in the future the extension of veterinary activity to include the alternative medical therapy should be regarded for the practitioner as a challenge and an opportunity at the same time.     

Cytotoxic Drug Residues in Urine of Dogs Receiving Anticancer Chemotherapy

The presence of cytotoxic drug residues in urine of dogs may represent an exposure risk for pet owners and other people as well as a potential environmental contaminant. However, studies on cytotoxic drug residues in excretions of clinical patients are lacking in veterinary oncology. Hypothesis: Variable concentrations of cytotoxic residues are present in urine samples, depending on sampling time and substance. Animals: Client‐owned dogs with lymphoma or mast cell tumors treated with standard chemotherapy protocols. Methods: Urine samples were collected before, directly after, and on days after administration of chemotherapy. Measurement of vincristine, vinblastine, cyclophosphamide, and doxorubicin residues in canine urine was performed by a quantitative liquid chromatography tandem mass spectrometry (LC/MS/MS) method. Results: Median cyclophosphamide residue concentration was 398.2 μg/L directly after treatment (d0) and was below the level of detection on days 1–3 (d1, d2, d3). Median vincristine residue concentration was 53.8 μg/L directly after treatment and was 20.2, 11.4, and 6.6 μg/L on days 1, 2, and 3. Median vinblastine residues were 144.9 (d0), 70.8 (d1), 35.6 (d2), and 18.7 μg/L (d3) with low concentrations detectable for 7 days after treatment. Median urine doxorubicin concentrations were 354.0 (d0), 165.6 (d1), 156.9 (d2), and 158.2 μg/L (d3). Low concentrations of doxorubicin were measurable up to 21 days after administration. Conclusions and Clinical Importance: Variable concentrations of chemotherapeutics were measured in urine samples, depending on sampling time point and drug. Findings may inform current chemoprotection guidelines and help minimize exposure risks.     

AVMA guide for veterinary medical waste management

Lawmakers have enacted a variety of laws and regulations to ensure proper disposal of certain potentially infectious or otherwise objectionable waste. The veterinary medical profession supports scientifically based regulations that benefit public health. In 1988, Congress passed the Medical Waste Tracking Act, a federal program that mandates tracking certain regulated waste. Several types of waste generated in the typical clinical veterinary medical practice are considered regulated veterinary medical waste. Discarded needles, syringes, and other sharps; vaccines and vials that contained certain live or attenuated vaccines; cultures and stocks of infectious agents and culture plates; research animals that were exposed to agents that are infectious to human beings and their associated waste; and other animal waste that is known to be potentially harmful to human beings should be handled as regulated veterinary medical waste. Regulated veterinary medical waste should be handled with care. It should be decontaminated prior to disposal. The most popular, effective methods of decontamination are steam sterilization (autoclaving) and incineration. Chemical decontamination is appropriate for certain liquid waste. Waste should be packaged so that it does not spill. Sharps require rigid puncture- and leak-resistant containers that can be permanently sealed. Regulated veterinary medical waste that has not been decontaminated should be labeled with the universal biohazard symbol. Generators retain liability for waste throughout the entire disposal process. Therefore, it is essential to ensure that waste transporters and disposal facilities comply with state and federal requirements. Veterinary practices should maintain a written waste management program and accurate records of regulated veterinary medical waste disposal. Contingency planning and staff training are other important elements of a veterinary medical waste management program. The guide includes a model veterinary medical waste management program; however, it does not address all the variations in state and local regulations. Veterinarians should obtain copies of state and local laws and regulations and modify AVMA's model plan to create an individualized practice plan that complies with federal, state, and local laws and regulations. State and local veterinary medical organizations should monitor state and local regulation to influence decisions that affect veterinarians and to keep their members informed of changing requirements. Veterinarians and veterinary medical organizations must stay involved so that regulations do not unfairly burden the veterinary medical profession.     

Selection of antibiotics for meticillin‐resistant Staphylococcus pseudintermedius: time to revisit some old drugs?

The aim of this review is to consider systemic therapy options for meticillin-resistant Staphylococcus pseudintermedius (MRSP). Infections caused by MRSP in small animals--particularly dogs--have been frustrating veterinarians in recent years. After a susceptibility test is performed, veterinarians are left to select from drugs that have not been frequently encountered on a susceptibility report. Some of these are old drugs that have not been used regularly by veterinary dermatologists. As MRSP is, by definition, resistant to all β-lactam antibiotics, including cephalosporins, penicillins and amoxicillin-clavulanate combinations, the β-lactam drugs are not an option for systemic treatment. As most MRSPs are multidrug resistant, familiar drugs, such as trimethoprim-sulfonamides, fluoroquinolones, macrolides and lincosamides (clindamycin), are also not usually an option for treatment. Therefore, veterinarians are left with drugs such as rifampicin, chloramphenicol, tetracyclines, aminoglycosides and vancomycin to choose from on the basis of an in vitro susceptibility test. Some of these drugs were originally approved over 50 years ago and may not be familiar to some veterinarians. Each of these drugs possesses unique properties and has particular advantages and disadvantages. Veterinarians should be particularly aware of the adverse effects, limitations and precautions when using these drugs. New drugs also have been developed for meticillin-resistant Staphylococcus aureus in humans. These include linezolid, ceftaroline, daptomycin and tigecycline. Although these drugs are very infrequently--if ever--considered for veterinary use, the properties of these drugs should also be known to veterinary dermatologists.     

Australian veterinarians who work with horses: attitudes to work and career

OBJECTIVE: To describe the attitudes to their work and career of those Australian veterinarians who work with horses. METHOD: Questionnaires were mailed to 866 veterinarians who had been identified as working with horses, and 87% were completed and returned. Data were entered onto Excel spreadsheets, and analysed using the SAS System for Windows. RESULTS: The main attractions of veterinary work with horses were the horses themselves and the equine industries, but working outdoors and with rewarding clients, and the satisfaction of successful outcomes were attractions for many. The list of disadvantages was longer, and included unreasonable and disagreeable clients as well as those who provided inadequate facilities, could not control their horses or did not care for them. The physical demands and risks of injury, the amount of time required, low rates of return and difficulties in collecting payment, were other major disadvantages. Some mentioned concerns about litigation, unethical behaviour, and recruiting and retaining veterinarians competent with horses. For many in mixed practice, the difficulties in affording modern equipment, and of developing and maintaining their own competence with horses, was a real concern. More than three-quarters of the respondents reported that their careers had lived up to expectations and that they would become veterinarians again; 70% of equine veterinarians would become an equine veterinarian again. Almost all (93%) of the respondents were either very glad, or 'generally glad though with some misgivings' that they had done the veterinary course. Older veterinarians reported suffering less stress, and being more content with their career, than younger colleagues. CONCLUSIONS: The advantages of doing veterinary work with horses outweigh the disadvantages for most veterinarians, especially those well advanced in their careers.