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tvpjournal.com | September/October 2016 | T O day' S Ve T erinary Prac T ice GU e ST edi TO ria L 15 Investing time in understanding this process can help incorporate more scientific evidence into your practice and enable you to provide the best care possible to your patients. Integrat I ng n ew e v I dence Clinicians can use strategies to efficiently access information from the peer-reviewed literature to aid in their practices, and they should be willing to implement changes when new information becomes available. Furthermore, clinicians should remain aware that cognitive biases could influence their medical decision-making. Although the process of combining clinical experience and scientific evidence can be challenging, the tenets of evidence-based veterinary medicine can help guide clinicians by raising awareness of inherent limitations and providing knowledge and tools to help mitigate them. Thoughtful integration of new evidence into practice decision-making can support effective communication between veterinary professionals and clients, while at the same time continually improving the quality of veterinary medicine. References 1. American Animal Hospital Association. Pediatric neutering. aaha.org/professional/resources/pediatric_ neutering.aspx. 2. American Association of Feline Practitioners. Early spay and castration position statement. catvets.com/ guidelines/position-statements/early-spay-castration. 3. Spain VC, Scarlett J, Mattison SM. When to neuter dogs and cats: A survey of New York State veterinarians' practices and beliefs. JAAHA 2002; 38(5):482-488. 4. Larson RL, White BJ. Importance of the role of the scientific literature in clinical decision making. JAVMA 2015; 247(3):254-258. 5. Larson RL, White BJ. First steps in efficient use of the scientific literature in veterinary practice. JAVMA 2015; 247(1):58-64. 6. White BJ, Larson RL. Systematic evaluation of scientific research for clinical relevance and control of bias to improve clinical decision making. JAVMA 2015; 247(5):496-500. 7. White BJ, Larson RL. Systematic evaluation of scientific research for appropriateness of data analysis to improve clinical decision making. JAVMA 2015; 247(7):759-762. Kirk J. Breuninger, VMD, MPH, is a member of the Banfield Applied Research and Knowledge (BARK) team, where he performs and disseminates research that contributes to advancing medical quality and patient safety. He received his veterinary degree from University of Pennsylvania and his Master of Public Health degree from Temple University. He is a member of the 2016–2017 AVMA Future Leaders class, was awarded the 2009 George B. Wolff Legislative Leadership Award, and was recognized as the 2015 Pennsylvania Veterinarian of the Year by the Pennsylvania Veterinary Medical Association. Antimicrobial for Subcutaneous Injection in Dogs and Cats Only CAUTION: Federal (USA) law restricts this drug to use by or on the order of a licensed veterinarian. INDICATIONS: Dogs CONVENIA is indicated for the treatment of skin infections (secondary superficial pyoderma, abscesses, and wounds) in dogs caused by susceptible strains of Staphylococcus intermedius and Streptococcus canis (Group G). Cats CON VENIA is indicated for the treatment of skin infections (wounds and abscesses) in cats caused by susceptible strains of Pasteurella multocida. CONTRAINDICATIONS: CONVENIA is contraindicated in dogs and cats with known allergy to cefovecin or to b-lactam (penicillins and cephalosporins) group antimicrobials. Anaphylaxis has been reported with the use of this product in foreign market experience. If an allerg ic reaction or anaphylaxis occurs, CONVENIA should not be administered again and appropriate therapy should be instituted. Anaphylaxis may require treatment with epinephrine and other emergency measures, including oxygen, intravenous fluids, intravenous antihistamine, corticosteroids, and airway management, as clinically indicated. Adverse reactions may require prolonged treatment due to the prolonged sys temic drug clearance (65 days). WARNINGS: Not for use in humans. Keep this and all drugs out of reach of children. Consult a physician in case of accidental human exposure. For subcutaneous use in dogs and cats only. Antimicrobial drugs, including penicillins and cephalosporins, can cause allergic reactions in sensitized individuals. To minimize the possibility of allergic reactions, those handling such ant imicrobials, including cefovecin, are advised to avoid direct contact of the product with the skin and mucous membranes. PRECAUTIONS: Prescribing antibacterial drugs in the absence of a proven or strongly suspected bacterial infection is unlikely to provide benefit to treated animals and may increase the risk of the development of drug-resistant animal pathogens. The safe use of CONVENIA in dogs or cats le ss than 4 months of age and in breeding or lactating animals has not been determined. Safety has not been established for IM or IV administration. The long-term effects on injection sites have not been determined. CONVENIA is slowly eliminated from the body, approximately 65 days is needed to eliminate 97% of the administered dose from the body. Animals experiencing an adverse reaction may need to be moni tored for this duration. CONVENIA has been shown in an experimental in vitro system to result in an increase in free concentrations of carprofen, furosemide, doxycycline, and ketoconazole. Concurrent use of these or other drugs that have a high degree of protein-binding (e.g. NSAIDs, propofol, cardiac, anticonvulsant, and behavioral medications) may compete with cefovecin-binding and cause adverse reactio ns. Positive direct Coombs' test results and false positive reactions for glucose in the urine have been reported during treatment with some cephalosporin antimicrobials. Cephalosporin antimicrobials may also cause falsely elevated urine protein determinations. Some antimicrobials, including cephalosporins, can cause lowered albumin values due to interference with certain testing methods. Occasionally, cep halosporins and NSAIDs have been associated with myelotoxicity, thereby creating a toxic neutropenia 4 . Other hematological reactions seen with cephalosporins include neutropenia, anemia, hypoprothrombinemia, thrombocytopenia, prolonged prothrombin time (PT) and partial thromboplastin time (PTT), platelet dysfunction and transient increases in serum aminotransferases. ADVERSE REACTIONS: Dogs A total of 320 d ogs, ranging in age from 8 weeks to 19 years, were included in a field study safety analysis. Adverse reactions reported in dogs treated with CONVENIA and the active control are summarized in Table 2. Table 2: Number of Dogs* with Adverse Reactions Reported During the Field Study with CONVENIA. Active Adverse Reaction CONVENIA Control (n=157) (n=163) Lethargy 2 7 Anorexia/Decreased Appetite 5 8 Vomiting 6 12 Diarrhea 6 7 Blood in Feces 1 2 Dehydration 0 1 Flatulence 1 0 Increased Borborygmi 1 0 *Some dogs may have experienced more than one adverse reaction or more than one occurrence of the same adverse reaction during the study. Mild to moderate elevations in serum g-glutamyl trans-ferase or serum alanine aminotransferase were noted post-treatment in several of the CONVENIA- treated dogs. No clinical abnormalities were noted with these findings. One CONVEN IA-treated dog in a separate field study experienced diarrhea post-treatment lasting 4 weeks. The diarrhea resolved. Cats A total of 291 cats, ranging in age from 2.4 months (1 cat) to 21 years, were included in the field study safety analysis. Adverse reactions reported in cats treated with CONVENIA and the active control are summarized in Table 3. Table 3: Number of Cats* with Adverse Reactions Reported Duri ng the Field Study with CONVENIA. Active Adverse Reaction CONVENIA Control (n=157) (n=163) Vomiting 10 14 Diarrhea 7 26 Anorexia/Decreased Appetite 6 6 Lethargy 6 6 Hyper/Acting Strange 1 1 Inappropriate Urination 1 0 *Some cats may have experienced more than one adverse reaction or more than one occurrence of the same adverse reaction during the study. Four CONVENIA cases had mildly elevated post-study ALT (1 case was elevated pre-study). No clinical abnormalities were noted with these findings. Twenty-four CONVENIA cases had normal pre-study BUN values and elevated post-study BUN values (37– 39 mg/dL post-study). There were 6 CONVENIA cases with normal pre- and mildly to moderately elevated post-study creatinine values. Two of these cases also had an elevated post-study BUN. No clinical abnormalities were noted with these findings. One CONVENIA-treated cat in a separate field study experienced diarrhea post-treatment lasting 42 days. The diarrhea resolved. FOREIGN M ARKET EXPERIENCE : The following adverse events were reported voluntarily during post-approval use of the product in dogs and cats in foreign markets: death, tremors/ataxia, seizures, anaphylaxis, acute pulmonary edema, facial edema, injection site reactions (alopecia, scabs, necrosis, and erythema), hemolytic anemia, salivation, pruritus, lethargy, vomiting, diarrhea, and inappetance. For a copy of the Material Safety Data Sheet, (MSDS) or to report a suspected adverse reaction call Zoetis Inc. at 1-888-963-8471. STORAGE INFORMATION: Store the powder and the reconstituted product in the original carton, refrigerated at 2° to 8° C (36° to 46° F). Use the entire contents of the vial within 56 days of reconstitution. PROTECT FROM LIGHT. After each use it is important to return the unused portion back to the refrigerator in the original carton. As with other cephalosporins, the color of the solution may vary from clear to amber at reconstitution and may darken over time. If stored as recommended, solution color does not adversely affect potency. HOW SUPPLIED: CONVENIA is available as a 10 mL multi-use vial containing 800 milligrams of cefovecin as a lyophilized cake. NADA# 141-285, Approved by FDA Distributed by Zoetis Inc. Kal amazoo, MI 49007 January 2013 PAA035845A&P; (cefovecin sodium) Brief Summary of Prescribing Information tvpjournal.com | September/October 2016 GU e ST edi TO ria L 15