Download The Effect of ANTIROBE® Capsules (clindamycin hydrochloride) on

VETERINARY MEDICAL SERVICES
E X P L O R A T I O N S
in Veterinary Medicine
The Effect of ANTIROBE Capsules
(clindamycin hydrochloride) on Gingival Crevicular Fluid
and Immune Mediators in Dogs
®
results
THE BIG PICTURE.
• Dental plaque and gingival indices
were significantly lower in dogs treated
with ANTIROBE (P ≤ 0.0001).
• The volume of gingival crevicular fluid
(GCF), a reliable indicator for the degree
of inflammation, declined significantly
following treatment with ANTIROBE
Source Material: Zetner K, Pum G, Rausch W-D, Rausch-Fan X-H,
Hung ST. Effect of clindamycin hydrochloride on gingival crevicular fluid
and immune mediators in beagles. Praktische Tierarzt. 2001;82(1):22-32;
Vet Therap. 2002;3(2):177-188.
THE PROCESS OF DISCOVERY.
Periodontitis is a common infection in veterinary practice and the leading
cause of tooth loss in dogs. The condition begins with gingivitis, an
inflammation of the gingiva and gums caused by accumulating bacteria.
Left unchecked, the multiplying bacteria form plaque, which subsequently
mineralizes into tartar. Bacteria eventually invade the sulcus, the crevice
between the gingiva and the root. (See Figure 1 on page 3.) As the gingiva
regress, underlying periodontal structures detach from the root, and pockets
develop.Advancing periodontitis affects all of the periodontal structures,
including cementum, periodontal ligaments, and alveolar bone.
(P ≤ 0.0001).
• Levels of immune mediators decreased
significantly after treatment with
ANTIROBE (P ≤ 0.05).
The presence of immune mediators provides early evidence of the
inflammatory and degenerative processes of periodontal disease.
The junctional epithelium and underlying gingival plexus play a vital
role in local defense mechanisms, inflammatory reactions, and gingival
crevicular fluid (GCF) production. As soon as toxins cross the epithelial
junction, they activate the immune system. This provocation increases
the volume of GCF and releases numerous immune mediators, including
leukotriene B4 (LTB4), prostaglandin E2 (PGE2), and polymorphonuclear
(PMN) elastase. Leukotriene B4 is a powerful proinflammatory agent,
especially in the early stage of gingivitis. Prostaglandin E2 increases 2-fold
to 3-fold in the GCF of dogs with gingivitis and 5-fold to 6-fold during
active stages of periodontitis. Along with other immune mediators,
PGE2 increases bone destruction. Levels of PMN elastase increase
in the GCF of dogs with gingivitis and, in humans, correlate with probe
depth and loss of attachment. In this study, Zetner and colleagues
evaluated the effect of ANTIROBE Capsules on immune mediators.
HOW THE STUDY WAS CONDUCTED.
WHAT WAS LEARNED.
®
In a double-blind, crossover study, 10 dogs received ANTIROBE
Capsules (clindamycin hydrochloride) 11 mg/kg per day orally for
14 days, and 10 dogs served as untreated controls. Five months later,
the treatments were reversed. Plaque and gingival indices were assessed
on 6 reference teeth of each patient, and the volume of GCF was
measured before and after the 2 study periods.The plaque index
was scored from 0 to 4,1 as was the gingivitis index.2 Concentrations
of PGE2 , PMN elastase, and LTB 4 were determined by ELISA.
Calculus was removed ultrasonically and the teeth were polished at
the end of each study period.
Compared with untreated controls, 2 weeks of treatment
with ANTIROBE Capsules decreased the amount of GCF
by 65% in the first series and 73% in the second series.The plaque
index fell 94% in the first series and 85% in the second series, and
the gingivitis index decreased by 88% in the first series and 87%
in the second.These positive changes accompanied similar
reductions in immune mediators.The mean reduction in PGE2
was 33% in the first series and 40% in the second. Levels of LTB4
declined by 18% in the first series and 24% in the second series.
Mean PMN elastase values were 45% higher before treatment
with ANTIROBE than after. See Table 1.
Table 1. Effects of oral treatment with clindamycin (11 mg/kg) on periodontal variables and immune mediators in beagles with
periodontal disease.
Series 1
Control (n = 10)
Variable
ANTIROBE (n = 10)
Before Treatment
After Treatment
Before Treatment
After Treatment
82.63 ± 32.87
83.90 ± 33.03
92.55 ± 32.66
32.55 ± 16.5*†
Plaque index
2.63 ± 0.69
2.38 ± 0.61
2.83 ± 0.72
0.17 ± 0.38*†
Gingivitis index
2.08 ± 0.67
2.12 ± 0.69
2.30 ± 0.65
0.27 ± 0.45*†
Prostaglandin E2 (ng/mL)
44.21 ± 15.68
42.21 ± 12.82
44.66 ± 10.53
29.97 ± 5.38‡
Leukotriene B4 (ng/mL)
55.29 ± 6.21
50.55 ± 4.84
67.33 ± 7.51*
55.20 ± 8.85‡
Not done
Not done
Not done
Not done
Gingival crevicular fluid (units)
PMN elastase
Series 2
Control (n = 10)
Variable
ANTIROBE (n = 10)
Before Treatment
After Treatment
Before Treatment
After Treatment
68.02 ± 22.41
61.42 ± 19.23
75.65 ± 24.71
20.30 ± 9.45*†
Plaque index
2.55 ± 0.65
2.40 ± 0.59
2.40 ± 0.59
0.37 ± 0.55*†
Gingivitis index
2.22 ± 0.72
2.13 ± 0.77
2.35 ± 0.55
0.30 ± 0.46*†
Prostaglandin E2 (ng/mL)
22.69 ± 4.24
24.97 ± 4.04
68.62 ± 31.84*
41.21 ± 16.39‡
Leukotriene B4 (ng/mL)
51.31 ± 9.76
53.41 ± 7.10
65.82 ± 10.29*
50.12 ± 8.03‡
PMN elastase (µg/L
42.21 ± 15.58
41.52 ± 16.49
74.76± 32.92*
41.38 ± 12.42‡
Gingival crevicular fluid (units)
*Significantly different than control group value (P ≤ 0.05).
† Significantly different than pretreatment value (P ≤ 0.0001).
‡ Significantly different than pretreatment value (P ≤ 0.05).
PMN = polymorphonuclear.
Data are shown as mean ± standard deviation.
references
Sulcus
REFERENCES.
Figure 1. Illustration of tooth and surrounding structures.
1. Logan EI, Boyce EN. Oral health assessment in dogs: parameters
and methods. J Vet Dent. 1994;11:58-63.
TALK IT OUT.
Numerous researchers have documented the antimicrobial
activity of ANTIROBE in the mouth.3-5 One group also noted
that ANTIROBE reduces bacteria in the surrounding air during
ultrasonic removal of calculus.6 This excellent antimicrobial activity
likely results from clindamycin’s superior penetration of oral tissues,
including saliva, the gingival crevice, and bone.Tissue concentrations
of ANTIROBE have been shown to be higher than plasma
concentrations.7,8 Professor Zetner postulates that the PGE2 activity
may be a reflection of high concentrations of clindamycin in bone,
which may help reduce decalcification and subsequent inflammation
better than mechanical cleaning alone.ANTIROBE Capsules are
contraindicated in animals with a history of hypersensitivity to clindamycin
or lincomycin.
®
THE FINAL WORD.
2. Silness J, Loe H. Periodontal disease in pregnancy. II. Correlation
between oral hygiene and periodontal condition. Acta Odontol Scand.
1964;22:121-135.
3. Henke CL, Colmery BH. Treating canine dental infections with oral
clindamycin hydrochloride. Vet Med. 1987;82:197-199.
4. Johnson DM, Erwin ME, Barrett MS, Gooding BB, Jones RN.
Antimicrobial activity of ten macrolide, lincosamine and streptogramin
drugs tested against Legionella species. Eur J Clin Microbiol Infect Dis.
1992;11(8):751-755.
5. Mischke R, Amtsberg G, Beckmann G, Schmidt H, Nolte I.
Wirksamkeit und Verträglichkeit von Clindamycin als Begleitende
Therapie von Gingivitis und Periodontitis nach Zahnsteinenfernung
beim Hund. Kleintierpraxis. 1992;37:423-492.
6. Zetner K, Thiemann G. Die Bedeutung von Clindamycin und
Pilzen bie Oralen Infektionen. Kleintierpraxis. 1993;38:689-760.
7. Burrows GE. Pharmacotherapeutics of macrolides, lincomycins,
and spectinomycin. JAVMA. 1980;176:1072-1077.
8. ANTIROBE Capsules package insert.
This study showed that treatment with ANTIROBE significantly
reduced the indices of plaque and gingivitis while also significantly
decreasing levels of destructive immune mediators.ANTIROBE
is beneficial as an adjunct to cleaning teeth and treating periodontal
disease, because of its direct antimicrobial effect and its ability to
potentiate opsonization and phagocytosis.9
9. Gemmell CG, Peterson PK, Schmeling D, Mathews J, Quie PG.
Antibiotic-induced modification of Bacteroides fragilis and its susceptibility
to phagocytosis by human polymorphonuclear leukocytes. Eur J Clin
Microbiol. 1983;2(4):327-334.
ANTIROBE®
NDC 0009-3043-01, NDC 0009-3044-01, NDC 0009-3045-01, NDC 0009-3045-08, NDC 0009-5015-01
brand of clindamycin hydrochloride capsules, USP
ANTIROBE AQUADROPS®
NDC 0009-3179-01
brand of clindamycin hydrochloride liquid
Caution: Federal (USA) law restricts this drug to use by or on the order of a licensed veterinarian.
DESCRIPTION
ANTIROBE Capsules and ANTIROBE AQUADROPS Liquid contain clindamycin hydrochloride which is the
hydrated salt of clindamycin. Clindamycin is a semisynthetic antibiotic produced by a 7(S)-chlorosubstitution of
the 7(R)-hydroxyl group of a naturally produced antibiotic produced by Streptomyces lincolnensis var. lincolnensis.
ANTIROBE Capsules (For Use in Dogs Only):
25 mg Capsule, each yellow and white capsule contains clindamycin hydrochloride equivalent to 25 mg of
clindamycin.
75 mg Capsule, each green capsule contains clindamycin hydrochloride equivalent to 75 mg of clindamycin.
150 mg Capsule, each light blue and green capsule contains clindamycin hydrochloride equivalent to 150 mg
of clindamycin.
300 mg Capsule, each light blue capsule contains clindamycin hydrochloride equivalent to 300 mg of clindamycin.
ANTIROBE AQUADROPS Liquid (For Use in Dogs and Cats) is a palatable formulation intended for oral
administration. Each mL of ANTIROBE AQUADROPS contains clindamycin hydrochloride equivalent to 25 mg
clindamycin; and ethyl alcohol, 8.64%.
ACTIONS
Site and Mode of Action: Clindamycin is an inhibitor of protein synthesis in the bacterial cell. The site of
binding appears to be in the 5OS sub-unit of the ribosome. Binding occurs to the soluble RNA fraction of certain
ribosomes, thereby inhibiting the binding of amino acids to those ribosomes. Clindamycin differs from cell wall
inhibitors in that it causes irreversible modification of the protein-synthesizing subcellular elements at the ribosomal
level.
MICROBIOLOGY: Clindamycin is a lincosaminide antimicrobial agent with activity against a wide variety of
aerobic and anaerobic bacterial pathogens. Clindamycin is a bacteriostatic compound that inhibits bacterial
protein synthesis by binding to the 50S ribosomal subunit. The minimum inhibitory concentrations (MICs) of
Gram-positive and obligate anaerobic pathogens isolated from dogs and cats in the United States are presented
in Table 1 and Table 2. Bacteria were isolated in 1998-1999. All MICs were performed in accordance with the
National Committee for Clinical Laboratory Standards (NCCLS).
Table 1. Clindamycin MIC Values (µg/mL) from Diagnostic Laboratory Survey Data Evaluating Canine
Pathogens in the U.S. During 1998-991
Number of
Isolates
MIC50
MIC85
MIC90
Range
Staphylococcus aureus
Staphylococcus intermedius
Staphylococcus spp.
Beta-hemolytic streptococci
Streptococcus spp.
17
28
18
46
11
0.5
0.25
0.5
0.5
0.5
0.5
0.5
0.5
0.5
≥4.0
≥4.0
≥4.0
≥4.0
≥4.0
≥4.0
0.25-≥4.0
0.125-≥4.0
0.25-≥4.0
0.25-≥4.0
0.25-≥4.0
Osteomyelitis/Bone3
Staphylococcus aureus
Staphylococcus intermedius
Staphylococcus spp.
Beta-hemolytic streptococci
Streptococcus spp.
20
15
18
21
21
0.5
0.5
0.5
0.5
≥4.0
0.5
≥4.0
≥4.0
2.0
≥4.0
0.5
≥4.0
≥4.0
2.0
≥4.0
0.54
0.25-≥4.0
0.25-≥4.0
0.25-≥4.0
0.25-≥4.0
Dermal/Skin5
Staphylococcus aureus
Staphylococcus intermedius
Staphylococcus spp.
Beta-hemolytic streptococci
25
48
32
17
0.5
0.5
0.5
0.5
≥4.0
≥4.0
≥4.0
0.5
≥4.0
≥4.0
≥4.0
0.5
0.25-≥4.0
0.125-≥4.0
0.25-≥4.0
0.25-0.5
Organism
Soft Tissue/Wound2
1 The correlation between the in vitro susceptibility data and clinical response has not been determined.
2 Soft Tissue/Wound: includes samples labeled wound, abscess, aspirate, exudates, draining tract, lesion, and mass
3 Osteomyelitis/Bone: includes samples labeled bone, fracture, joint, tendon
4 No range, all isolates yielded the same value
5 Dermal/Skin: includes samples labeled skin, skin swab, biopsy, incision, lip
Table 2. Clindamycin MIC Values (µg/mL) from Diagnostic Laboratory Survey Data Evaluating Feline
Pathogens from Wound and Abscess Samples in the U.S. During 19981
Organism
Bacteroides/Prevotella
Fusobacterium spp.
Peptostreptococcus spp.
Porphyromonas spp.
Number of
Isolates
MIC50
MIC90
Range
30
17
18
13
0.06
0.25
0.13
0.06
4.0
0.25
0.5
0.25
≤0.015-4.0
≤0.015-0.5
≤0.015-8.0
≤0.015-8.0
1 The correlation between the in vitro susceptibility data and clinical response has not been determined.
PHARMACOLOGY
Absorption: Clindamycin hydrochloride is rapidly absorbed from the
canine and feline gastrointestinal tract.
Dog Serum Levels: Serum levels at or above 0.5 µg/mL can be
maintained by oral dosing at a rate of 2.5 mg/lb of clindamycin
hydrochloride every 12 hours. This same study revealed that average
peak serum concentrations of clindamycin occur 1 hour and 15 minutes
after oral dosing. The elimination half-life for clindamycin in dog serum
was approximately 5 hours.There was no bioactivity accumulation after
a regimen of multiple oral doses in healthy dogs.
Cat Serum Levels: Serum levels at or above 0.5 µg/mL can be
maintained by oral dosing at a rate of 2.5 mg/lb of clindamycin
hydrochloride every 24 hours. The average peak serum concentration
of clindamycin occurs approximately 1 hour after oral dosing. The
elimination half-life of clindamycin in feline serum is
approximately 7.5 hours. In
healthy cats, minimal accumulation occurs after multiple
oral doses of clindamycin
hydrochloride, and steadystate should be achieved by
the third dose.
METABOLISM AND EXCRETION
Extensive studies of the metabolism and excretion of clindamycin
hydrochloride administered orally in animals and humans have shown
that unchanged drug and bioactive and bioinactive metabolites are
excreted in urine and feces. Almost all of the bioactivity detected in
serum after ANTIROBE product administration is due to the parent
molecule (clindamycin). Urine bioactivity, however, reflects a mixture of
clindamycin and active metabolites, especially N-dimethyl clindamycin
and clindamycin sulfoxide.
TOXICOLOGY AND SAFETY
Rat and Dog Data: One year oral toxicity studies in rats and dogs at
doses of 30, 100 and 300 mg/kg/day (13.6, 45.5 and 136.4 mg/lb/day)
have shown clindamycin hydrochloride to be well tolerated. Differences
did not occur in the parameters evaluated to assess toxicity when comparing groups of treated animals with
contemporary controls. Rats administered clindamycin hydrochloride at 600 mg/kg/day (272.7 mg/lb/day) for six
months tolerated the drug well; however, dogs orally dosed at 600 mg/kg/day (272.7 mg/lb/day) vomited, had
anorexia, and subsequently lost weight. At necropsy these dogs had erosive gastritis and focal areas of necrosis
of the mucosa of the gall bladder.
Safety in gestating bitches or breeding males has not been established.
Cat Data: The recommended daily therapeutic dose range for clindamycin hydrochloride (ANTIROBE AQUADROPS
Liquid) is 11 to 33 mg/kg/day (5 to 15 mg/lb/day) depending on the severity of the condition. Clindamycin
hydrochloride (ANTIROBE AQUADROPS Liquid) was tolerated with little evidence of toxicity in domestic shorthair
cats when administered orally at 10x the minimum recommended therapeutic daily dose
(11 mg/kg; 5 mg/lb) for 15 days, and at doses up to 5x the minimum recommended therapeutic dose for 42 days.
Gastrointestinal tract upset (soft feces to diarrhea) occurred in control and treated cats with emesis occurring
at doses 3x or greater than the minimum recommended therapeutic dose (11 mg/kg/day; 5 mg/lb/day). Lymphocytic
inflammation of the gallbladder was noted in a greater number of treated cats at the 110 mg/kg/day (50 mg/lb/day)
dose level than for control cats. No other effects were noted. Safety in gestating queens or breeding male cats
has not been established.
INDICATIONS
ANTIROBE (brand of clindamycin hydrochloride) Capsules (for use in dogs only) and AQUADROPS Liquid
(for use in dogs and cats) are indicated for the treatment of infections caused by susceptible strains of the
designated microorganisms in the specific conditions listed below:
Dogs: Skin infections (wounds and abscesses) due to coagulase positive staphylococci (Staphylococcus
aureus or Staphylococcus intermedius). Deep wounds and abscesses due to Bacteroides fragilis, Prevotella
melaninogenicus, Fusobacterium necrophorum and Clostridium perfringens. Dental infections due to
Staphylococcus aureus, Bacteroides fragilis, Prevotella melaninogenicus, Fusobacterium necrophorum and
Clostridium perfringens. Osteomyelitis due to Staphylococcus aureus, Bacteroides fragilis, Prevotella
melaninogenicus, Fusobacterium necrophorum and Clostridium perfringens.
Cats: Skin infections (wounds and abscesses) due to Staphylococcus aureus, Staphylococcus intermedius
and Streptococcus spp. Deep wounds and infections due to Clostridium perfringens and Bacteroides fragilis.
Dental infections due to Staphylococcus aureus, Staphylococcus intermedius, Streptococcus spp., Clostridium
perfringens and Bacteroides fragilis.
CONTRAINDICATIONS
ANTIROBE Capsules and ANTIROBE AQUADROPS Liquid are contraindicated in animals with a history of
hypersensitivity to preparations containing clindamycin or lincomycin.
Because of potential adverse gastrointestinal effects, do not administer to rabbits, hamsters, guinea pigs, horses,
chinchillas or ruminating animals.
WARNINGS
Keep out of reach of children. Not for human use.
PRECAUTIONS
During prolonged therapy of one month or greater, periodic liver and kidney function tests and blood counts
should be performed.
The use of ANTIROBE occasionally results in overgrowth of non-susceptible organisms such as clostridia and
yeasts.Therefore, the administration of ANTIROBE should be avoided in those species sensitive to the gastrointestinal
effects of clindamycin (see CONTRAINDICATIONS). Should superinfections occur, appropriate measures should
be taken as indicated by the clinical situation.
Patients with very severe renal disease and/or very severe hepatic disease accompanied by severe metabolic
aberrations should be dosed with caution, and serum clindamycin levels monitored during high-dose therapy.
Clindamycin hydrochloride has been shown to have neuromuscular blocking properties that may enhance the
action of other neuromuscular blocking agents. Therefore, ANTIROBE should be used with caution in animals
receiving such agents.
Safety in gestating bitches and queens or breeding male dogs and cats has not been established.
ADVERSE REACTIONS
Side effects occasionally observed in either clinical trials or during clinical use were vomiting and diarrhea.
To report adverse reactions or a suspected adverse reaction call 1-800-793-0596.
DOSAGE AND ADMINISTRATION
Dogs: Infected Wounds, Abscesses and Dental Infections
Oral: 2.5-15.0 mg/lb body weight every 12 hours.
Duration: Treatment with ANTIROBE products may be continued up to a maximum of 28 days if clinical
judgment indicates. Treatment of acute infections should not be continued for more than three or four days if no
response to therapy is seen.
Dosage Schedule:
Capsules
ANTIROBE 25 mg, administer 1-6 capsules every 12 hours for each 10 pounds of body weight.
ANTIROBE 75 mg, administer 1-6 capsules every 12 hours for each 30 pounds of body weight.
ANTIROBE 150 mg, administer 1-6 capsules every 12 hours for each 60 pounds of body weight.
ANTIROBE 300 mg, administer 1-6 capsules every 12 hours for each 120 pounds of body weight.
Liquid
ANTIROBE AQUADROPS, administer 1-6 mL/10 lbs body weight every 12 hours.
Dogs: Osteomyelitis
Oral: 5.0-15.0 mg/lb body weight every 12 hours.
Duration: Treatment with ANTIROBE is recommended for a minimum of 28 days. Treatment should not be
continued for longer than 28 days if no response to therapy is seen.
Dosage Schedule:
Capsules
ANTIROBE 25 mg, administer 2-6 capsules every 12 hours for each 10 pounds of body weight.
ANTIROBE 75 mg, administer 2-6 capsules every 12 hours for each 30 pounds of body weight.
ANTIROBE 150 mg, administer 2-6 capsules every 12 hours for each 60 pounds of body weight.
ANTIROBE 300 mg, administer 2-6 capsules every 12 hours for each 120 pounds of body weight.
Liquid
ANTIROBE AQUADROPS, administer 2-6 mL/10 lbs body weight every 12 hours.
Cats: Infected Wounds, Abscesses, and Dental Infections
5.0 - 15.0 mg/lb body weight once every 24 hours depending on the severity of the condition.
Duration: Treatment with ANTIROBE AQUADROPS Liquid may be continued up to a maximum of 14 days if
clinical judgment indicates. Treatment of acute infections should not be continued for more than three to four
days if no clinical response to therapy is seen.
Dosage Schedule:
ANTIROBE AQUADROPS, to provide 5.0 mg/lb, administer 1 mL/5 lbs body weight once every 24 hours; to
provide 15.0 mg/lb, administer 3 mL/5 lbs body weight once every 24 hours.
HOW SUPPLIED
ANTIROBE Capsules are available as:
25 mg - bottles of 600 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NDC 0009-3043-01
75 mg - bottles of 200 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NDC 0009-3044-01
150 mg - bottles of 100 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NDC 0009-3045-01
150 mg - blister packages of 100 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NDC 0009-3045-08
300 mg - blister packages of 100 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NDC 0009-5015-01
NADA #120–161, Approved by FDA
ANTIROBE AQUADROPS Liquid is available as 20 mL filled in 30 mL bottles (25 mg/mL) supplied in packers
containing 12 cartoned bottles with direction labels and calibrated dosing droppers. NDC 0009-3179-01.
NADA #135–940, Approved by FDA
To report a suspected adverse reaction or to request a material safety data sheet (MSDS), call 1-800-793-0596.
Store at controlled room temperature 20° to 25° C (68° to 77° F) [see USP].
ANTIROBE Capsules
Made in Canada for
Pharmacia & Upjohn Company
Kalamazoo, MI 49001, USA
By Patheon YM Inc.
Toronto, Ontario, M3B 1Y5, CANADA
Revised October 2002
ANTIROBE is a registered trademark
of Pharmacia & Upjohn Company.
© 2002 Pharmacia Corporation. All rights reserved.
ANTIROBE AQUADROPS
Made by
Pharmacia & Upjohn Company
Kalamazoo, MI 49001, USA
813 805 712
692074
3179-01-000
www.pharmaciaAH.com
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