Browsing tag: medicines

Antibiotic resistance: should the veterinary industry be doing more to help?

tablets image vet help direct

Antibiotic resistance, like global warming, is a threat to our future that keeps popping up in the media. The topic moved centre-stage today, with the long awaited publication of a major report that specifies the severity of the risk, and the measures that need to be taken to avert the threat.

It’s a long report, at 84 pages, and it’s worth reading for those with a serious interest in the subject, but here’s the gist of what’s being said.

Antibiotics are critical for modern medicine and surgery

First, the issue: antibiotics are a special category of antimicrobial drugs that underpin modern medicine (and veterinary medicine). If they lose their effectiveness, key surgical procedures (such as intestinal surgery, caesarean sections and joint replacements) and important medical treatments that depress the immune system (such as chemotherapy) for cancer) could become too dangerous to perform.

Why should antibiotics lose their effectiveness? Basically, bacteria are sometimes able to develop mechanisms to avoid being killed by antibiotics, developing so-called “resistant strains”. These are then able to multiply in the presence of the antibiotic, rendering the drug useless. There are many factors that predispose to antibiotic resistance, but essentially the more often antibiotics are used, the more likely bacteria are to develop resistance.

Antibiotic resistance could soon kill more people than currently die from cancer

How big is the problem? At the moment, 700,000 human deaths happen every year due to antibiotic resistance. If current trends continue, by 2050 this will reach a figure of 10 million deaths every year; more people than currently die from cancer. The economic cost is equally shocking, an unimaginable trillions of dollars in wasted antibiotics that don’t work and the consequent medical outcomes.

Ten steps to solve the problem

So what can be done? The report makes ten recommendations, and global government action is needed to put these into place.

  1. A global public awareness campaign to educate all of us about the problem of drug resistance, and in particular children and teenagers. Ignorance can only make this issue worse.
  2.  New drugs need to be developed to replace the ones that are not working anymore because of resistance. A truly new class of antibiotics has not been developed for decades.
  3. Use antibiotics more sparingly in humans and animals, to reduce the unnecessary use that speeds up drug resistance. By 2020, it should be compulsory that the prescription of antibiotics can only be allowed if there is data to support the choice. One specific suggestion is a new tax on antibiotics for animal use to make them less attractive.
  4. Develop new, more rapid diagnostic tests to help doctors and vets limit their use to only cases where they are genuinely needed.
  5. Reduce the extensive and unnecessary use of antibiotics in agriculture, restricting the use in animals of antibiotics that are vital for human health. The widespread advertising and marketing of antibiotics for animals should be reviewed.
  6. Promote development and use of vaccines and other alternatives to prevent infections from developing in the first place.
  7. Improve the numbers, pay and recognition of people working in infectious disease. Currently, infectious disease doctors are the lowest paid of 25 medical fields in the USA.
  8. Establish a Global Innovation Fund for early-stage and non-commercial research which is just not being done at the moment.
  9. Better incentives to promote investment in new drugs
  10. Build a global coalition for real action – via the G20 and the UN

The most relevant aspect of the report to vets is obviously number (5): can we do more to limit antibiotic use in animals? HealthForAnimals, the Global Animal Medicines Association, believes that we are already doing enough but perhaps it takes outsiders to view our activities with a clear objective eye.

What can small animal vets do to limit antibiotic usage?

The reduction of antibiotic use on farms is a significant recommendation in the report, while their use in pets isn’t even mentioned. But small animal vets use antibiotics every day, and we need to examine our own roles in this area. If you read the veterinary press, it’s common to see third generation cephalosporins – one of the most advanced groups of antibiotics – being marketed as a first line antibiotic for vets in small animal practice. Meanwhile when humans go to their GP with common problems like chest infections, medical doctors seem to have become far better than vets at avoiding antibiotic use, not using antibiotics at all for minor infections, and only using older drugs like amoxycillin if antibiotics are judged to be absolutely necessary. More modern antibiotics like amoxycillin-clavulanate are only prescribed if the simpler drugs don’t work. In contrast, it’s standard practice for vets to choose these “stronger” drugs as a first choice. It’s easy to see why vets do this – we want our patients to get better as rapidly as possible, with the least possible risk of treatment failing. We justify this as “looking after animal welfare”, but if medical doctors can take a stronger anti-antibiotic line than vets, do we need to think again?

Vets in practice have got far better at using antibiotics appropriately, but should our industry be doing even more to help with this serious problem?

Giving medication to pets: a necessary but challenging task

c210medicatingpets

Giving medication to pets is not easy. In a typical case of a dog with a skin condition, I may send the owner home with three types of tablets to be given twice daily for ten days. As I write up the final details of the patient’s file, I sometimes reflect that I have sent the owner away with a challenging task to complete.

When vets give medicines, we often use the easy route of giving an injection, usually into the skin at the back of the neck. Most animals do not even notice this happening, since the skin in this area is loose, with insensitive innervation. Long acting injections are sometimes available, such as an antibiotic that lasts for two weeks, or a steroid that lasts for a month, but these drugs are only effective for particular cases. In most instances, ongoing medication has to be given by owners at home, and this is usually via the oral route, using tablets or capsules.

The digestive system rapidly absorbs substances given orally, and high blood levels are easily achieved. But there is a problem: most tablets need to be repeated once or twice daily and it is not always easy to make an animal swallow that pill.

I find the direct approach is the best route to try first. The animal is held firmly, the nose is pointed up to the ceiling, the lower jaw is pulled down so that the mouth is open, and the tablet is thrown to the back of the tongue. The mouth is then held closed until the animal swallows. It helps to have an assistant to hold the animal, with a towel wrapped around the front legs so that the patient cannot use their paws to push you away. Of course, with a wriggling, strong, uncooperative animal, it is not always so easy to put this technique into practice. There are definitely some animals that are classified as “unpillable”. Cats in particular can present a huge challenge.

Tablets and capsules can also be given in the food. It’s best to give a small portion of food laced with medicine before the main meal, to ensure that it is all eaten. Otherwise pets can very cleverly eat all around the medicine, carefully avoiding the most important part. Tablets can also be hidden inside morsels of food, like pieces of sausage or cheese. The best idea is to give a few unadulterated treats first, to lull the pet into a false sense of security before offering the medicated treat.

Some tablets are designed to be “palatable”, with a sweet, non-bitter taste. The drug companies advertising these products  sometimes tell stories of cats devouring them hungrily like children with sweets. In reality, many cats seem to be too clever to be fooled so easily.

With all forms of medicine, it’s very important to finish the course. It can be difficult to do this, especially when it’s a daily battle to give the medication, and when the animal seems to be better. However, if you stop giving medicine when your pet is “half better”, the problem is much more likely to recur. I find that it helps to make up a “tick chart” at the start of the treatment, which I complete every time a dose is given. When I tick the last box on my chart, the course is finished.

I have a great deal of respect for owners who uncomplainingly carry out my treatment instructions. When the healthy animal returns for a final check up, I often feel that I should present the owner with a medal, a prize and a “Congratulations” card for successful completion of the entire course of medication.

 

The Drugs Don’t Work – Or Do They?

Today I put to sleep a lovely old Collie owned by a lovely man. It was definitely the right decision, the dog was really struggling on his legs and had become very depressed and withdrawn. This is a common scenario and very often the way that arthritic pets come to their end. In fact, a very similar thing happened to our beloved family Labrador, Molly, a few years ago and although she was still trying to get about and clearly happy to be with us, she was obviously in a lot of pain which could no longer be controlled. Euthanasia in these situations is a true kindness and although still desperately upsetting, is by far the best thing for the pet.

However, just as I was discussing the euthanasia of this dog with his owner, he said something that stopped me in my tracks.

‘Well, we did try him on some of your arthritis medication a few months ago but to be honest it didn’t seem to be doing anything more than the Asprin I was giving him, so we stopped it’

Now, at this stage in the process there was no point in me making any comment on this statement (or my thoughts on giving pets human medications!) and you may think it sounds like quite a reasonable thing to say but to be honest, I really had to bite my tongue.

Arthritis is a very common problem in older pets but it is also very under-diagnosed because the signs can be difficult to spot, mainly because our animals are so stoical in the face of chronic pain. Even just a bit of stiffness after rest can indicate a significant problem. The medications we have to treat it are extremely effective but often, and especially in the older pets with more advanced arthritis, just one drug on it’s own doesn’t completely combat the problem and they need a combination of medicines to really keep them comfortable. (Anyone with an older relative will probably be familiar with this concept; my granny seems to be on hundreds of tablets!)

Our darling Molly was practically rattling in her last few months I had her on so many medications and supplements These kept her comfortable but eventually, they could no longer control her pain and give her the strength to get around, so the kindest thing was to let her go.

My message is, if you have an older pet, firstly, don’t assume that them slowing down and stiffening up is a ‘normal’ part of aging (well, in a way it is but that doesn’t mean we can’t do something about it!) and if the medicines your vet gives you don’t make much difference at first, don’t assume that that is because there isn’t a problem or that nothing else can be done, it may just be they need different tablets or combination therapy to give them their bounce back! This is far preferable to leaving them to struggle in silence and although, in the end, their arthritis may mean they need to be put to sleep, it will certainly give them more time and mean their final months with you are pain free and comfortable.

And finally, please don’t give your pets ANY human medications without talking to your vet about it first. Drugs often work very differently in animals than they do in people and some can be actually harmful.

Could Carprodyl Kill your Dog?

The headline in today’s Daily Mail is typically attention-grabbing: “Could the drug that cost this beloved pet its life
kill YOUR dog too?” The article tells the sad story of a thirteen year old Labrador who died after taking pain-relieving
medication prescribed by her vet. There’s no doubt that many owners of elderly, arthritis-ridden dogs will be rushing to
their vets this week to find out if their own pets are at risk of the same fate.
So what is this drug? Why do vets prescribe medicine which may risk such a severe reaction? And when they do use it,
why don’t they tell owners about the potential dangers?
First, the medication was Carprodyl, a generic form of a chemical called carprofen, which is part of a group of drugs
known as non-steroidal anti-inflammatory drugs (NSAIDS). Carprofen has become perhaps the most widely used pain
relieving medication used in veterinary medicine since it was launched as “Rimadyl” by Pfizer, around fifteen years
ago. The patent on the chemical has now lapsed, so a wide range of cheaper generic alternatives have become available.
Most vet clinics in the UK are likely to sell some version of the product.
Second, why do vets prescribe it? Simply put, because it’s the most effective way of treating arthritis in dogs. Many
millions of older animals have been given extra, pain-free life thanks to this type of medication. Three years ago, a
major review was published in the Vet Record, comparing the wide range of treatments available to help dogs with
the common, painful, debilitating problem of arthritis. The review gathered together the results of research papers
published between 1985 and 2007, attempting to derive the best science-based opinion of the best treatment method.
The conclusion? There was strong evidence that carprofen and two other commonly used drugs from the same group
were “effective in moderating the clinical signs of osteoarthritis”. There was only weak or moderate evidence that other
treatments were effective. The conclusion for any vet reading this paper was clear: carprofen and other similar drugs are
the most effective way of helping animals with arthritis.
Obviously, an effective drug needs to be safe, so what about those risks? While it’s true that all drugs in this group can
have undesirable and potentially life threatening consequences, the incidence is very low. The most common side effect
is gastric irritation: affected dogs suffer from gastroenteritis which usually resolves when the medication is stopped.
Much more rarely, there’s a very low risk of kidney failure associated with non-steroidal anti-inflammatory drugs. The
cause of this is complicated: it’s more common in geriatric patients suffering from underlying heart, kidney or liver
disease, but it can seem to happen in a random fashion. To minimise this risk, vets may suggest blood or urine tests
before starting a dog onto anti-arthritis medication. Such tests don’t completely remove the small risk, and they add
significantly to the cost of treatment for a pet, so they aren’t always done.
So finally, why don’t vets always tell owners about the potential dangers of such medication? There’s a lot of variation
in what happens here: some vets do take the time to tell owners about every possible side effect of every drug that’s
used. The problem with this approach is that it’s time consuming, leading to longer (and more expensive) consultations
for owners. Most owners don’t particularly want to hear a long list of potential side effects that are unlikely to happen,
and they’re happy to trust that the vet, on balance, feels that the medication is most appropriate having taken all the risks
and benefits into account.
Vets may also feel that detailed listings of potential adverse reactions may lead to unnecessary worrying for an owner,
so they just mention the most common side effects (“stop the tablets and let me know if she gets an upset stomach”).
Sometimes a compromise may be to hand out the package insert with the tablets: the owner can then read the full list of
possible complications if they so wish (and if they have a magnifying glass).
I feel very sorry for the owners of any animal that suffers the consequences of a serious adverse reaction to medication.
There’s no easy answer here, but there’s a simple message: if you want to know about potential side effects of any drug,
ask your vet. We’re happy to tell you if you’re happy to listen. It’s likely that the same treatment decision will still
be made, but at least, in the rare instance of a severe reaction, you won’t have that awful sense of unfairness that you
weren’t told about the risk.

The headline in today’s Daily Mail is typically attention-grabbing: “Could the drug that cost this beloved pet its life kill YOUR dog too?” The article tells the sad story of a thirteen year old Labrador who died after taking pain-relieving medication prescribed by her vet. There’s no doubt that many owners of elderly, arthritis-ridden dogs will be rushing to their vets this week to find out if their own pets are at risk of the same fate.

So what is this drug? Why do vets prescribe medicine which may risk such a severe reaction? And when they do use it, why don’t they tell owners about the potential dangers?

First, the medication was Carprodyl, a generic form of a chemical called carprofen, which is part of a group of drugs known as non-steroidal anti-inflammatory drugs (NSAIDS). Carprofen has become perhaps the most widely used pain relieving medication used in veterinary medicine since it was launched as “Rimadyl” by Pfizer, around fifteen years ago. The patent on the chemical has now lapsed, so a wide range of cheaper generic alternatives have become available. Most vet clinics in the UK are likely to sell some version of the product.

Second, why do vets prescribe it? Simply put, because it’s the most effective way of treating arthritis in dogs. Many millions of older animals have been given extra, pain-free life thanks to this type of medication. Three years ago, a major review was published in the Vet Record, comparing the wide range of treatments available to help dogs with the common, painful, debilitating problem of arthritis. The review gathered together the results of research papers published between 1985 and 2007, attempting to derive the best science-based opinion of the best treatment method. The conclusion? There was strong evidence that carprofen and two other commonly used drugs from the same group were “effective in moderating the clinical signs of osteoarthritis”. There was only weak or moderate evidence that other treatments were effective. The conclusion for any vet reading this paper was clear: carprofen and other similar drugs are the most effective way of helping animals with arthritis.

Obviously, an effective drug needs to be safe, so what about those risks? While it’s true that all drugs in this group can have undesirable and potentially life threatening consequences, the incidence is very low. The most common side effect is gastric irritation: affected dogs suffer from gastroenteritis which usually resolves when the medication is stopped. Much more rarely, there’s a very low risk of kidney failure associated with non-steroidal anti-inflammatory drugs. The cause of this is complicated: it’s more common in geriatric patients suffering from underlying heart, kidney or liver disease, but it can seem to happen in a random fashion. To minimise this risk, vets may suggest blood or urine tests before starting a dog onto anti-arthritis medication. Such tests don’t completely remove the small risk, and they add significantly to the cost of treatment for a pet, so they aren’t always done.

So finally, why don’t vets always tell owners about the potential dangers of such medication? There’s a lot of variation in what happens here: some vets do take the time to tell owners about every possible side effect of every drug that’s used. The problem with this approach is that it’s time consuming, leading to longer (and more expensive) consultations for owners. Most owners don’t particularly want to hear a long list of potential side effects that are unlikely to happen, and they’re happy to trust that the vet, on balance, feels that the medication is most appropriate having taken all the risks and benefits into account.

Vets may also feel that detailed listings of potential adverse reactions may lead to unnecessary worrying for an owner, so they just mention the most common side effects (“stop the tablets and let me know if she gets an upset stomach”).

Sometimes a compromise may be to hand out the package insert with the tablets: the owner can then read the full list of possible complications if they so wish (and if they have a magnifying glass).

I  feel very sorry for the owners of any animal that suffers the consequences of a serious adverse reaction to medication. There’s no easy answer here, but there’s a simple message: if you want to know about potential side effects of any drug, ask your vet.  We’re happy to tell you if you’re happy to listen. It’s likely that the same treatment decision will still be made, but at least, in the rare instance of a severe reaction, you won’t have that awful sense of unfairness that you weren’t told about the risk.

If you are concerned that your dog is ill or sick please use our interactive dog symptom guide to find out what you should do

More Useful Information

Examining your pet

Simple ways to check the health of your pet. Vets use these techniques as part of their clinical examiniation.

Medicating your pet

Arming you with the same simple techniques for stress free pill giving.

Worming & Flea Treatment

Information and advice in treating your pet for worms and fleas.