Download Selected therapeutic doses

Selected Therapeutic Doses
Assoc. Prof. Ivan Lambev (www.medpharm-sofia.eu)
Formulations and dose rates
Neostigmine
• 0.1 mg/kg IV initial dose, repeated after 5 min if
required for the reversal of muscle relaxation
• 0.5 mg/kg oral q. 8 h to treat myasthenia gravis
Edrophonium
• 0.5–1 mg/kg IV initial dose
for the reversal of muscle relaxation
• 0.1–0.5 mg/kg IV for myasthenia gravis diagnosis
Formulations and dose rates of Atropine
Dogs and Cats:
- Preanesthetic and treatment of bradycardia
• 0.022–0.044 mg/kg
- Treatment of cholinergic toxicity
• 0.2–2.0 mg/kg: give one-quarter dose
i.v. and remainder s.c. or i.m.
Adrenaline (epinephrine) is available in
an injectable formulation as 0.1 mg/mL (1:10000)
and 1 mg/mL (1:1000) solutions.
DOGS AND CATS
• Cardiac resuscitation: 0.05–0.5 mg (0.5–5 mL) of
1:10000 solution intratracheally, IV or intracardially
• Anaphylaxis: 0.02 mg/kg IV. Dose may be doubled and
given intratracheally
– Dilute 1 mL of 1:1000 solution in 10 mL saline and give
1 mL/5 kg IV or IM. May repeat q. 5–15 min
• Feline asthma: 0.1 mL of 1:1000 solution SC or IV
– Dilute 1 mL of 1:1000 solution in 10 mL saline and give
1 mL/10 kg IV or IM. May repeat q. 5–15 min
Non-selective Beta-blockers as
Sedative, resp. as BMD
Propranolol p.o. Pindolol p.o.
0.5–0.3 mg/kg/12 h 0.125–0.25 mg/kg
q. 12 h
0.2–1 mg/kg/8 h
–
H1-histamine antagonists
Cats
Dogs
Cyproheptadine
0.4–0.5 mg/kg/12 h p.o.
Diphenhydramine
2–4 mg/kg/12 h p.o.
Hydroxyzine
2.2 mg/12 h p.o.
Cyproheptadine
0.3–2 mg/kg/12 h p.o.
Diphenhydramine
2–4 mg/kg/12 h p.o.
Hydroxyzine
0.5–2.2 mg/12 h p.o.
Prescribe of cat with body mass
3 kg drug in dose 0.4 mg/kg/12 h p.o.
with H1- and 5-HT2-blocking action
as an appetite stimulant in form of
syrop 40 mg/100 ml in bottle
(chlorpyramine, cyproheptadine,
diphenhydramine).
Rp./ Syrup Cyprohepatadine 40 mg/100 ml
(or: Sirupi Cyproheptadini 40 mg/100 ml)
D. t. d № 1 in bottle.
S. 2 x 3 ml daily 15 min before
meals with water or milk 1 month.
#
Prescribe of dog with body mass
15 kg H1-agent in dose 2 mg/kg/12 h
orally in form of tablets of 30 mg
for the treatment allergies, incect
bites, motion sickness
and travel anxiety (morphine,
propofol, diphenhydramine).
Rp./ Diphenhydramini 30 mg
Da scatulam № 1 in tablets.
Signa. 2 x 1 tablet daily by mouth.
#
Rp./ Diphenhydramini 30 mg
D. scat. № 1 in tabl.
S. 2 x 1 tablet daily by mouth.
BUPRENORPHINE (semisyntetic derivative
of thebaine):
DOGS: 5–40 µg/kg IM, SC, IV or epidural
applicaton or q.8 h
CATS: 5–40 µg/kg IM, SC, IV or epidural
applicaton or q.8 h
PETHIDINE
(Meperidine – USAN; Lydol® – Sopharma)
DOGS AND CATS: 2–10 mg/kg IM, SC
•Almost identical to morphine
•Tends to cause restlessness
rather than sedation
•Antimuscarinic effects: dry mouth
blurred vision
•Less antitussive
•Shorter duration of action
(4 to 6 h) – preferred in labour
Prescribe of dog with body mass 15 kg
opioid analgesic in dose 5 mg/kg s.c.
in form of solution 100 mg/2 ml five
amulles for premidication
(pethidine, diazepam, ketamine).
Rp./ Sol. Pethidini 100 mg/2 ml
D. t. d. № 5 in amp.
S. 1.50 ml s.c.
#
In detail:
Rp./ Solutionis Pethidini 100 mg/2 ml
Da tales doses № 5 in ampullis.
Signa. 1.50 ml subcutaneously.
TRAMADOL (a weak agonist at µ-receptors) provides
moderate pain relief. It also inhibits monoamine
transporters (principally NA and 5-HT) which is
produces analgesia synergistically with µ-agonism.
DOGS
• 1–5 mg/kg PO q.8–12 h
CATS
• 1–2 mg/kg PO q.12 h
Phenobarbital is available as oral (tablets
or elixir) or injectable preparation (i.v./i.m.).
• For the chronic treatment of seizures in
dogs dosing should begin at
2–5 mg/kg/day PO q.12 h.
Cats: 1.5–2.5 mg/kg PO q.12 h.
In some dogs or cats, the starting dosage
may result in ADRs. Should these adverse effects
not resolve after 2 weeks of therapy, a reduction in
dose may be indicated.
Chlorpromazine
Dogs and Cats:
• 50–1000 mcg/kg i.v., i.m., s.c.
• 3 mg/kg p.o.
Prescribe of pig with body mass 80 kg
neuroleptic in dose 2 mg/kg i.m. in form
of solution 4000 mg/100 ml in five vials
for treatment of fear and aggression
(Feliway®, Stresnil®, DAP®).
Azaperone
®
(Stresnil )
2 mg/kg IM
Effect lasts 6 h.
4000 mg/100 ml
Rp./ Sol. Stresnili 4000 mg/100 ml
D. t. d. № 5 in vials.
S. 4 ml i.m.
Inject STRESNIL IM just behind
the ear (into the muscle above the
wing of the atlas) or into the rump
(semitendinosus and
semimembranosus muscle).
HALOPERIDOL
Parrots:
• 0.2 – 0.4 mg/kg
p.o. q.12 h
(start at lowerst doses
and increase to 0.02 mg
q2d to effect)
• 1–2 mg/kg i.m. q.3 weeks;
lower dose for cockatoos,
African greys and
Quaker parrots.
Dogs:
• 0.05–4 mg p.o. q.12 h
Cockatoo
African
greys
parrots
Quaker parrot
Dogs:
Innovar-Vet® (0.4 mg/mL fentanyl and
Droperidol (20 mg/ml): 0.05–0.1 mL/kg IM
Hypnorm® (contains 0.2 mg/mL fentanyl and
10 mg/mL fluanisone – butyrophenone compounds):
0.5 mL/kg IM
Hypnorm®:
Rabbits, rats and mice
• 0.2–0.5 mL/kg IM or IP for sedation or premedication
Guinea pigs:
• 1 ml/kg IM or IP for sedation or premedication
Intravenous administration of butyrophenones
is not recommended.
Diazepam
Dogs
• 0.1–0.5 mg/kg IV
• 2–10 mg/dog PO q. 8 h
for muscle relaxation
Cats
• 0.05–0.4 mg/kg IV
• 1.25–5 mg/cat PO q. 8 h for muscle relaxation
Doses at the lower end of the range are used for
sedation/premedication (0.1–0.25 mg/kg) and
appetite stimulation, while higher doses may
be required to control seizures (0.5 mg/kg).
Status epilepticus
•An IV bolus of diazepam should initially be given
at a dosage of 0.5–1 mg/kg. Onset of its activity
occurs about 2–3 min after administration. This
dosage may be repeated 2–3 times.
Midazolam. Since it is water soluble,
it is much less
irritating with IV or
IM administration.
Others: Clorazepate and Lorazepam.
Prescribe of dog with BM 10 kg drug
in dose 1 mg/kg i.v. in form of solution
0.5% 2 ml (= 10 mg/2 ml) in five vials
(flacon) for treatment of status
epilepticus (medetomidine,
acepromazine, diazepam).
Rp./ Solutionis Diazepami 0.5% 2 ml
Da tales doses № 5 in vials.
Signa (or: Scribe). 2 ml i.v.
This dosage may be repeted
2–3 times.
#
Te same prescription briefly:
Rp./ Sol. Diazepami 10 mg/2 ml
D. t. d. № 5 in vials.
S. 2 ml i.v. …....
Midazolam
Dogs
• 0.05–0.2 mg/kg IV or IM
• 0.2 mg/kg/h IV continuous infusion
Cats
• 0.05–0.2 mg/kg IV or IM
Amitriptyline
Tricyclic
Antidepressants
1 – 4 mg/kg p.o.
q. 12 – 24 h
0.5 – 1 mg/kg
p.o. q. 24 h
Doxepin
3 – 5 mg/kg p.o.
q. 8 – 12 h
for acral lick
dermatitis
0.5 – 1 mg/kg p.o.
q. 12 – 24 h
SSRIs
Fluoxetine
Paroxetine
1 – 2 mg/kg p.o.
q. 24 h
1 mg/kg p.o.
q. 24 h
0.5 – 1 mg/kg p.o.
q. 24 h
0.5 – 1 mg/kg p.o.
q. 24 h
Prescribe of dog with body mass
20 kg SSRI in dose 1 mg/kg/12 h p.o
in form of tablets of 10 mg for
treatment of acrial lick dermatitis
(fluoxetine, amitriptyline, lidocaine).
Rp./ Fluoxetine 10 mg
D. scat. № 1 in tabl.
S. 2 x 2 tablets daily
by mouth two weeks.
Thiopental is a sodium salt that is soluble in water
and 0.9% saline. For use in small animals, sufficient
water or saline is added to make a solution of 2.5%.
•The aqueous solution is strongly alkaline and is
incompatible with analgesics, phenothiazines
(e.g. acepromazine), adrenaline, muscle relaxants.
•The dosage of thiopental required for induction of
anesthesia in the unpremedicated animal is 20–25
mg/kg IV. To avoid excitement during induction,
one-half of this calculated dose must be given as
a bolus. Additional quarter-doses may be required
to obtain depth of anesthesia.
•Premedication is preferred and reduces the
induction requirement of Thiopental by
50–75%, i.e. to a dose of 10–12.5 mg/kg i.v.
•A single dose of thiopental provides
anesthesia for about 10–15 min i.v.
•Intravenous Diazepam (0.25–0.5 mg/kg) given
just before thiopental administration reduces its
requirements to 5–10 mg/kg and reduces the
duration of effect to about 5–10 min.
INTRAMUSCULAR KETAMINE AND
PHENOTHIAZINE COMBINATIONS
•Low doses of ketamine (2–3 mg/kg) may be
combined with acepromazine and opioid and
administered IM (or SC) to premedicate or
sedate painful or fractious cats.
USE OF KETAMINE AS AN ANALGESIC
•in dogs and cats:
0.1–1 mg/kg IV or 1–2.5 mg/kg IM
•in dogs: 2–10 µg/kg/min as an IV infusion
Propofol induces anesthesia in dose 6.5 mg/kg IV
in dogs and 8 mg/kg in cats. The onset of its action
begins after 30 s. A single dose provides 2–10 min
unconsciousness. Complete recovery after a single
dose occurs within 15–20 min in the dog and
30 min in the cats. Propofol is a donor of NO with
amnesic and antiemetic action.
Penicilline G Sodium®:
20 000 – 40 000 /IU/kg/BW
q.6–8 h i.v., i.m., s.c.
Penicillin-VK® (Potassium):
10 mg/kg/BW q.8 h p.o.
Cloxacillin,
Dicloxacillin,
Flucloxacillin:
10 – 40 mg/kg
q.8 h p.o.
500 mg
Flucloxacillin
Prescribe of dog with body
mass 50 kg narrow spectrum
antistahylococcal penicillin
in dose 20 mg/kg/8 h
in capsules 500 mg
(benzylpenicillin, flucloxacillin,
ticarcillin).
Rp./ Flucloxacillini 500 mg
Da tales doses № 1 in bottle.
Signa (Scribe). 2 capsules/8 h
by mouth with woods two weeks.
Cat abscesses
Amoxicillin:
10 – 20 mg/kg/BW
q. 8–12 h
i.v., i.m., s.c. p.o.
AMOXICILLIN
Cefalonium (Cepravin™): 250 mg
Carton – 8 cows: 32 syringes)
• Long-acting cephalosporin
• Cure existing infections at dry off
• Protect against mastitis and reduce
new infections at calving
Cefalonium (Cepravin™): 250 mg in spray
syringes (jeringas – spanish): intrammary
Indications:
In conjunction with teat spraying and proper management of the
cow during the drying off period, the careful administration of
Cepravin Dry Cow at drying off reduces new infections in the
dry period and treats subclinical mastitis.
Dosage
1 syringe per 3 monts immediately after final milking
Withholding Period
Milk: Treatment to be at least 49 days before calving.
Milk from the first 8 milkings after calving must be discarded.
Meat: 30 days
Prescribe of cow with mastitis
during dry off period
long-acting cephalosporin
from first generation
for intramammary application:
(cefalonium, ceftriaxone,
doxycycline).
Rp./ Suspensionis Cefalonium 250 mg
D. t. d. № 4 in spray syringes.
S. One spray syringe
intramammary per 3 monts
immediatly after final milking.
Cefalonium: INN
Cepravin: Regested
Trade Name (Trade mark)
Cefalexin p.o.
•Cats: 22 – 50 mg/kg q.8–12 h
•Dogs: 20 – 40 mg/kg q.8–12 h
Cefuroxime
Zinacef™:
20–50 mg/kg/BW
q.8–12 h
i.v., i.m., s.c.
Cefoxitin
10–30 mg/kg
q.6–8 h
i.v., i.m., s.c.
Ceftriaxone
15 – 50 mg/kg
q.12–24 h i.v.
Cefpodoxime
5 – 10 mg/kg
q.12–24 h
Amoxicillin & Clavulanate
(Augmentin®, Clavulox®)
12.5–25 mg/kg q.8–12 h
p.o., i.m., s.c.
Amikacin
Gentamicin
– sol. 80 mg/2 ml (80 mg/8 h i.m.)
Kanamycin
Neomycin
- Bivacin – spray derm. fl 150 ml
(neomycin/bacitracin), Nemybacin®
- Topocin – pulvis adspersorius
(neomycin/bacitracin)
Netilmicin
Streptomycin
Tobramycin. Inhaled Tobramycin (Tobi®)
is used to treat mucoviscidosis in humans.
Gentamicin:
6 mg/kg q.24 h
i.m., i.v., s.c.
Tobramycin:
1–2 mg/kg q. 8 h
i.m., i.v., s.c.
Prescribe of horse with body
mass 400 kg aminoglycoside in
solution 1200 mg/30 ml in vials
for treatment over 10 days of
Pseudomanas infection
in dose 2 mg/kg/8 h i.m.
(vancomycin, tobramycin,
timentin).
Rp./ Sol. Tobramycin 1.2 g mg/30 ml
D. t. d. № 30 in vials.
S. 20 ml/8 h i.m. 10 days.
Doxycycline: 5–10 mg/kg/12 h p.o. or i.v.
Minocycline: 5–15 mg/kg/12 h p.o.
Oxytetracycline: 20 mg/kg/8 h p.o.
Chlorampenicol
p.o., i.v., i.m., s.c.
• Dogs: 50 mg/kg/8 h
• Cats: 50 mg/kg/12 h
Florfeniciol (Norfenicol®)
Cattle
Treatment of respiratory tract infections in clinically diseased
cattle due to Mannheimia haemolytica, Pasteurella multocida
and Histophilus somni, susceptible to Florfenicol.
Dosage:
Intramuscular injection: 20 mg/kg BM to be
administered twice 48 h apart using a 16-gauge needle.
Subcutaneous injection: 40 mg/kg BM
to be administered once only using a 16-gauge needle.
The dose volume given at any one injection site should not
exceed 10 ml. The injection should only be given in the neck.
Florfeniciol
– Norfenicol®
Swine
Treatment of acute outbreaks of respiratory disease
caused by strains of Actinobacillus pleuropneumoniae
and Pasteurella multocida, susceptible to Florfenicol.
Dosage
Intramuscular injection: 15 mg/kg BM
into the neck muscle twice at 48 h intervals using
a 16-gauge needle. The volume administered per
injection site should not exceed 3 ml.
Florfeniciol (Norfenicol®)
Withdrawal Period
Cattle
Meat and offal:
By intramuscular injection (at 20 mg/kg, twice): 39 days
By subcutaneous injection (at 40 mg/kg, once): 44 days
Milk:
Not permitted for use in lactating animals producing milk
for human consumption.
Swine
Meat and offal:
By intramuscular injection (at 15 mg/kg, twice): 22 days
Prescribe of cow with BW 450 kg
drug in bottle (300 mg/ml – 100 ml)
for treatment of pleuropneumoniae,
which have to inject i.m. only two
times through 48 h in dose
20 mg/kg BW (azithromycin,
clindamycine, florfenicol).
Rp./ Sol. Florfenicoli 300 mg/ml – 100 ml
D. S. 2 x 30 ml i.m. through 48 h.
Azithromycin
•Dogs: 10 mg/kg/24 h
•Cats: 5 mg/kg q.24–48 h
Erythromycin
10–20 mg/kg q.8–12 h p.o.
Clarithromycin
2.5–10 mg/kg/12 h p.o.
Tylosin
10 mg/kg/8 h p.o.
Clindamycin
10 – 20 mg/kg
q. 12 h
Lincomycin
–
p.o., i.m., i.v., s.c.
12.5 – 25 mg/kg
q. 12 h
p.o., i.m., i.v., s.c.
10 – 20 mg/kg p.o.
q. 8 – 12 h
Prescribe drug in vials
(600 mg/4 ml) for treatment
of rhinosinuitis of cat with
BM 3 kg in dose 20 mg/kg
BM s.c./12 h for 10 days
(clindamycin, co-trimoxazole,
rifampicin).
Rp./ Sol. Clindamycini 600 mg/4 ml
D. t. d. № 2 in vials.
S. 0,4 ml/12 h s.c. 10 days.
Co-trimoxazolе (BAN)
30 mg/kg q.12–24 h
p.o., i.v., i.m., s.c
Sulfacetamidе
•collyrium 20% 10 ml
For local treatment of bacterial conjunctivitis
METRONIDAZOLE
10–20 mg/kg q.12–24 h p.o.
Nitrofurantoin
®
(Furadantin ):
4 mg/kg q.6–8 h
Furazolidone: 2.2–20 mg/kg q.8–24 h p.o.
Rifampicin
(Rifampin)
10–20 mg/kg/12 h:
To treat
Rhodococcus equi pneumonia in foals
Cofazimine – p.o.
•Dogs: 4–8 mg/kg/8 h
•Cats: 4–8 mg/kg/8 h
Trifluridine (trifluorthymidine – TFT) is a fluorinated
pyrimidine. It has in vitro inhibitory effects against herpes
simplex virus (types 1 and 2) and cytomegalovirus. The
primary therapeutic indication for TFT is
feline herpetic keratitis
and it is usually applied
in 1% collyrium 6 to 8
times per day.
Adverse reactions include
discomfort on application
and palpebral edema.
Prescribe drug in bottle
(1% 7.5 ml) for treatment
of feline herpetic keratits
(indinavir, trifluridine,
zidovudine).
Rp./ Sol. Trifluridini 1% 7.5 ml
D. t. d. № 2 in bottle.
S. 4 x 1 drops daily in
each eye two weeks.
Drugs which are not recommended
for use in cats
Paracetamol (Acetaminophen – USAN):
Methemoglobinemia,
and Heinz body anemia
•Apomorphine: Significant CNS depression
•Azathioprine: Bone marrow suppression
•Benzocaine: Methemoglobinemia, laryngeal edema
•Cisplatin: Fatal acute pulmonary edema
•Propylthiouracil: Lethargy, weakness, anorexia, bleeding diathesis
•Phenytoin: Sedation, ataxia, anorexia, dermal atrophy
•Scopolamine: Tendency to cause behavioral changes
•Sodium phosphate enemas: depression, ataxia, vomiting, bloody diarrhea
•Permethrin (high concentration products): Hyperesthesia, generalized
tremors, muscle fasciculations, hyperthermia, seizures, death
PRINCIPLES OF RATIONAL
ANTIBACTERIAL
THERAPY
(Adapted from Laurence et al., 1997 & others)
The following principles, many of which
apply to drug therapy in general, are a
guide to good clinical practice
with antimicrobial agents.
(1) Make a diagnosis precisely:
– defining the site of action;
– defining the microorganism(s) responsible
and their sensitivity to drugs;
– biological samples for laboratory must be
taken before treatment is begun.
(2) Aims of therapy
The goal of antibacterial therapy is to help the body
eliminate infectious organisms without toxicity to the
host. It is important to recognize that the natural defense
mechanisms of a patient are of primary importance in
preventing and controlling infection. Examples of
natural defenses against bacterial invasion are:
●the mucociliary escalator in the respiratory tract
●the flushing effect of urination
●the normal flora in the GIT.
All such mechanisms can be affected by disease or
therapeutic interventions.
Once microbial invasion occurs, various host
responses serve to combat the invading
organisms, including:
●the inflammatory response
●cellular migration and phagocytosis
●the complement system
●antibody production.
The difficulty of controlling infections in immunocompromised patients emphasizes that antibacterial therapy
is most effective when it supplements endogenous
defense mechanisms rather than when acting as the
sole means of control.
(3) Consider factors affecting the success
of antibacterial therapy
•Bacterial susceptibility
Various factors need to be considered in susceptibility
testing. The minimum inhibitory concentration (MIC) is
the concentration of drug that must be attained at the
infection site. In general, if bacteria are not susceptible
to a drug in vitro they will be resistant in vivo.
•Distribution to the site of infection
To be effective, an antibacterial agent must be
distributed to the site of infection and come into contact
with the infecting organism in adequate concentrations.
Bacteria that locate intracellularly (Bartonella,
Brucella, Chlamydia, Mycobacterium, Rickettsia)
will not be affected by antibacterial agents that remain
in the extracellular space. Staphylococcus is
facultatively intracellular and may sometimes
resist treatment because of intracellular survival.
Drugs that accumulate in leukocytes and other
cells include fluoroquinolones, lincosamides,
sulfonamides and macrolides but
aminoglycosides and β-lactams do not achieve
effective intracellular concentrations.
An infectious process often adversely affects the
distribution of a drug in vivo. An exception
is inflammation of the meninges (meningitis), which
reduces the normal barrier between blood and CSF,
so that antibacterial agents may cross this barrier.
This breakdown of barriers by inflammation does not
occur to an appreciable extent with the blood–prostate
and blood–bronchial barrier.
Effective antibacterial concentrations may not be
achieved in poorly vascularized tissues, e.g.
the extremities during shock, sequestered bone
fragments or heart valves.
(4) Remove barriers to cure (e.g. lack of free
drainage of abscesses, obstruction in the
urinary or respiratory tracts).
(5) Decide whether therapy is necessary.
As a general rule, acute infections require
therapy whilst chronic infections
may not. Chronic abscess or empyema
respond poorly. Even some acute infections
such as gastroenteritis are better managed
symptomatically than by antimicrobials.
(6) Choose the most suitable route of
administration of antibacterial drug(s)
● Topical administration is valuable for disorders of
eye and ear and some skin or gut infections. High
drug concentration may be achieved locally in this
way and some drugs too toxic for routine systemic
administration (bacitracin, neomycin, polymyxins)
can be useful topically.
● Oral administration is adequate in most infections
and is usually preferable for home treatment. Some
owners find it easier to administer drugs orally with
food.
If in doubt, administration on an empty stomach
(no food for 1–2 h before and after dosing)
is recommended, as the most common outcome
of drug–ingesta interactions is impaired systemic
drug availability.
●Parenteral administration is not routinely
advantageous but can be useful for fractious,
unconscious or vomiting patients, or those with
oral/pharyngeal/esophageal pain or dysfunction.
(7) Select the best drugs. This involves
consideration of:
– specificity (the antimicrobial activity of a
drug must cover the infecting organisms);
– pharmacokinetic factors (the chosen drug
must reach the site of infection (e.g. by
crossing BBB);
– the patients (who may previously had
allergic reactions to antimicrobials or
whose routes of drug elimination may be
impaired, e.g. by renal disease).
8. Client consent and compliance
As with all drug therapy, antibacterials will not
be effective unless administered correctly to
the patient. It is important to maximize the
likelihood that a client will administer
drugs at the right dose and dosing interval.
(9) Indications for combination therapy:
– to avoid the development of resistance
in chronic infections (e.g. FIV, tuberculosis).
– to broaden the antibacterial spectrum:
a) in a unknown mixed infection;
b) unusual pathogens, including Mycobacterium,
Rhodococcus and fungi.
c) if the microorganism cannot be predicted
(septicemia complicating neutropenia);
– to obtain potentation (e.g. penicillin plus
gentamicin for enterococcal endocarditis)
(10) Antimicrobial therapy in pregnancy
or lactation
PRC B have:
•Azithromycine
•Erythromycine
•Penicillins
•Most
cephalosporines
PRCs
LRCs
A: controlled studies
show no risk (Vit. B9)
B: no evidence of risk in
humans (Penicillins)
C: risk cannot be ruled
out (Bisoprolol)
D: positive evidence of
risk (Diazepam)
X: contraindicated in
pregnancy (Estrogens)
L1: safest (Ibuprofen,
Paracetamol)
L2: safer (Cephalosporins,
Omeprazole)
L3: moderately safe
(Acarbose, Aspirin)
L4: possibly hazardous
(Diazepam)
L5: contraindicated
(ACE inhibitors)
(11) Administer the drug in optimum dose
and frequency
– Inadequate dose may encourage the
development of microbial resistance.
– Intermittent dosing is preffered to
continual infusion.
– Plasma concentration monitoring can be
applied to optimize therapy with aminosides,
fluoroquinolones, co-trimoxazole, and
cephalosporins, in patients with kidney disease.
(12) Continue therapy until apparent
cure has been achieved.
– Most acute infections are treated for
5 to 10 days. There are many exceptions
to this, such as typhoid fever, tuberculosis, and infective endocarditis, in which
relapse is possible long after apparent
clinical cure and so the drugs are
continued for a long time, determined
by clinical experience.
(13) Test for cure. In some infections,
microbiological proof of cure is desirable because
disappearance of symptoms and signs
occurs before the microorganisms are
eradicated, e.g. urinary tract infections
(examinations must be done after
withdrawal of drug therapy).
(14) Prophylactic therapy for surgical
and dental procedures should be of very limited
duration. It should be started at the time of
surgery to reduce the risk of producing
resistant microorganisms.
(15) Remember that the most important carriers
of cross infections are your 10 fingers.
Standard Euthanasia Methods
for Commonly Used Species
Rodents (Mice, Rats, Gerbils,
Hamsters, Guinea Pigs, and Voles)
•Carbon dioxide (CO2) to effect
•Sodium Pentobarbital 100 or > mg/kg IV, IP
•Commercial Euthanasia Solution:
Sodium pentobarbital 390 mg/ml +
Sodium phenytoin 50 mg/ml
(≈ 86 mg/kg pentobarbital)
•Cervical dislocation under anesthesia
Rabbits
•Sodium Pentobarbital 100 or > mg/kg IV, IP
•Commercial Euthanasia Solution:
Sodium pentobarbital 390 mg/ml +
Sodium phenytoin 50 mg/ml (≈ 86 mg/kg pentobarbital)
•Exsanguination under anesthesia
Cats and Dogs
•Sodium Pentobarbital 100 or > mg/kg IV
•Commercial Euthanasia Solution:
Sodium pentobarbital 390 mg/ml +
Sodium phenytoin 50 mg/ml (≈ 86 mg/kg pentobarbital)
•Potassium chloride under anesthesia to effect
Livestock (Cattle, Goats, Horses,
Sheep, and Swine)
•Sodium Pentobarbital 100 or > mg/kg IV
•Commercial Euthanasia Solution:
Sodium pentobarbital 390 mg/ml +
Sodium phenytoin 50 mg/ml (≈ 86 mg/kg pentobarbital)
Nonhuman Primates
•Sodium Pentobarbital 100 or > mg/kg IV, IP
•Commercial Euthanasia Solution:
Sodium pentobarbital 390 mg/ml +
Sodium phenytoin 50 mg/ml (≈ 86 mg/kg pentobarbital)
Amphibians and Fish
•Sodium Pentobarbital 100 or > mg/kg IV, ICL
•Commercial Euthanasia Solution:
Sodium pentobarbital 390 mg/ml +
Sodium phenytoin 50 mg/ml (≈ 86 mg/kg pentobarbital)
•Benzocaine hydrochloride 250 mg/liter (Water bath)
•Tricaine methane sulfonate 3 g/liter
(Water bath buffered with sodium bicarbonate)
Abbreviations
IC – intracardiac
ICL – intracoelomic
IP – intraperitoneal
IV – intravenous
The coelum is a
fluid-filled cavity
between the body
wall and the
intestines.
Birds
•Carbon dioxide to effect
•Sodium Pentobarbital 100 mg/kg IV, ICL
•Commercial Euthanasia Solution:
Sodium pentobarbital 390 mg/ml +
Sodium phenytoin 50 mg/ml (≈ 86 mg/kg pentobarbital)
Reptiles
•Sodium Pentobarbital 100 or > mg/kg
IV, ICL
•Commercial Euthanasia Solution:
Sodium pentobarbital 390 mg/ml +
Sodium phenytoin 50 mg/ml (≈ 86 mg/kg pentobarbital)