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Adverse Drug Reaction and Toxicity Caused by Commonly Used Antimicrobials in Canine Practice

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Adverse Drug Reaction and Toxicity Caused by Commonly Used Antimicrobials in Canine Practice Veterinary World, EISSN: 2231-0916 REVIEW ARTICLE Available at www.veterinaryworld.org/Vol.7/May-2014/6.pdf Open Access Adverse drug reaction and toxicity caused by commonly used antimicrobials in canine practice 122234 K. Arunvikram , Ipsita Mohanty , K. K. Sardar , S. Palai , G. Sahoo and R. C. Patra 1. Division of Pharmacology and Toxicology, Indian Veterinary Research Institute, Izatnagar -243122, Uttar Pradesh, India: 2. Department of Pharmacology and Toxicology, Veterinary College, Orissa University of Agricultural and Technology, Bhubaneswar - 751 003, Odisha, India;3. Department of Biochemistry, Veterinary College, Orissa University of Agricultural and Technology, Bhubaneswar - 751 003, Odisha, India; 4. Department of Clinical Medicine, Veterinary College, Orissa University of Agricultural and Technology, Bhubaneswar - 751 003, Odisha, India Corresponding author: Ipsita Mohanty, email: [email protected] Received:20-03-2014, Revised: 05-04-2014, Accepted: 08-04-2014, Published online: 08-05-2014 doi: 10.14202/vetworld.2014.299-305 How to cite this article: Arunvikram K, Mohanty I, Sardar KK, Palai S, Sahoo G and Patra RC (2014) Adverse drug reaction and toxicity caused by commonly used antimicrobials in canine practice,Veterinary World 7(5): 299-305. Abstract An adverse drug reaction (ADR) is a serious concern for practicing veterinarians and other health professionals, and refers to an unintended, undesired and unexpected response to a drug that negatively affects the patient's health. It may be iatrogenic or genetically induced, and may result in death of the affected animal. The ADRs are often complicated and unexpected due to myriad clinical symptoms and multiple mechanisms of drug-host interaction. Toxicity due to commonly used drugs is not uncommon when they are used injudiciously or for a prolonged period. Licosamides, exclusively prescribed against anaerobic pyoderma, often ends with diarrhoea and vomiting in canines. Treatment with Penicillin andβ -lactam antibiotics induces onset of pemphigious vulgare, drug allergy or hypersensitivity. Chloroamphenicol and aminoglycosides causes Gray's baby syndrome and ototoxicity in puppies, respectively. Aminoglycosides are very often associated with nephrotoxicity, ototoxicity and neuromuscular blockage. Injudicious use of fluroquinones induces the onset of arthropathy in pups at the weight bearing joints. The most effective therapeutic measure in managing ADR is to treat the causative mediators, followed by supportive and symptomatic treatment. So, in this prospective review, we attempt to bring forth the commonly occurring adverse drug reactions, their classification, underlying mechanism, epidemiology, treatment and management as gleaned from the literature available till date and the different clinical cases observed by the authors. Keywords: adverse drug reaction,allergy, antibiotics, canines, drug interaction, hypersensitivity, toxicity. Introduction of the western world [1]. Around 2.9–5.6 % of all The veterinarians and other health professional human patients admitted to hospitals suffer fromADRs commonly encounter inter-individual variations in and as many as 35% of them experience anADR during response to drug administration. Some patients their stay in hospital. The overall incidence of serious respond well to a particular therapy, while others fail to ADRs is 6.7 % and of fatal ADRs is 0.32 % in demonstrate idiosyncrasy. Often, small animal hospitalized patients [2]. A recent study in Turkey clinicians are informed by the dog owners or breeders revealed that maximum cases on ADR in animals were that their dogs are sensitive to a particular type of reported from vitamin-mineral-amino acid preparations medication. This variation in drug response among (39%), followed by antibacterials and anthelmentics individuals is due to the varied genetic make-up which (26%). The most observed adverse drug reactions were explains the adverse drug reactions and offers a major anaphylaxis and the local reactions at the injected site step towards safe pharmacotherapy. Therefore, phar- [3]. The documented incidence ofADR in pets is lower macogenetics has been used to explain idiosyncratic than that of human, probably due to fewer drugs prescribed drug reactions in veterinary patients. The genotype- per animal patientsvis-a-vis human patients, and poor specific approaches to therapy in childhood (GATC), a investigations on ADR in animal patients following national Adverse Drug Reaction (ADR) network, has drug administration. ADR, in many occasions, is been established in Canada in 2005 to report specific erroneously attributed to disease progression or the ADRs in children and identify the predictive genomic onset of another disease process instead of being easily biomarkers of drug risk and thus, to provide a recognized [4]. The use of drugs, biological, vaccines, framework ofADR surveillance [1]. and dietary supplements is aimed at beneficial thera- Adverse drug reactions (ADRs) are associated peutic outcomes, provided they are being used in accurate with serious harmful effects and may lead to death in dose and diseases and the outcome is thoroughly both human and animal patients. ADRs are ranked as monitored. However, their use is associated with the fifth major cause of mortality in human population inherent risks both in human and veterinary practice. Copyright: The authors. This article is an open access article licensed ADRs are the frequently seen problems and under the terms of the Creative Commons Attribution License results in deleterious health consequences and remain a (http://creativecommons.org/licenses/by/2.0) which permits serious challenge in terms of associated morbidity and unrestricted use, distribution and reproduction in any medium, provided the work is properly cited. mortality [5]. Several plant-based medicinal products Veterinary World, EISSN: 2231-0916 299 Available at www.veterinaryworld.org/Vol.7/May-2014/6.pdf have been evaluated for ameliorating the toxic effects, include anaphylaxis fromβ -lactam antibiotic, serum even after ADR reported following administration of sickness from anti-thymocyte globulin, contact dermatitis anticancer drug, cisplastin [6]. from topical antihistamine, hemolytic anaemia from In this review we have detailed down the ADR penicillin, morbilliform rash from sulphonamides,anti- associated with common antibacterials, mechanisms convulsant hypersensitivity syndrome, toxic epidermal governing them as well as the steps involved in necrolysis, drug-induced lupus-like syndrome [9]. management and treatment. This document would Similarly, dry mouth from antihistamines, hepato- serve as an overview for the veterinary clinicians and toxicity from methotrexate, thrush while taking antibiotic, hence, prevent future injuries for companion animal seizure from theophy-lline, while taking erythromycin, practice. and seizure from excessive lidocaine (xylocaine) are the examples of predictable non-immunologic drug Adverse drug reaction reactions. Unpredictable non-immunologic drug reactions There is no universally accepted definition for an include pseudoallergic, idiosyncratic and intolerance ADR. Most definitions are more or less similar to that [9]. explained by the World Health Organization (WHO) or Pseudoallergic reactions are mostly caused by the United States Food and Drug Administration direct activation of the mast cells and their degranu- (USFDA).As per the WHO definition, an adverse drug lation by drugs such as opiates, vancomycin and event is any response to a drug that is noxious and radiocontrast media. The clinical signs are often same unintended in doses normally used in people or animals as that of type-I hypersensitivity, except that they do for diagnosis, prevention, and treatment. On the other not involve drug specific IgE. Idiosyncratic reactions hand, the USFDA describes serious adverse drug are often unpredicted and are qualitatively aberrant events as events that result in patient's death, life- reactions with much less prevalence. Drug-induced threatening outcomes, hospitalization, disability, hemolysis with deficiency of glucose-6-phosphate congenital anomaly, and outcomes requiring dehydrogenase (G6PD) is a good example of idiosyncratic healthcare interventions [1, 3]. Some ADRs may be reaction. However, drug intolerance explains a lower predictable, based upon a drug's pharmacodynamic threshold to the normal pharmacologic action of a drug. and pharmacokinetic properties or may be Presence of a foreign substance or drug or idiosyncratic due to underling genetic factors. Hence, xenobiotic activate T-cells, which in turn express skin an identification of predisposing genotypes may homing receptors, necessary for presentation of improve patient management through the prospective allergen and thus ultimately leads to cellular apoptosis selection of appropriate remedy [4]. and inflammation [9]. Epidemiological data support the existence of Classification specific factors that increase the risk of ADR. Female ADRs are often classified as type-A occurring gender, infection with human immunodeficiency virus frequently and typically dose related and type-B, which (HIV), and herpes virus infection have been reported to is often, termed as idiosyncratic reactions. Type-A increase the risk. Asthma, systemic lupus erythematosus reactions represent an extension of the drug's and use ofβ- blockers increases the risk for drug therapeutic effect occurring frequently, such as hypersensitivity reactions [10].Atopic
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