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  Discussion on Excede by Pfizer - use in horses?
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Member:
lilo

Posted on Saturday, May 15, 2010 - 12:21 pm:

Hi DrO,

Just today I received an email from a Riding Club member about a 16 year old mare who got sick and died after her second injection of Excede (recommended by her Vet while recovering from a facial wound). I can not verify that story, but am adding the information from the website excede.com here. It does mention diarrhea as a side effect, but does not talk about acid reflux in horses. Apparently a study by W.S.U. has found that as a side effect also.

Anyway - I wanted to know if you have heard or read anything about Excede as an antibiotic for use in horses - it has apparently been used for cattle and swine, and only recently been approved for use in horses.

Thanks in advance,
Lilo

From excede.com:

EXCEDE® (Ceftiofur Crystalline Free Acid) Sterile Suspension is the first and only licensed antibiotic for horses that offers a full course of therapy in just 2 doses. By reducing the administration requirements from 10 daily doses of a comparative antibiotic to a 2-dose regimen, EXCEDE makes the treatment process less stressful for the horse and more convenient for the veterinarian, caretaker and horse owner.

Indicated for the treatment of lower respiratory tract infections caused by susceptible strains of Streptococcus equi subspecies zooepidemicus (S. zooepidemicus), EXCEDE helps optimize compliance to ensure that horses experience a smooth road to recovery.

IMPORTANT SAFETY INFORMATION: As with all drugs, the use of EXCEDE is contraindicated in animals with known allergy to ceftiofur or to the ß-lactam group (penicillins and cephalosporins) of antimicrobials. Do not use EXCEDE in horses intended for human consumption. The administration of antimicrobials in horses under conditions of stress may be associated with diarrhea, which may require appropriate veterinary therapy. Though safe in cattle when properly administered, inadvertent intra-arterial injection is possible and fatal. EXCEDE has a pre-slaughter withdrawal time of 13 days in cattle. Do not use in calves to be processed for veal. For complete details, refer to the full prescribing information.

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Member:
scooter

Posted on Saturday, May 15, 2010 - 1:33 pm:

Hi Lilo, I'll be curious what Dr.O. thinks of excede, my vet said something about it one day. I asked him if the horses had a reaction to it and he said YES. This was awhile ago and I don't remember exactly what it was, but do remember him saying it was pretty bad.

We have had calves get Hellacious (is that a word) lumps from it, one lump had to be punctured, it was a big as a basketball on one of them!!! The calf was fine after that, but since then I have been a little put off by it. It is suppose to be a good antibiotic, I was surprised when I saw they were using it in horses.. anyway JME.
Moderator:
DrO

Posted on Sunday, May 16, 2010 - 10:50 am:

Hello Lilo,
Horses can an do have serious reactions to any antibiotic so single reports of problems have little significance as to the bigger question of how safe is this product. Here is a copy of the adverse reaction study involving hundreds of horses:

ADVERSE REACTIONS
The injection of EXCEDE Sterile Suspension in the horse may cause firmness, swelling, sensitivity, and/or edema at the injection site (see ANIMAL SAFETY).

A total of 373 horses of various breeds, ranging in age from 4 months to 20 years, were included in the field study safety analysis. Injection site swelling (edema) was reported in 10 of 278 (3.6%) EXCEDE-treated horses and 1 of 95 (1%) of the placebo-treated horses. Of the 10 EXCEDE-treated horses with injection site swelling, 8 horses had swellings of 4 cm or less in diameter, one horse had a 10 cm diameter swelling and one horse had injection site reactions to both injections measuring 25 x 12 cm each. The injection site reactions in EXCEDE-treated horses resolved over 1 to 20 days.

At least one episode of diarrhea, loose, soft, or cowpie stools were observed in 25 of 278 (9%) of the EXCEDE-treated horses and 7 of 95 (7%) of the placebo-treated horses. The duration of episodes in EXCEDE-treated horses ranged from a single observation of loose stool to observations lasting 6 days. All cases were self-limiting and resolved with minimal (a single dose of loperamide) or no treatment.

The material safety data sheet (MSDS) contains more detailed occupational safety information. To obtain a material safety data sheet, please call 1-800-733-5500. To report any adverse event please call 1-800-366-5288.

The toxicology studies are a bit harder to interpret. The first big study was complicated by large numbers of founders and the problem began before treatment was instituted so appears to have been related to the husbandry (dietary changes and concrete floors). Subsequent studies found that when 8 horses were given 3 times the label dosage for 4 injections each 4 days apart (twice as long as labelled for) there were no fatalities and all reactions, diarrhea and local reactions to injections, were self limiting.

I have not used Exceed but would consider it. I would be ready with NSAID's to limit local reaction, particularly following the second injection. Then again this is true of all antibiotics we give to horses IM. The volumes required, the sensitivity of the horse, and sensitivity of the horse owner to changes means local reactions are going to be commonly reported. To read more about ceftiofur, the active ingredient see HorseAdvice.com » Treatments and Medications for Horses » Antibiotics and Antimicrobials » Naxcel (Ceftiofur) and the Cephalosporins.
DrO
Member:
lilo

Posted on Sunday, May 16, 2010 - 3:24 pm:

Thank you, DrO. The horse in question had the following symptoms - "After her 2nd injection, she stopped eating, 2 days later had severe diarrhea,and died with acid reflux bloody mouth." Again, I do not know this person and do not know what else may have been going on with that horse at the time.

I do realize that any horse can have a reaction. I personally know a friend who lost a horse after it had been sedated with Dormosedan for work on its teeth, and yet any vet I talk to considers Dormosedan a very safe sedative.

So - one has to be prepared that a horse may react adversely. The website for Excede does mention the diarrhea, and that inadvertent intra-arterial injection may be fatal.

Thank you again for publishing the study,
Lilo
Moderator:
DrO

Posted on Monday, May 17, 2010 - 6:24 pm:

Yes one should be prepared for adverse reactions and these are particularly hard to treat without huge amounts of rapidly administered IV fluids. I have seen colitis associated with trimethoprim-sulfa and it is reported with penicillin, other cephalosporins, and the tetracycline family. The vomiting probably should not be considered a direct action of the drug but from the severe shock (septic and dehydration) and resulting lack of smooth muscle tone allowing stomach fluid reflux.

Any drug not approved for IV use should be considered toxic if given IV.
DrO
Member:
lilo

Posted on Monday, May 17, 2010 - 8:52 pm:

Thanks again for your insight. I have been fortunate in not having to use antibiotics on my horses, but, one never knows.
Lilo
Moderator:
DrO

Posted on Tuesday, May 18, 2010 - 7:28 pm:

You know it is odd Lilo, I typically run a herd of about 6 to 10 horses, young, old, and pregnant, and have not had to use antibiotics or medications of any kind in general since...since I cannot remember when. I asked Jamette and she reminds me of the pedunculated lipoma that rapped itself around the colin of a horse in 2008 but other than that I would guess it has been 10 years anybody here has received a course of systemic antibiotics.
DrO
Member:
lilo

Posted on Tuesday, May 18, 2010 - 9:58 pm:

That is good news, DrO. Let us hope our horses remain healthy.
Lilo
New Member:
beebede1

Posted on Wednesday, Nov 10, 2010 - 5:27 pm:

Hi Dr O.,
This is just an FYI, so folks can be better informed (wish I'd known).
I'm posting this as I prepare to run down to the barn to put the first round of hot and cold packs on my mare's neck.
This previously healthy, 8 yr old QH mare sustained a small puncture wound on the point of her hock last Wednesday night, and was seen by the vet on Thursday. To be safe, the vet gave her an IM injection of 15cc of a "new antibiotic", Excede ("similar to Naxcel, but time-release). The wound is healing nicely, and she has been totally sound and acting fine until today. This afternoon (6 days post-injection!!!), the whole side of her neck is grossly swollen and sensitive. Vet recommended a dose of Banamine and the hot/cold packs. She said to watch for complications and plan on it taking one to two weeks to resolve (if there are no complications). The selling point of this antibiotic (oil-based, time-release/therefore more coverage with fewer injections) is working against us when dealing with a drug reaction. A Google search is turning-up some scary and sometimes fatal reactions. I guess this drug has only been approved for horses since February 2010? After this experience, I won't allow it to be used again on any of my horses...
Moderator:
DrO

Posted on Thursday, Nov 11, 2010 - 7:51 pm:

Hello Donna,
This is the problem with such anecdotal stories, if we followed every one we would not be able to feed or treat horses with anything. By anecdotal I am not suggesting your story is not true. Individual horses can have adverse reactions to anything. To use an individuals response to a particularly horse to a particular food or drug as a lesson for all horses is destructive. The significant reaction rate of 4% in large studies when used according to directions is well within other IM abiotic rates.

I certainly understand your caution with this horse and this medication but such swelling and pain reactions would be common with any other daily administered IM antibiotic for a week or two of admin at recommended dosages.
DrO
Member:
beebede1

Posted on Thursday, Nov 11, 2010 - 9:36 pm:

Thanks Dr. O!
I totally understand what you're saying, and I know that someone's horse is
going to be one of those 4% that react atypically.
I have also been around the industry long enough to know that drugs can get
approved and fielded, only to get pulled when it becomes tragically apparent
there are unintended consequences...
Some of the anecdotal stories I came across (if you can believe them)
involved dead/dying horses and veterinarians filing lawsuits against Pfizer.
There seemed to be an inordinate amount of chatter about a drug that has
only been approved for use in equines for 8 months.

Bottom line, to have such a significant reaction almost six days after the
one and only injection of Excede, still scares me. The mare was due to have
the 2nd injection on the day she reacted - thank God she didn't get it!
I do wonder if it was the transport agent and not the antibiotic my mare
reacted to. Now my vet has flagged her chart and will not give her anything
in the penicillin family. Live and learn!!!!

Thanks again for being the voice of reason!

Best Regards,
Donna
Moderator:
DrO

Posted on Friday, Nov 12, 2010 - 8:17 am:

I remember when ivermectin became available for the first time, in the first five years I had two clients myself that wanted to sue them over adverse reactions and many thought it was the devils gift to the horse world.

When I give my first injection of Excede I will divide the dosage to not exceed 10 ml per injection site. This has been shown to decrease the number and severity of reactions.
DrO
Member:
npo33901

Posted on Saturday, Nov 13, 2010 - 4:03 am:

Dr. O , forgive me for my lack of knowledge. Would you please explain to me what is " IV fluids ?" ? And your comment " any drug not approved for IV use should be considered toxic if given IV ".
From the posting of 17.May 20010.
I am sorry to have to ask you this - to take you time .
Thank you, AM.
Moderator:
DrO

Posted on Saturday, Nov 13, 2010 - 9:19 am:

IV fluids are fluids given IntraVenously (IV) usually to prevent or correct moderate to severe dehydration. In the case of drug reactions often you are fighting anaphylactic shock which causes a dangerous DrOp in blood pressure and fluids are used to bring the blood pressure up.

Injectable drugs come labelled with recommended dosage routes, for example: subcutaneously (SQ), intramuscular (IM), and intravenously. While some drugs can be used safely in unlabeled ways many drugs can only be given in certain ways and cause disease if the label directions are not followed. Some of the most serious problems are when SQ or IM only labeled drugs are used IV.
DrO
Member:
npo33901

Posted on Saturday, Nov 13, 2010 - 4:58 pm:

Dr. O. thank you for your detail answer.
I was reading IV - like Roman number four 4 !! - Silly me.-
AM.
New Member:
kristam

Posted on Friday, Jun 28, 2013 - 6:06 am:

Dr O, We have a 18 yo horse (gelding ) in QT facility . He is a recent save from slaughter truck. Local vet states he has start of pneumonia (low fever yellow drainage and occasional coughing thru day) and wants to give Excede IM he has been on PCN IM x3 or 4 doses.Our QT person believes he has improved last 24 hrs and is eating and drinking well. Is there another strong Respiratory ABT that you might suggest. Thank You Krista with Florida Dog and Horse Rescue (Tampa Bay Area)
Moderator:
DrO

Posted on Sunday, Jun 30, 2013 - 5:30 pm:

Welcome Krista,
I believe we can help you with your question but let me get you started off right so you can get the best answer as quick as possible. You will get more responses if you start your own discussion rather than post at the bottom of another member's discussion. Each discussion is "owned" by the original poster and all replies in that discussion should either directly or indirectly address the concerns of the original poster.

We do have a better article covering your topic on the HorseAdvice.com » Diseases of Horses » Respiratory System menu. I think your question is answered in the Pneumonia article on that page. At the end of the article you will find a list of already existing discussions on this topic. You should first review the article as it will have important information on your subject. Next check the titles of the already existing discussions to see if your question has already been answered. If your question remains unanswered, now is the time to Start a New Discussion. Under the list of existing discussions you will find the "Start New Discussion" button.
DrO
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