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Veterinary Forum January 2009 (Vol 26, No 1)

Clinical Report — What's new in the veterinary armamentarium?

by Janice Willard, DVM, MS, Sophia Yin, DVM, MS (Animal Science)

    As we ring in the New Year, we resolve to bring to our practices a renewed sense of purpose and enthusiasm. To help us keep those resolutions, here is a set of recent medications and diagnostic tests designed specifically for the veterinary patient. The following quick overview is by no means an exhaustive list but includes a few products that opinion leaders told Forum they are excited to see on the market.

    Convenia

    One of the most frustrating parts of veterinary medicine is when veterinarians accurately diagnose a condition and prescribe a beneficial course of treatment, but the pet owner is unable to follow through on the medication regimen.

    Even with the best intentions, giving a medication regularly can be difficult for pet owners. Doses are missed because of busy schedules, unavoidable events and pets that are difficult to pill. To make compliance worse, pet owners have a tendency to stop giving a medication as soon as the pet starts looking or acting better.

    Unfortunately, noncompliance with antibiotic treatment has a sinister aspect — if doses are missed, not given according to instructions or stopped before the full course of antibiotic has been given, there is a chance that antibiotic-resistant organisms can develop because the appropriate therapeutic concentrations were not sustained to control the bacterial population.

    Convenia (cefovecin sodium), a new injectable antibiotic from Pfizer Animal Health, may improve compliance in administering antibiotic prescriptions. Clinical trials involving 320 dogs and 291 cats with common skin infections conducted in 26 US veterinary clinics found that a single injectable dose of cefovecin sodium was as effective as a 14-day course of veterinary-labeled oral cephalosporin.1,2

    Although a single dose was generally efficacious, it is recommended that the patient be checked after 14 days to determine whether a second dose is needed.1,2

    Probiotics

    When animals are affected by gastrointestinal (GI) upset or receive antibiotic therapy, normal GI microflora can be altered, which can affect recovery and long-term health. It has long been a part of veterinary medicine to try to reestablish normal GI function with a simple form of probiotic therapy, such as feeding yogurt with live strains of beneficial bacteria.

    Probiotics are defined as "live microorganisms that, when administered in adequate amounts, confer a health benefit to the host." Studies suggest that probiotics may have a beneficial effect following antibiotic administration or an adverse GI event. In addition, patients with such conditions as pancreatitis, allergies or inflammatory bowel disease may benefit from probiotics.3"9

    Several products have recently become available for veterinary use. Proviable from Nutramax Laboratories, Inc., FortiFlora brand Canine and Feline Nutritional Supplements from Nestlé Purina and ProStora MAX from Iams Veterinary Formula contain probiotics that are specifically targeted to the canine and/or feline GI tracts by promoting a strong, digestive system and a healthy microfloral balance in the GI tracts.4,6

    Because probiotics are not marketed as a treatment or cure for a specific disease, they are considered a nutritional supplement, and the FDA does not regulate these products. For that reason, manufacturers are not required to show efficacy or viability or to list what bacterial strains are present. Therefore, veterinarians should recommend products from reputable companies that have studies and data to support their claims.7,10

    Cardiopet proBNP

    B-type natriuretic peptide (BNP) is a substance released by the heart in response to increased hydrostatic pressure, which causes stretching of the myocardium. When BNP is released into circulation, it has biologic effects that counter those of the angiotensin and aldosterone systems and functions to reduce filling pressure in the heart. BNP is stored as a prohormone and when released it is cleaved into C and N terminal portions. The N portion (NTproBNP) is more stable, and blood levels have been shown to correlate with the severity of cardiac disease.11

    Cardiopet proBNP, a new test developed by IDEXX Laboratories, measures circulating levels of NTproBNP, thereby allowing the veterinarian to make an assessment regarding the presence or severity of cardiac disease in dogs and cats. Although echocardiography remains the gold standard for assessing the degree and type of cardiac disease, it requires additional expense as well as expertise to perform and interpret.11,12

    "This test is less invasive," says Allison Heaney, DVM, MS, DACVIM, of the Washington State University College of Veterinary Medicine, "and is particularly beneficial in differentiating between dyspnea that is respiratory or cardiac in origin when a rapid diagnosis is needed."

    Cardiopet proBNP can point to the need for more extensive testing, such as echocardiography, and can facilitate identification of cardiac disease before clinical signs develop, allowing closer monitoring and greater potential for timely intervention.

    Spec fPL

    Feline pancreatitis is a disease shrouded in mystery and misdirection. A cat with pancreatitis can present with vague signs, such as anorexia, vomiting, lethargy and even diarrhea; all of these signs also can present concurrently with other feline diseases.13 Pain can be difficult to recognize in cats, yet we are learning that feline pancreatitis is often a painful condition.13 Spec fPL, a feline pancreas-specific lipase test from IDEXX Laboratories, tests for the level of feline pancreatic lipase in the blood, allowing veterinarians to evaluate a feline patient's pancreatic health. It is available as a stand-alone, disease-specific test or as part of a sick cat panel.13,14

    "We are learning that feline pancreatitis is a lot more common than we initially thought," says Marnin Forman, DVM, DACVIM, at MedVet Medical and Cancer Center for Pets in Worthington, Ohio. "The advantage of this test is that it is a rapid way to diagnose pancreatitis in cats or to eliminate it as a possibility in cats that present with generalized signs of illness."

    Today is an exciting time to be a veterinarian because advances have improved our availability to diagnose and treat disease with accuracy and efficiency while promoting quality of life for our patients.

    1. Passmore CA, Sherington J, Stegemann MR. Efficacy and safety of cefovecin (Convenia) for the treatment of urinary tract infections in cats. J Small Anim Pract 2008;49(6):295-301.

    2. Passmore CA, Sherington J, Stegemann MR. Efficacy and safety of cefovecin (Convenia) for the treatment of urinary tract infections in dogs. J Small Anim Pract 2007;48(3):139-144.

    3. Sartor RB. Therapeutic manipulation of the enteric microflora in inflammatory bowel disease: antibiotics, prebiotics and probiotics. Gastroenterology 2004;126:1620-1633.

    4. Sleator RD, Hill C. New frontiers in probiotic research. Lett Appl Microbiol 2008;46:143-147.

    5. Floch MH, Madsen KK, Jenkins DJA, et al. Recommendations for probiotic use. J Clin Gastroenterol 2006;40:275-278.

    6. Czarnecki-Maulden GL. Effect of dietary modulation of intestinal microbiotics on reproduction and early growth. Theriogenology 2008;70:286-290.

    7. Weese JS. Microbiologic evaluation of commercial probiotics. JAVMA 2002;220(6):794-797.

    8. Ballongue J. Bifidobacteria and probiotic action. In: Salimen S, von Wright A, Ouwehand A (eds). Lactic Acid Bacteria: Microbiological and Functional Aspects, ed 3. New York: Marcel Dekker; 2004:103-111.

    9. Pascher M, Hellweg P, Kohl-Parisini A, Zentek JH. Effects of a probiotic Lactobacillus acidophilus strain on feed tolerance in dogs with nonspecific dietary sensitivity. Arch Anim Nutr 2008;62(2):107-116.

    10. Weese JS, Arroyo L. Bacteriological evaluation of dog and cat diets that claim to contain probiotics. Can Vet J 2003;44(3):212-216.

    11. Rush JE. Chronic valvular heart disease in dogs. In: Proceedings from the 26th Annual Waltham Diets/OSU Symposium for the Treatment of Small Animal Cardiology; October 19-20, 2002.

    12. University of Illinois. Unpublished data on cats with confirmed hypertrophic cardiomyopathy as part of a clinical study, 1998-1999.

    13. De Cock HE, Forman MA, Farver TB, et al. Prevalence and histopathologic characteristics of pancreatitis in cats. Vet Pathol 2007;44:39-49.

    14. Forman MA, Marks SL, De Cock HE, et al. Evaluation of serum feline pancreatic lipase immunoreactivity and helical computed tomography versus conventional testing for the diagnosis of feline pancreatitis. J Vet Intern Med 2004;18:807-815.

    References »

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