Monday, June 16, 2008

Finally, The Magic "Shot" Has Arrived

Some pets can be difficult and uncooperative for owners attempting to administer oral medications. On occasion, "difficult and uncooperative" is far too kind a description for the way some pets act when approached with oral medication, a problem especially prevalent with cats and small dogs. Owners of pets like this, when faced with the reality of having to administer oral antibiotics for a typical antibiotic course (10-14 days), often ask me, "isn't there just s shot you can give instead?"

Up until just last week, my answer to this question has always been that I could indeed give an antibiotic injection, but after 24 hours it will wear off, and oral antibiotics will have to begin to be administered, lessening the total course by only one day. However, all that changed when I attended a seminar presented by Pfizer, a major animal health pharmaceutical company, introducing their one time injectable antibiotic, Convenia (generically called cefovecin).

Convenia is an antibiotic that persists in canine and feline tissues for 17 days or longer according to data obtained from its extensive veterinary use in Europe, enabling bacterial fighting activity for up to 17 days or longer from just one injection. This is beneficial for the owner because they do not have to preoccupy themselves with the administration of oral medication. For owners with pets that are challenging to medicate, Convenia is especially attractive.

For veterinarians, we love Convenia because it takes out of the equation the single most common reason why antimicrobial treatment fails: owner non-compliance. Owners frequently fail to administer antibiotics in a timely fashion due to scheduling conflict, or busy lifestyles leading to forgetfulness. On other occasions, seeing significant improvement in the early stages of treatment, they decide to stop treatment to save the rest of the antibiotics for another time they suspect an infection and want to try to save on a vet visit. In fact, statistically, only less than 25% of pet owners administer medications as directed and to completion, a fact that both astounds and alarms me.

These actions lead to not only a relapse of infection, but often infections that are new and improved, because they have developed antibiotic resistance. With Convenia, veterinarians eliminate owner compliance issues, placing treatment entirely in our hands.

Of course, no drug is perfect and comes with its own set of drawbacks, and Convenia is no exception. As a cephalosporin class antibiotic, it is only going to be effective against gram positive bacteria with limited gram negative action, making it appropriate for only certain types of infections. Right now, it is only labelled for use against skin infections (most of which tend to be streptococcus or staphylococcus species bacteria), although, I suspect that it will likely be a good choice for upper respiratory infections and first or second time urinary tract infections.

The other drawback is the price of treatment, with the average injection costing the pet owner around $2 per pound of body weight. While this may be quite affordable for owners of small to medium sized dogs or cats, the price of treatment can get very high for large or giant breeds.

Still, having been using the drug for a little over a week, I find my clinic already flying through its supplies of Convenia. When used at appropriate times, Convenia has proven itself an invaluable tool to ensure owner treatment compliance, as well as create convenience and ease of treatment for clients.

P.S.: I have no affiliation with, nor do I receive any incentives from, Pfizer, As such, my critique of Convenia 100% objective, written solely for my reader's information, and not meant to be taken as an endorsement of any kind.


Jeff said...

Have you had a chance to see how cats with upper-respiratory infections have responded to Convenia yet?

My kitty has been fighting a nasty upper respiratory infection for more than two months. Everyone agrees that its root cause is almost certainly herpes... but with a nasty bacterial co-infection as well. Back in March, he had a similar infection. He was given an oral cephalosporin antibiotic for 2 weeks (not sure about the name... it was a yellow-orange suspension that supposedly was banana-flavored), and its effect was rapid and dramatic. Within 24 hours, he was visibly improved, and he was almost symptom free a few days later. Then, about 2 months later, I bought a house, and we moved in shortly afterward. He was obviously stressed out by the move, the sneezing & coughing came back, then came back with a vengeance about a month later.

His new vet wasn't convinced that he had a bacterial infection on top of the herpes, and only prescribed 4 days of Clavamox (with instructions to come get a refill if it appeared to help). It didn't appear to help at all, so I accepted that it was probably just a herpes outbreak and let it go. About a week later, he seemed to get a little bit better, which lent more evidence to the herpes theory.

Unfortunately, he started to decline again, and every day was a little worse than the day before. Finally, last Friday I came home from work, and was horrified to hear his breathing from 20 feet away. I ran him straight to the vet, who saw his snot (yellow-green), decided that regardless of whether or not it originated with a herpes outbreak, there's almost certainly a bacterial infection in there RIGHT NOW, probably WAS bacterial last month too, and that it's now probably picked up a bit of resistance. She prescribed a 14-day course of Clavamox. I brought up the previous month's treatment failure, and mentioned the spectacular results he had from the cephalosporin antibiotic a few months earlier. She acknowledged that cephalosporin is very good, but said that they only had it in tablet form. I remembered the hell and grief I went through the LAST time I had to pill him, and decided to stick with the Clavamox.

I took him home, started him on the Clavamox, and (to my surprise) he improved dramatically over the next day and a half. Unfortunately, he eventually learned how to avoid swallowing the Clavamox, learned how to spit it out, and eventually started vomiting a few minutes after almost every dose. After a few days of seeing half of each dose end up on the floor almost immediately, and the other half end up on the floor a few minutes later, I put two and two together, and concluded that it's probably upsetting his stomach. He's probably trying to avoid swallowing it because he's figured out it gives him a stomachache, and the irritation itself is causing him to throw up a little while later. And because most of each dose is ending up on the floor, he's getting worse again.

Anyway, that's how I found your blog. I was researching injectable antibiotics (since that seems to be about the only option that's NOT vulnerable to spitting out or throwing up), tripped over a reference to Convenia, saw that it's from the cephalosporin family, remembered that he had a good response from another cephalosporin antibiotic a few months ago, and decided to study it a bit more to see whether it might be a viable treatment option for my kitty.

So far, I've seen lots of evidence that Convenia is probably his best real-world option right now, and nothing (besides the FDA's lack of official blessing) to suggest that it's a worse option than doing nothing, or continuing the downward spiral of fighting with him to take his medicine, then having most of it end up on the floor anyway while he gets a little bit worse every day. At this point I'm desperate enough to take him in for daily shots if I absolutely HAVE to, but seeing how he now hides under the bed (where he's figured out I can't easily get to him) whenever he suspects it's "Medicine Time", I suspect that by day 3 or 4, he'll become equally adept at hiding under the bed to try avoiding his daily visit to the doctor. I'm personally willing to give him daily shots if there really IS an injectable antibiotic that's likely to be meaningfully better... but I don't know how enthused his new doctor will be about that particular option.

If you HAVE used Convenia for a cat with upper respiratory infection, did you follow the same dosing that you'd use for a skin infection, or did you use a larger or smaller dose? Did a single shot do the trick, or did you have to give a second shot 6-14+ days later (possibly at a lower dose) to nudge the blood serum level back up into the therapeutic range for a few more days to finish clearing it up? If you DID give a second shot, was it obvious at the time that it was going to be necessary? Or was the second dose given as a precaution, or after the cat appeared to be better... but then had the symptoms reappear?

Thanks! My kitty definitely needs help right now, and if Convenia looks like it might be a viable treatment option for him, I'd REALLY like to give it a try before subjecting him to daily trips to the vet for a shot, or fighting a losing battle with him over the oral antibiotics, unless there's some REALLY compelling reason to do otherwise. Cost is no object... I just want my little kitty (a.k.a. "My Son") to get better, with as little ongoing trauma to him (and me) as possible. If you've had any experiences with Convenia and upper respiratory infections in cats (good, bad, or otherwise), I'm sure there are other vets who'd like to read about them :-)

Anonymous said...

Update --

My kitty ultimately needed two courses of Convenia (the second 7 days after the first), but it seemed to do the job quite nicely. I *do* think the second dose probably should have been given a little sooner, though. He started visibly improving about a day after the shot and was almost symptom-free by day 3, but started to slowly relapse on day 4. He wasn't nearly as sick on day 7 as he was on day 0, but was definitely getting a bit worse every day on days 5-7. After the second shot, the improvement wasn't as rapid or dramatic as the improvement over the first, but it WAS obvious that he was getting a little bit better every day instead of getting a little bit worse.

The bad news is that he's sick again... same thing, almost as bad as before. The good news is that he was symptom-free for over a month thanks to the first two courses of Convenia, and I think I might have figured out what's causing (or at least contributing) to his respiratory problems. Since August, I've discovered that my house has a MAJOR problem with both mold (species unknown) behind the drywall in several rooms and Serratia Marcescens. I think I was able to shield my kitty from the worst of it during removal/decontamination of the living room's drywall (HEPA air cleaner and dehumidifier in living room isolated from rest of house by plastic barrier, Filtrete filters in the A/C changed every other day for 2 weeks, and forcing him to spend as much time outside as possible), but I guess the residue (or whatever remains behind the walls of the second floor) was enough to trigger a new infection, because he started sneezing about a week after I finished the remediation job, and has slowly worsened ever since.

Going forward, it looks like I'm going to have to get a whole-house HEPA air cleaner, possibly augmented by a whole-house dehumidifier, and just be aggressive about getting him to the vet for Convenia whenever I notice him starting to get sick again to try and nip it in the bud.

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