Off licence ear solution - would this formula be effective?

RE: Off licence ear solution - would this formula be effective?

Iain McAllister — Fri, 02 Oct 2015 11:32:10 GMT

[quote user="Aine Seavers"]with Triz edta.
118ml dried powder
23.6ml of Baytril 50
82.6ml of distilled h20
11.8mls of dexameth
= 5mg/ml of dexameth.[/quote]

Not only did he not follow cascade but he made up a solution that would be unlikely to be therapeutic anyway - 100ml saline 2ml 2.5% baytril and 1ml dex... ie 20 times less baytril and 10 x less dex than the formula above

RE: Off licence ear solution - would this formula be effective?

Utlendigur — Wed, 30 Sep 2015 21:01:43 GMT

[quote user="Martin Atkinson"]

Aine, where do you get the tris EDTA powder from?

[/quote]

Triz-aural (dechra)

RE: Off licence ear solution - would this formula be effective?

Rob Loxley — Wed, 30 Sep 2015 19:21:44 GMT

[quote user="Martin Atkinson"]Aine, where do you get the tris EDTA powder from?[/quote]

isn't the recipe for triz crystals in the bottle, made up to 118ml?

RE: Off licence ear solution - would this formula be effective?

Aine Seavers — Wed, 30 Sep 2015 10:04:47 GMT

will check for you with a vet mate here who loves the stuff as years since I used it- Ceva had the licence here until a couple of years ago- not sure who has the rights now- shows how long the recipe has been around.!!

You can do it without the tris- the very very original one was baytril with dexason in I think Epiotic! but dont quote me on that until I find out more. Some of the derm specialists on Vetsurg may remember that exact formula.

RE: Off licence ear solution - would this formula be effective?

Martin Atkinson — Wed, 30 Sep 2015 09:55:40 GMT

Aine, where do you get the tris EDTA powder from?

RE: Off licence ear solution - would this formula be effective?

Aine Seavers — Wed, 30 Sep 2015 07:46:01 GMT

inappropriate to use it in this case but this mix has been around about 10 years in derm world- used until Baytril otic licenced drops came in- but some specialist still like it-have seen it made with amikacin/edta/dex as well.- gaining some traction again now in countries without the cascade as made up fresh in smaller amounts for targeted cases- the case posted above would not be one of them!

Have used it once years ago-cleared a chronic pseudomonas very fast.

106ml, 8oz) of TrisEDTA + 12 ml enrofloxacin wasone dilution recommended as were these formulae-no longer have the references but would be from Derm gurus at the time.

6ml Baytril inj
12ml of saline
or prop.glycol( if TM not ruptured)
2ml of 5% dexamethasone NAP
1.5mls in each ear.

with Triz edta.
118ml dried powder
23.6ml of Baytril 50
82.6ml of distilled h20
11.8mls of dexameth
= 5mg/ml of dexameth.

RE: Off licence ear solution - would this formula be effective?

Rob Loxley — Tue, 29 Sep 2015 22:35:39 GMT

[quote user="Braden Collins"]I personally see that as them trying to push the vets to stock their brand to fit within the cascade rather than trying to produce a great product for that species.[/quote]

I did have a wry smile when I reported one of the drug companies to the VMD for the advertising for their dog product that says 'cat' on the detailer, when it is clearly not licensed in cats. We'll see what come of that...

RE: Off licence ear solution - would this formula be effective?

Braden Collins — Tue, 29 Sep 2015 14:25:20 GMT

I will often use a TrizEDTA/dex/enrofloxacin home made combo for pseudomonas which I find works very well. That being said, we don't have the cascade in Australia.

To me, this treatment made up by the vet will work, but it is a pretty clear breach of the cascade and I think a sledge hammer to crack a nut approach which I think is pretty irresponsible.

The cascade pretty clearly states:

The principle of the Cascade is that, if there is no suitable veterinary medicine authorised in the UK to treat a condition, the veterinary surgeon responsible for the animal may, in particular to avoid causing unacceptable suffering, treat the animal in accordance with the following sequence, in descending order of priority:

o A veterinary medicine authorised in the UK for use in another animal species or for a different condition in the same species.

o If there is no such product, the next option is either –  a medicine authorised in the UK for human use, or  a veterinary medicinal product (VMP) not authorised in the UK but authorised in another Member State (MS) for use in any animal species (in the case of a food-producing animal the medicine must be authorised in a food producing species) in accordance with an import certificate issued by the VMD.

o If there is no such product, the last option is a medicine prescribed by the veterinary surgeon responsible for treating the animal and prepared extemporaneously by a veterinary surgeon, a pharmacist or a person holding an appropriate manufacturer’s authorisation. In exceptional circumstances, medicines may be imported from Third countries through the VMD’s import scheme.

I think the prescribing vet has jumped a few of those steps.....

As for the purpose of the cascade, I thought it was to protect/help animals until drugs like cimetidine had licensed products produced at many times the cost. After that, I started to believe it was for the drug companies. I don't think the drug companies really help that perception when they not-so-subtly include statements in their advertisements "the only licensed X for use in cats". I personally see that as them trying to push the vets to stock their brand to fit within the cascade rather than trying to produce a great product for that species.

RE: Off licence ear solution - would this formula be effective?

Martin Atkinson — Tue, 29 Sep 2015 14:08:02 GMT

[quote user="Charlotte Marshall"]

Only time I have used DIY eardrums with baytril has been in cases with ruptured eardrums. And where pseudomonas was suspected or confirmed. All currently licensed products are contraindicated with ruptured eardrums. I can't remember the mix I used though.

[/quote]Actually I went to a CPD talk last week on this topic and the speaker did mention that you could concoct your own special brew for these circumstances containing the appropriate ingredients. I just check my notes and its not in there so I see if I can contact the speaker and will come back on it. Watch this space.

RE: Off licence ear solution - would this formula be effective?

Charlotte Marshall — Tue, 29 Sep 2015 13:54:43 GMT

RE: Off licence ear solution - would this formula be effective?

Bob Russell — Tue, 29 Sep 2015 12:23:54 GMT

I would tend to agree that nobody is going to want to bring a prosecution under cascade. Many of us here would probably help fund the defence costs!!

RE: Off licence ear solution - would this formula be effective?

Bob Russell — Tue, 29 Sep 2015 12:22:01 GMT

Why not just give a shot of the steroid to reduce the inflammation and make the patient more comfortable? Any infection should be self limiting once the FB has gone!

RE: Off licence ear solution - would this formula be effective?

Gillian Mostyn — Tue, 29 Sep 2015 11:08:56 GMT

We're talking about 2 different situations and I do think (hope) they would be handled differently by the VMD. Using a drug with an active ingredient that is licensed (even if not the 'correct' formulation) is very different to DIY ear drops - no?

Anyway, I have distracted you from the original OPs question, which was regarding the likely efficacy.

RE: Off licence ear solution - would this formula be effective?

Martin Atkinson — Tue, 29 Sep 2015 10:13:15 GMT

[quote user="Gillian Mostyn"]Although it has significant flaws, surely you can see that the idea behind the cascade, to make sure vets were using licensed, tried and tested products, was a sound one? Nobody should be peddling their own home-made (cheap as chips) ear drops as a first line treatment! [/quote] I can see and I agree however......[quote user="Anthony Todd"]

Most of the drugs had been tried and tested for yonks and could easily have been given a licence by right.

The licence was just that, but only to add to the profit, in the case of these tried and tested drugs.

[/quote]Wot he says.

[quote user="Eamon McAllister"]Probably the biggest scam ever perpetrated by the pharmaceutical industry on the veterinary profession and the pet owning public. No one has ever been prosecuted because in my opinion any case if vigorously defended would be thrown out of court setting a precedent and the whole sleazy house of cards would collapse.[/quote] Wot he says as well.

RE: Off licence ear solution - would this formula be effective?

Eamon McAllister — Mon, 28 Sep 2015 22:59:56 GMT

[quote user="Martin Atkinson"]

[quote user="Anthony Todd"]No the whole point of the cascade is to prevent vets using well proven, long in veterinary use, well tested and established human products and replace them with rebranded re-labled identical products, probably made in the same plant by the same manufacturer which end up costing sometimes ten times the price with no advantage to anyone except lots of profit for the reseller, some extra profit for the vet [increased, but same, markup] and considerable extra cost to the public [eg phenobarbitone posts passim][/quote]Well for once I'm in complete agreement with you Anthony (except, knowing what you look like, the male model bit!) and am just as cynical about manufacturers using the cascade as a back door to increased profitability. Indeed I would challenge the RCVS/DEFRA whoever to prosecute me for using generic drugs which have been in use for generations when someone cynically decides to make a branded version of exactly the same product when the medical profession is told it must use generic versions if one is available.

[/quote] Agreed. Probably the biggest scam ever perpetrated by the pharmaceutical industry on the veterinary profession and the pet owning public. No one has ever been prosecuted because in my opinion any case if vigorously defended would be thrown out of court setting a precedent and the whole sleazy house of cards would collapse.

RE: Off licence ear solution - would this formula be effective?

Rob Loxley — Mon, 28 Sep 2015 22:57:48 GMT

[quote user="Iain McAllister"]any views on the effectiveness of this?[/quote]

I'd expect removing the grass seed to be highly effective in resolving the problem!

I'd personally not be using FQs 1st line, most grass seed removals don't need heavy duty followup treatment IME

RE: Off licence ear solution - would this formula be effective?

Anthony Todd — Mon, 28 Sep 2015 22:10:42 GMT

Most of the drugs had been tried and tested for yonks and could easily have been given a licence by right.

The licence was just that, but only to add to the profit, in the case of these tried and tested drugs.

RE: Off licence ear solution - would this formula be effective?

Francisco Gomez — Mon, 28 Sep 2015 21:58:47 GMT

Your friend's vet would need to have a look at their use of antibiotics me thinks... but I guess our veterinary qualification gives us the right and power to make this sort of decisions... I've known that cocktail for a long time (I don't use it, I haven't got the time, neither I have a cocktail shaker) and Pseudomonas, when present, has a characteristic and elegant look and aroma...

... and none of us was there.

RE: Off licence ear solution - would this formula be effective?

Gillian Mostyn — Mon, 28 Sep 2015 21:15:32 GMT

[quote user="Martin Atkinson"] am just as cynical about manufacturers using the cascade as a back door to increased profitability. [/quote]

The manufacturers may be using the cascade rules to their profit, but that wasn't the reason the cascade was introduced.

Although it has significant flaws, surely you can see that the idea behind the cascade, to make sure vets were using licensed, tried and tested products, was a sound one? Nobody should be peddling their own home-made (cheap as chips) ear drops as a first line treatment!

RE: Off licence ear solution - would this formula be effective?

Martin Atkinson — Mon, 28 Sep 2015 19:00:34 GMT

RE: Off licence ear solution - would this formula be effective?

Anthony Todd — Mon, 28 Sep 2015 18:20:48 GMT

[quote user="Martin Atkinson"]It wasn't Anthony T by any chance was it? [/quote]

If I was a modvet I suppose I would say I was deeply offended, via private message, had been frightened off the forum and was going to give up vetting and become a male model, as I was disillusioned by the modern profession etc. etc. and privately burst into tears as criticism is so hurtful and unhelpful.

But I'll just respond to this:

The whole point of the cascade is to prevent people peddling their own homemade remedies when there are licensed and 'safer' products available.

No the whole point of the cascade is to prevent vets using well proven, long in veterinary use, well tested and established human products and replace them with rebranded re-labled identical products, probably made in the same plant by the same manufacturer which end up costing sometimes ten times the price with no advantage to anyone except lots of profit for the reseller, some extra profit for the vet [increased, but same, markup] and considerable extra cost to the public [eg phenobarbitone posts passim]

I can't think of any DIY concoction I have ever used, or which has ever been used widely by anyone, but I stand to be corrected, even though I may cry and continue my new career path.

RE: Off licence ear solution - would this formula be effective?

Robin Grimmer — Mon, 28 Sep 2015 17:51:33 GMT

That is a cocktail reserved for Pseudomonas. So totally ott for a grass seed. A squirt of canaural would have done the job!

RE: Off licence ear solution - would this formula be effective?

Martin Atkinson — Mon, 28 Sep 2015 17:10:12 GMT

It wasn't Anthony T by any chance was it?

But was the £60 for the drops of the whole procedure?

RE: Off licence ear solution - would this formula be effective?

Iain McAllister — Mon, 28 Sep 2015 15:43:09 GMT

The seed had been in a few days so may have provoked some inflammatory response I suppose..

RE: Off licence ear solution - would this formula be effective?

Gillian Mostyn — Mon, 28 Sep 2015 15:41:02 GMT

[quote user="Iain McAllister"]My thoughts were that the level of baytril and dexamethasone in the fianl solution we be so low as to be unlikely to be theraputically effective and that putting saline down the ear and leaving it in is not ideal in the first place...[/quote]

Agreed. But seeing as it only had a grass seed removed, and didn't require any further treatment, I'm sure it got better regardless!