A revolutionary new and exciting antibiotic!

RE: A revolutionary new and exciting antibiotic!

Bob Russell — Fri, 08 Jul 2016 13:56:52 GMT

Editing has made this look as if it is my post and sympathies!

It may be illegal and price cannot officially be used as an excuse in itself. I don't believe you can abuse cascade as I consider it a bit unnecessary for non-food producing species. If a pet owner is happy to take a small risk for reduced cost then it should be up to them.

There are some circumstances where I will enter the grey zone including where it prevents a treatment option being affordable.

I happily accept that cascade is sensible for food producing species!

RE: A revolutionary new and exciting antibiotic!

Martin Atkinson — Fri, 08 Jul 2016 09:19:12 GMT

[quote user="Bob Russell"]Check all they like, but it is irrelevant really; prescribing generics when there is licenced version available is illegal, and price cannot be cited as a reason for using, abusing or blatantly flouting the cascade regs.[/quote]There is a difference between starting to use a generic when there is a clear choice between a licenced and a generic version based purely on cost or if the licenced version is specially formulated for our species, and one which has been in use forever over a licenced version of exactly the same drug in exactly the same strength which some enterprising pharma company has identified as a quick way to profit through the back door of the cascade, especially when as has been illustrated they can't be bothered formulating more appropriate doses and advise dosing at levels we consider to be potentially harmful. In practice it is splitting hairs but I would be prepared to defend the latter usage in court.

RE: A revolutionary new and exciting antibiotic!

Evelyn Barbour-Hill — Thu, 07 Jul 2016 01:18:50 GMT

[quote user="Iain Richards"]

Pedantry or good science?

Antibiotic is more usually reserved for antibacterial medicines, although strictly speaking I believe it should be only naturally produced substances that are antibiotics. As metronidazole acts against anaerobes as well as protozoa, I suspect Evelyn is using the latter defintion.

[/quote]

antibiotic

/an·ti·bi·ot·ic/ (-bi-ot´ik) a chemical substance produced by a microorganism, which has the capacity toinhibit the growth of or to kill other microorganisms; antibiotics sufficiently nontoxic to the host are used in the treatment ofinfectious diseases."

It is reasonable to extend "antibiotic" to synthetic and modified developments of naturally-produced extracted antibiotic drugs, so amoxycillin, for instance, is classed as an antibiotic.

Metronidazole, sulphonamides and trimethoprim are examples of antibacterial drugs that are not antibiotics. Antimicrobial, in fact, since metronidazole and the sulphonamides will act against some protozoa, too.

Were you all asleep in your pharmacology lectures?

If we are a scientific profession we should be as precise as possible.

However I admit that the original post did not call for my comment. I offered it because I was in that sort of mood.

RE: A revolutionary new and exciting antibiotic!

Iain Richards — Wed, 06 Jul 2016 22:19:18 GMT

[quote user="James Laidlaw"]

[quote user="Evelyn Barbour-Hill"]

Metronidazole is not an antibiotic.

[/quote]

Pedant alert!

Are you going to enlighten the masses?

[/quote]

Pedantry or good science?

RE: A revolutionary new and exciting antibiotic!

James Laidlaw — Wed, 06 Jul 2016 21:52:44 GMT

[quote user="Clive Ansell"]As an aside; what would happen if an assistant or a locum in a practice refused to prescribe generics that were on the shelf, because a licenced form of the same drug exists, only the practice refuses to order it in? just wondered like.[/quote]

They get antsy and try to see if any of the other vets will use it (not from personal experience or anything... )

RE: A revolutionary new and exciting antibiotic!

Bob Russell — Wed, 06 Jul 2016 17:51:22 GMT

[quote user="Clive Ansell"]

[quote user="Anthony Todd"]200mg, 400mg and 500mg seem to be the human sizes, according to Google so 200mg would have been better for cats I would assume.[/quote]

Metrobactin comes in 250mg and 500mg sizes, so a 5 Kg cat could have 1 x 250mg or 1/2 x 500mg sid, or 1/2 x 250mg or 1/4 x 500mg bid. simples.

[quote user="Anthony Todd"]Check the generic 200mg price [or the clients will....][/quote]

Check all they like, but it is irrelevant really; prescribing generics when there is licenced version available is illegal, and price cannot be cited as a reason for using, abusing or blatantly flouting the cascade regs.

As an aside; what would happen if an assistant or a locum in a practice refused to prescribe generics that were on the shelf, because a licenced form of the same drug exists, only the practice refuses to order it in? just wondered like.

[/quote]Write a prescription for the owner to get online?

RE: A revolutionary new and exciting antibiotic!

Virginia Campbell — Wed, 06 Jul 2016 17:11:06 GMT

[quote user="Hannah Wynne Richards"]

I'd say that was a dangerously high dose - everyrthing is going to start twitching!

Wynne

[/quote]

I have seen CNS signs once, in a dog that got dispensed 400mg rather than 200mg tabs by mistake. Can't remember what dose it actually got but would have been 50mg/kg max as we follow the formulary 15-25mg/kg recommendation.

I agree, would have big reservations about using this dose. I want to know how many animals and what kind of populations this was tested on..not all blood brain barriers are created equal. If we use it at 15-25mg/kg now, is that off label use?

RE: A revolutionary new and exciting antibiotic!

Richard Carter — Wed, 06 Jul 2016 16:28:34 GMT

and the dose is way too high - at this level you will be getting cns side effects. 10-15mg/kg as per formulary, 25mg/kg to kill protozoa.

RE: A revolutionary new and exciting antibiotic!

Clive Ansell — Wed, 06 Jul 2016 15:59:37 GMT

[quote user="Anthony Todd"]200mg, 400mg and 500mg seem to be the human sizes, according to Google so 200mg would have been better for cats I would assume.[/quote]

Metrobactin comes in 250mg and 500mg sizes, so a 5 Kg cat could have 1 x 250mg or 1/2 x 500mg sid, or 1/2 x 250mg or 1/4 x 500mg bid. simples.

[quote user="Anthony Todd"]Check the generic 200mg price [or the clients will....][/quote]

RE: A revolutionary new and exciting antibiotic!

Hannah Wynne Richards — Wed, 06 Jul 2016 15:56:00 GMT

I'd say that was a dangerously high dose - everyrthing is going to start twitching!

Wynne

RE: A revolutionary new and exciting antibiotic!

Anthony Todd — Wed, 06 Jul 2016 13:05:12 GMT

[quote user="Clive Ansell"]No. Dechra's recommended dose rate is 50mg/kg daily, or divided in to 25mg/kg twice daily. So a 500mg tablet for a 10kg dog (or cat!)[/quote]

200mg, 400mg and 500mg seem to be the human sizes, according to Google so 200mg would have been better for cats I would assume.

Check the generic 200mg price [or the clients will....]

RE: A revolutionary new and exciting antibiotic!

Bob Russell — Wed, 06 Jul 2016 11:23:00 GMT

Legislation is based on the Veterinary Medicinal Products Directive 2001/82/EC (as amended).

The EC bit is the give away!

Anyone wanting to have it amended to exclude non-food producing animals should get their arguments prepared to submit to the BVA and/or DEFRA who (I assume) will be responsible for untangling UK legislation from European regulations.

I very much doubt much will change as the pharmaceutical companies are likely to have some input. I must admit for medicines that I use in small quantities I will continue to order smaller, blister packs of human generics. This reduces the level of waste rather than be price driven.

Oxytet comes into this group. Owners are informed that it is a human one that is being prescribed and have the choice of having their very own pot on the shelf or pay pennies. So far everyone is happy with the arrangement (VMD would be less happy though). This is the result of a risk/benefit assessment of course!

Come and get me!

RE: A revolutionary new and exciting antibiotic!

Clive Ansell — Wed, 06 Jul 2016 11:00:54 GMT

[quote user="Anthony Todd"]500mg tablets sound like a human dose;[/quote]

No. Dechra's recommended dose rate is 50mg/kg daily, or divided in to 25mg/kg twice daily. So a 500mg tablet for a 10kg dog (or cat!)

RE: A revolutionary new and exciting antibiotic!

Anthony Todd — Wed, 06 Jul 2016 10:03:49 GMT

[quote user="Michael Woodhouse"]To be fair they come in bulk pots and are priced less than many of the generics.[/quote]

To be just as fair; they come in bulk pots ['cos they're dirt cheap to produce] and are priced more than many of the generics.....

500mg tablets sound like a human dose; not even a a manufacturing cost then....

Is, or was it, an EU "directive" that vets had to use only vet licensed drugs?

If so, can it be revoked so vets can go back to generics they used safely for 40 years before the VMD decree?

RE: A revolutionary new and exciting antibiotic!

Hannah Wynne Richards — Wed, 06 Jul 2016 08:05:01 GMT

Virginia. Could be usefull in a zoo practice - slightly less so if your cat patients are moggies, not lions.

Wynne

RE: A revolutionary new and exciting antibiotic!

Michael Woodhouse — Wed, 06 Jul 2016 00:29:10 GMT

To be fair they come in bulk pots and are priced less than many of the generics.

Stop flapping

RE: A revolutionary new and exciting antibiotic!

James Laidlaw — Wed, 06 Jul 2016 00:28:52 GMT

[quote user="Evelyn Barbour-Hill"]

Metronidazole is not an antibiotic.

[/quote]

Pedant alert!

Are you going to enlighten the masses?

RE: A revolutionary new and exciting antibiotic!

Virginia Campbell — Wed, 06 Jul 2016 00:27:09 GMT

"500mg tablets for dogs and cats"

Would that be Norwegian Giant Monster cats?

RE: A revolutionary new and exciting antibiotic!

Evelyn Barbour-Hill — Tue, 05 Jul 2016 23:44:57 GMT

Metronidazole is not an antibiotic.

RE: A revolutionary new and exciting antibiotic!

Martin Atkinson — Tue, 05 Jul 2016 23:27:32 GMT

Another back door to the cascade and a cynical move to make a big profit.

There should be some clause in the cascade that allows us to ignore such blatant profiteering and legally continue to use the generic version. I hereby give notice to the VMD that I will do precisely that. Come and get me.

RE: A revolutionary new and exciting antibiotic!

James Laidlaw — Tue, 05 Jul 2016 22:16:44 GMT

Clickbait!