|
Enrofloxacin is a synthetic chemotherapeutic agent from the class of the
quinolone carboxylic acid derivatives. It has antibacterial activity against a
broad spectrum of Gram negative and Gram positive bacteria (See Tables I and
II). It is rapidly absorbed from the digestive tract, penetrating into all
measured body tissues and fluids (See Table III). Tablets are available in three
tablet sizes (22.7, 68.0 and 136.0 mg enrofloxacin).
ACTIONS:
Microbiology:
Quinolone carboxylic acid derivatives are classified as DNA gyrase inhibitors.
The mechanism of action of these compounds is very complex and not yet fully
understood. The site of action is bacterial gyrase, a synthesis promoting
enzyme. The effect on Escherichia coli is the inhibition of DNA synthesis
through prevention of DNA supercoiling. Among other things, such compounds lead
to the cessation of cell respiration and division. They may also interrupt
bacterial membrane integrity.1
Enrofloxacin
is bactericidal, with activity against both Gram negative and Gram positive
bacteria. The minimum inhibitory concentrations (MICs) were determined for a
series of 39 isolates representing 9 genera of bacteria from natural infections
in dogs and cats, selected principally because of resistance to one or more of
the following antibiotics: ampicillin, cephalothin, colistin, chloramphenicol,
erythromycin, gentamicin, kanamycin, penicillin, streptomycin, tetracycline,
triple sulfa and sulfa/trimethoprim. The MIC values for enrofloxacin against
these isolates are presented in Table I. Most strains of these organisms were
found to be susceptible to enrofloxacin in vitro but the clinical
significance has not been determined for some of the isolates.
The
susceptibility of organisms to enrofloxacin should be determined using
enrofloxacin 5 mcg disks. Specimens for susceptibility testing should be
collected prior to the initiation of enrofloxacin therapy.
TABLE I —
MIC Values for Enrofloxacin Against Canine and Feline Pathogens (Diagnostic
laboratory isolates, 1984)
|
Organisms
|
Isolates
|
MIC Range
(mcg/mL)
|
|
Bacteroides
spp.
|
2
|
2
|
|
Bordetella
bronchiseptica
|
3
|
0.125-0.5
|
|
Brucella
canis
|
2
|
0.125-0.25
|
|
Clostridium
perfringens
|
1
|
0.5
|
|
Escherichia
coli
|
5*
|
≤0.016-0.031
|
|
Klebsiella
spp.
|
11*
|
0.031-0.5
|
|
Proteus
mirabilis
|
6
|
0.062-0.125
|
|
Pseudomonas
aeruginosa
|
4
|
0.5-8
|
|
Staphylococcus
spp.
|
5
|
0.125
|
*Includes feline
isolates.
The
inhibitory activity on 120 isolates of seven canine urinary pathogens was also
investigated and is listed in Table II.
TABLE II —
MIC Values for Enrofloxacin Against Canine Urinary Pathogens (Diagnostic
laboratory isolates, 1985)
|
Organisms
|
Isolates
|
MIC Range
(mcg/mL)
|
|
E. coli
|
30
|
0.06-2.0
|
|
P.
mirabilis
|
20
|
0.125-2.0
|
|
K.
pneumoniae
|
20
|
0.06-0.5
|
|
P.
aeruginosa
|
10
|
1.0-8.0
|
|
Enterobacter
spp.
|
10
|
0.06-1.0
|
|
Staph.
(coag. +)
|
20
|
0.125-0.5
|
|
Strep.
(alpha hemol.)
|
10
|
0.5-8.0
|
Distribution
in the Body: Enrofloxacin
penetrates into all canine and feline tissues and body fluids. Concentrations of
drug equal to or greater than the MIC for many pathogens (See Tables I, II and
III) are reached in most tissues by two hours after dosing at 2.5 mg/kg and are
maintained for 8-12 hours after dosing. Particularly high levels of enrofloxacin
are found in urine. A summary of the body fluid/tissue drug levels at 2 to 12
hours after dosing at 2.5 mg/kg is given in Table III.
TABLE III —
Body Fluid/Tissue Distribution of Enrofloxacin in Dogs and Cats
|
Single
Oral Dose = 2.5 mg/kg (1.13 mg/lb)
|
|
|
Post-treatment
Enrofloxacin Levels
|
|
|
Canine
(n=2)
|
Feline
(n=4)
|
|
Body Fluids
(mcg/mL)
|
2
Hr.
|
8
Hr.
|
2
Hr.
|
12
Hr.
|
|
Bile
|
–
|
–
|
2.13
|
1.97
|
|
Cerebrospinal
Fluid
|
–
|
–
|
0.37
|
0.10
|
|
Urine
|
43.05
|
55.35
|
12.81
|
26.41
|
|
Eye Fluids
|
0.53
|
0.66
|
0.45
|
0.65
|
|
Whole Blood
|
1.01
|
0.36
|
–
|
–
|
|
Plasma
|
0.67
|
0.33
|
–
|
–
|
|
Serum
|
–
|
–
|
0.48
|
0.18
|
|
Tissues
(mcg/g) Hematopoietic System
|
|
Liver
|
3.02
|
1.36
|
1.84
|
0.37
|
|
Spleen
|
1.45
|
0.85
|
1.33
|
0.52
|
|
Bone Marrow
|
2.10
|
1.22
|
1.68
|
0.64
|
|
Lymph Node
|
1.32
|
0.91
|
0.49
|
0.21
|
|
Urogenital
System
|
|
Kidney
|
1.87
|
0.99
|
1.43
|
0.37
|
|
Bladder Wall
|
1.36
|
0.98
|
1.16
|
0.55
|
|
Testes
|
1.36
|
1.10
|
1.01
|
0.28
|
|
Prostate
|
1.36
|
2.20
|
1.88
|
0.55
|
|
Ovaries
|
–
|
–
|
0.78
|
0.56
|
|
Uterine Wall
|
1.59
|
0.29
|
0.81
|
1.05
|
|
Gastrointestinal
and Cardiopulmonary Systems
|
|
Lung
|
1.34
|
0.82
|
0.91
|
0.33
|
|
Heart
|
1.88
|
0.78
|
0.84
|
0.32
|
|
Stomach
|
3.24
|
2.16
|
3.26
|
0.27
|
|
Small
Intestine
|
2.10
|
1.11
|
2.72
|
0.40
|
|
Large
Intestine
|
–
|
–
|
0.94
|
1.10
|
|
Other
|
|
Fat
|
0.52
|
0.40
|
0.24
|
0.11
|
|
Skin
|
0.66
|
0.48
|
0.46
|
0.17
|
|
Muscle
|
1.62
|
0.77
|
0.53
|
0.29
|
|
Brain
|
0.25
|
0.24
|
0.22
|
0.12
|
|
Mammary Gland
|
0.45
|
0.21
|
0.36
|
0.30
|
|
Feces
|
1.65
|
9.97
|
0.37
|
4.18
|
Pharmacokinetics:
In dogs, the absorption and elimination characteristics of the oral formulation
are linear (plasma concentrations increase proportionally with dose) when
enrofloxacin is administered at up to 11.5 mg/kg, twice daily.
Approximately 80% of the orally administered dose enters the systemic
circulation unchanged. The eliminating organs, based on the drug's body
clearance time, can readily remove the drug with no indication that the
eliminating mechanisms are saturated. The primary route of excretion is via the
urine. The absorption and elimination characteristics beyond this point are
unknown. In cats, no oral absorption information is available at other than 2.5
mg/kg, administered orally as a single dose. Saturable absorption and/or
elimination processes may occur at greater doses. When saturation of the
absorption process occurs, the plasma concentration of the active moiety will be
less than predicted, based on the concept of dose proportionality.
Following
an oral dose in dogs of 2.5 mg/kg (1.13 mg/lb) enrofloxacin reached 50% of
its maximum serum concentration in 15 minutes and peak serum level was reached
in one hour. The elimination half-life in dogs is approximately 2½-3 hours at
that dose, while in cats it is greater than 4 hours. In a study comparing dogs
and cats, the peak concentration and the time to peak concentration were not
different.
Breakpoint:
Based on pharmacokinetic studies of enrofloxacin in dogs and cats after a single
oral administration of 2.5 mg enrofloxacin/kg BW (i.e. half of the lowest-end
single daily dose range) and the data listed in Tables I and II, the following
breakpoints are recommended for canine and feline isolates.
|
Zone
Diameter (mm)
|
MIC
(µg/mL)
|
Interpretation
|
|
≥
21
|
≤
0.5
|
Susceptible
(S)
|
|
18
- 20
|
1
|
Intermediate
(I)
|
|
≤
17
|
≥
2
|
Resistant
(R)
|
A
report of “Susceptible” indicates that the pathogen is likely to be
inhibited by generally achievable plasma levels. A report of “Intermediate”
is a technical buffer and isolates falling into this category should be
retested. Alternatively the organism may be successfully treated if the
infection is in a body site where drug is physiologically concentrated. A report
of “Resistant” indicates that the achievable drug concentrations are
unlikely to be inhibitory and other therapy should be selected.
Standardized
procedures require the use of laboratory control organisms for both standardized
disk diffusion assays and standardized dilution assays. The 5 µg enrofloxacin
disk should give the following zone diameters and enrofloxacin powder should
provide the following MIC values for reference strains.
|
QC
strain
|
MIC
(µg/mL)
|
Zone
Diameter (mm)
|
|
E. coli ATCC
25922
|
0.008
- 0.03
|
32
- 40
|
|
P.
aeruginosa ATCC 27853
|
1
- 4
|
15
- 19
|
|
S. aureus ATCC
25923
|
|
27
- 31
|
|
S. aureus ATCC
29213
|
0.03
- 0.12
|
|
INDICATIONS:
Baytril®
(brand of enrofloxacin) Antibacterial Tablets are indicated for the management
of diseases associated with bacteria susceptible to enrofloxacin. Baytril
Antibacterial Tablets are indicated for use in dogs and cats.
EFFICACY
CONFIRMATION:
Dogs:
Clinical efficacy was established in dermal infections (wounds and abscesses)
associated with susceptible strains of Escherichia coli, Klebsiella
pneumoniae, Proteus mirabilis, and Staphylococcus intermedius; respiratory
infections (pneumonia, tonsillitis, rhinitis) associated with susceptible
strains of Escherichia coli and Staphylococcus aureus; and urinary
cystitis associated with susceptible strains of Escherichia coli, Proteus
mirabilis, and Staphylococcus aureus.
Palatability:
Free choice palatability in dogs was confirmed in a study in which 350
individual dosings resulted in a voluntary ingestion rate of 73%.
Cats:
Clinical efficacy was established in dermal infections (wounds and abscesses)
associated with susceptible strains of Pasteurella multocida, Staphylococcus
aureus, and Staphylococcus epidermidis.
CONTRAINDICATIONS:
Enrofloxacin
is contraindicated in dogs and cats known to be hypersensitive to quinolones.
Dogs:
Based on the studies discussed under the section on Animal Safety Summary, the
use of enrofloxacin is contraindicated in small and medium breeds of dogs during
the rapid growth phase (between 2 and 8 months of age). The safe use of
enrofloxacin has not been established in large and giant breeds during the rapid
growth phase. Large breeds may be in this phase for up to one year of age and
the giant breeds for up to 18 months. In clinical field trials utilizing a daily
oral dose of 5.0 mg/kg, there were no reports of lameness or joint problems in
any breed. However, controlled studies with histological examination of the
articular cartilage have not been conducted in the large or giant breeds.
ADVERSE REACTIONS:
Dogs:
Two of the 270 (0.7%) dogs treated with Baytril® (brand of
enrofloxacin) Tablets at 5.0 mg/kg per day in the clinical field studies
exhibited side effects, which were apparently drug-related. These two cases of
vomition were self-limiting.
Post-Approval
Experience: The following
adverse experiences, although rare, are based on voluntary post-approval adverse
drug experience reporting. The categories of reactions are listed in decreasing
order of frequency by body system.
Gastrointestinal:
anorexia, diarrhea, vomiting, elevated liver enzymes
Neurologic: ataxia,
seizures
Behavioral:
depression, lethargy, nervousness
Cats:
No drug-related side effects were reported in 124 cats treated with Baytril®
(brand of enrofloxacin) Tablets at 5.0 mg/kg per day for 10 days in clinical
field studies.
Post-Approval
Experience: The following
adverse experiences, although rare, are based on voluntary post-approval adverse
drug experience reporting. The categories of reactions are listed in decreasing
order of frequency by body system.
Ocular: Mydriasis,
retinal degeneration (retinal atrophy, attenuated retinal vessels, and
hyperreflective tapeta have been reported), loss of vision. Mydriasis may be an
indication of impending or existing retinal changes.
Gastrointestinal:
vomiting, anorexia, elevated liver enzymes, diarrhea
Neurologic: ataxia,
seizures
Behavioral:
depression, lethargy, vocalization, aggression
For medical emergencies or to
report adverse reactions, call 1-800-422-9874.
ANIMAL SAFETY
SUMMARY:
Dogs:
Adult dogs receiving
enrofloxacin orally at a daily dosage rate of 52 mg/kg for 13 weeks had only
isolated incidences of vomition and inappetence. Adult dogs receiving the tablet
formulation for 30 consecutive days at a daily treatment of 25 mg/kg did not
exhibit significant clinical signs nor were there effects upon the clinical
chemistry, hematological or histological parameters. Daily doses of 125 mg/kg
for up to 11 days induced vomition, inappetence, depression, difficult
locomotion and death while adult dogs receiving 50 mg/kg/day for 14 days had
clinical signs of vomition and inappetence.
Adult
dogs dosed intramuscularly for three treatments at 12.5 mg/kg followed by 57
oral treatments at 12.5 mg/kg, all at 12 hour intervals, did not exhibit either
significant clinical signs or effects upon the clinical chemistry, hematological
or histological parameters.
Oral
treatment of 15 to 28 week old growing puppies with daily dosage rates of 25
mg/kg has induced abnormal carriage of the carpal joint and weakness in the
hindquarters. Significant improvement of clinical signs is observed following
drug withdrawal. Microscopic studies have identified lesions of the articular
cartilage following 30 day treatments at either 5, 15 or 25 mg/kg in this age
group. Clinical signs of difficult ambulation or associated cartilage lesions
have not been observed in 29 to 34 week old puppies following daily treatments
of 25 mg/kg for 30 consecutive days nor in 2 week old puppies with the same
treatment schedule.
Tests
indicated no effect on circulating microfilariae or adult heartworms (Dirofilaria
immitis) when dogs were treated at a daily dosage rate of 15 mg/kg for 30
days. No effect on cholinesterase values was observed.
No
adverse effects were observed on reproductive parameters when male dogs received
10 consecutive daily treatments of 15 mg/kg/day at 3 intervals (90, 45 and 14
days) prior to breeding or when female dogs received 10 consecutive daily
treatments of 15 mg/kg/day at 4 intervals; between 30 and 0 days prior to
breeding, early pregnancy (between 10th & 30th days), late pregnancy
(between 40th & 60th days), and during lactation (the first 28 days).
Cats:
Cats in age ranges of 3 to 4 months and 7 to 10 months received daily treatments
of 25 mg/kg for 30 consecutive days with no adverse effects upon the
clinical chemistry, hematological or histological parameters. In cats 7-10
months of age treated daily for 30 consecutive days, 2 of 4 receiving 5 mg/kg, 3
of 4 receiving 15 mg/kg, 2 of 4 receiving 25 mg/kg and 1 of 4 nontreated
controls experienced occasional vomition. Five to 7 month old cats had no side
effects with daily treatments of 15 mg/kg for 30 days, but 2 of 4 animals had
articular cartilage lesions when administered 25 mg/kg/day for 30 days.
Doses
of 125 mg/kg for 5 consecutive days to adult cats induced vomition, depression,
incoordination and death while those receiving 50 mg/kg for 6 days had clinical
signs of vomition, inappetence, incoordination and convulsions, but they
returned to normal.
Enrofloxacin
was administered to thirty-two (8 per group), six- to eight- month-old cats at
doses of 0, 5, 20, and 50 mg/kg of body weight once a day for 21 consecutive
days. There were no adverse effects observed in cats that received 5 mg/kg body
weight of enrofloxacin. The administration of enrofloxacin at 20 mg/kg body
weight or greater caused salivation, vomition, and depression. Additionally,
dosing at 20 mg/kg body weight or greater resulted in mild to severe fundic
lesions on ophthalmologic examination (change in color of the fundus, central or
generalized retinal degeneration), abnormal electroretinograms (including
blindness), and diffuse light microscopic changes in the retina.
DRUG INTERACTIONS:
Compounds
that contain metal cations (e.g., aluminum, calcium, iron, magnesium) may reduce
the absorption of some quinolone-class drugs from the intestinal tract.
Concomitant therapy with other drugs that are metabolized in the liver may
reduce the clearance rates of the quinolone and the other drug.
Dogs:
Enrofloxacin has been administered to dogs at a daily dosage rate of 10 mg/kg
concurrently with a wide variety of other health products including
anthelmintics (praziquantel, febantel), insecticides (pyrethrins), heartworm
preventatives (diethylcarbamazine) and other antibiotics (ampicillin, gentamicin
sulfate, penicillin, dihydrostreptomycin). No incompatibilities with other drugs
are known at this time.
Cats:
Enrofloxacin was administered at a daily dosage rate of 5 mg/kg concurrently
with anthelmintics (praziquantel, febantel), an insecticide (propoxur) and
another antibacterial (ampicillin). No incompatibilities with other drugs are
known at this time.
WARNINGS:
For use in animals only. In
rare instances, use of this product in cats has been associated with Retinal
Toxicity. Do not exceed 5 mg/kg of body weight per day in cats. Safety in
breeding or pregnant cats has not been established. Keep out of reach of
children.
Avoid
contact with eyes. In case of contact, immediately flush eyes with copious
amounts of water for 15 minutes. In case of dermal contact, wash skin with soap
and water. Consult a physician if irritation persists following ocular or dermal
exposure. Individuals with a history of hypersensitivity to quinolones should
avoid this product. In humans, there is a risk of user photosensitization within
a few hours after excessive exposure to quinolones. If excessive accidental
exposure occurs, avoid direct sunlight.
For customer service or to
obtain product information, including Material Safety Data Sheet, call
1-800-633-3796.
PRECAUTIONS:
Quinolone-class
drugs should be used with caution in animals with known or suspected Central
Nervous System (CNS) disorders. In such animals, quinolones have, in rare
instances, been associated with CNS stimulation which may lead to convulsive
seizures.
Quinolone-class
drugs have been associated with cartilage erosions in weight-bearing joints and
other forms of arthropathy in immature animals of various species.
The
use of fluoroquinolones in cats has been reported to adversely effect the
retina. Such products should be used with caution in cats.
DOSAGE AND
ADMINISTRATION:
Dogs:
Administer orally at a rate to provide 5-20 mg/kg (2.27 to 9.07 mg/lb) of body
weight. Selection of a dose within this range should be based on clinical
experience, the severity of disease, and susceptibility of the pathogen. Animals
which receive doses in the upper-end of the dose range should be carefully
monitored for clinical signs that may include inappetence, depression, and
vomition.
|
Weight
of Dog
|
Once
Daily Dosing Chart
|
|
|
5.0
mg/kg
|
10.0
mg/kg
|
15.0
mg/kg
|
20.0
mg/kg
|
|
9.1
kg
(20 lb)
|
2x22.7
mg
tablets
|
1x22.7
mg plus
68 mg tablets
|
1x136
mg
tablet
|
1x136
mg plus
2x22.7 mg tablets
|
|
27.2
kg
(60 lb)
|
1x136
mg
tablet
|
2x136
mg
tablets
|
3x136
mg
tablets
|
4x136
mg
tablets
|
All tablet sizes are
double scored for accurate dosing.
Cats:
Administer orally at 5 mg/kg (2.27 mg/lb) of body weight. The dose for dogs and
cats may be administered either as a single daily dose or divided into two (2)
equal daily doses administered at twelve (12) hour intervals. The dose should be
continued for at least 2-3 days beyond cessation of clinical signs, to a maximum
of 30 days.
|
Weight
of Cat
|
Once
Daily Dosing Chart
(5 mg/kg/day)
|
|
5
lb
(2.27 kg)
|
1/2x22.7
mg tablet
|
|
10
lb
(4.5 kg)
|
1x22.7
mg tablet
|
|
15
lb
(6.8 kg)
|
1
and 1/2x22.7 mg tablets or
1/2x68 mg tablet
|
All tablet sizes are
double scored for accurate dosing.
Palatability:
Most dogs will consume Baytril®
Taste Tabs® Tablets willingly when offered by hand. Alternatively
the tablet(s) may be offered in food or hand-administered (pilled) as with other
oral tablet medications. In cats, Baytril® Taste Tabs®
Tablets should be pilled. After administration, watch the animal closely to be
certain the entire dose has been consumed.
Dogs
& Cats: The duration of
treatment should be selected based on clinical evidence. Generally,
administration of Baytril Tablets should continue for at least 2-3 days beyond
cessation of clinical signs. For severe and/or complicated infections, more
prolonged therapy, up to 30 days, may be required. If no improvement is seen
within five days, the diagnosis should be reevaluated and a different course of
therapy considered.
The
lower limit of the dose range in dogs and the daily dose for cats was based on
efficacy studies in dogs and cats where enrofloxacin was administered at 2.5
mg/kg twice daily. Target animal safety and toxicology were used to establish
the upper limit of the dose range for dogs and treatment duration for dogs and
cats.
STORAGE:
Dispense
tablets in tight containers only.
Product Information Provided by
Bayer Animal Health©
|