Efficacy, safety and tolerance of imidocarb dipropionate versus atovaquone or buparvaquone plus azithromycin used to treat sick dogs naturally infected with the Babesia microti-like piroplasm.

BACKGROUND: Piroplasmosis caused by the Babesia microti-like piroplasm (Bml) is increasingly being detected in dogs in Europe. Sick dogs show acute disease with severe anaemia associated with thrombocytopenia with a poor response to current available drugs. This study assesses the safety and tolerance of three treatments and compares their efficacy over a full year of follow up in dogs naturally infected with Bml. METHODS: Fifty-nine dogs naturally infected with Bml were randomly assigned to a treatment group: imidocarb dipropionate (5 mg/kg SC, 2 doses 14 d apart) (IMI); atovaquone (13.3 mg/kg PO q 8 h, 10 d)/azithromycin (10 mg/kg PO q 24 h, 10 d) (ATO); or buparvaquone (5 mg/kg IM, 2 d apart)/azithromycin (same dosage) (BUP). Before and after treatment (days 15, 45, 90 and 360), all dogs underwent a physical exam, blood tests and parasite detection (blood cytology and PCR). Clinical efficacy was assessed by grading 24 clinical and 8 clinicopathological signs from low to high severity. RESULTS: Before treatment, most dogs had severe regenerative anaemia (88.13%) and thrombocytopenia (71.4%). On treatment Day 45, clinical signs were mostly reduced in all dogs, and by Day 90, practically all dogs under the ATO or BUP regimen were clinically healthy (76.4 and 88%, respectively). Highest percentage reductions in laboratory abnormalities (82.04%) were detected in animals treated with ATO. Over the year, clinical relapse of Bml was observed in 8 dogs (8/17) treated with IMI. However, on Day 360, these animals had recovered clinically, though clinicopathological abnormalities were still present in some of them. Parasitaemia was PCR-confirmed on Days 90 and 360 in 47.05 and 50% of dogs treated with ATO, 68 and 60.08% with BUP, and 94.1 and 73.3% with IMI, respectively. Even after 360 days, 13.3% of the dogs treated with IMI returned a positive blood cytology result. CONCLUSIONS: IMI showed the worse clinical and parasitological, efficacy such that its use to treat Bml infection in dogs is not recommended. The treatments ATO and BUP showed better efficacy, though they were still incapable to completely eliminate PCR-proven infection at the recommended dose. All three treatments showed good tolerance and safety with scarce adverse events observed.

Imidocarb dipropionate in the treatment of Anaplasma marginale in cattle: Effects on enzymes of the antioxidant, cholinergic, and adenosinergic systems.

Anaplasmosis is a worldwide hemolytic disease in cattle caused by a gram-negative obligatory intracellular bacterium, characterized by anemia and jaundice. Among the treatments used for anaplasmosis is a drug called imidocarb dipropionate, also indicated as an immunomodulator agent. However, it causes side effects associated with increased levels of acetylcholine. In view of this, the effects of imidocarb dipropionate on the purinergic system, and antioxidant enzymes in animals naturally infected by Anaplasma marginale were evaluated. Young cattle (n = 22) infected by A. marginale were divided into two groups: the Group A consisted of 11 animals used as controls; and the Group B composed of 11 animals. Imidocarb dipropionate (5 mg/kg) was used subcutaneously to treat both groups (the Group A on day 6 and the Group B on day 0). The treatment reduced acetylcholinesterase (AChE), and adenosine deaminase (ADA) activities, and increased the dismutase superoxide and catalase activities. No changes on lipid peroxidation (TBARS levels) and BChE activities were noticed. These results suggest that imidocarb dipropionate used to treat A. marginale infection in cattle has effect on antioxidant enzymes, and significantly inhibits the enzymatic activities of ADA and AChE.

Evaluation of the use of atropine sulfate, a combination of butylscopolammonium bromide and metamizole sodium, and flunixin meglumine to ameliorate clinical adverse effects of imidocarb dipropionate in horses.

OBJECTIVE: To evaluate the ability of atropine sulfate, butylscopolammonium bromide combined with metamizole sodium, and flunixin meglumine to ameliorate the clinical adverse effects of imidocarb dipropionate in horses. ANIMALS: 28 horses with piroplasmosis. PROCEDURES: 28 horses were randomly assigned to 4 equal groups according to the pretreatment administered. Fifteen minutes before administration of 2.4 mg of imidocarb dipropionate/kg IM, horses in the first group were pretreated with 0.02 mg of atropine sulfate/kg IV, the second group with a combination of 0.2 mg of butylscopolammonium bromide/kg IV and 25 mg of metamizole sodium/kg IV, the third group with 1.1 mg of flunixin meglumine/kg IV, and the fourth (control) group with 1 mL of saline (0.9% NaCl) solution/50 kg IV. Physical examination, including evaluation of rectal temperature, heart and respiratory rates, capillary refill time, mucous membrane color, hydration status, abdominal sounds, signs of abdominal pain, salivation, diarrhea, and number of defecations, was performed. RESULTS: Imidocarb dipropionate use in the control group was associated with serious adverse effects including signs of abdominal pain (4/7 horses) and diarrhea (2/7). Horses pretreated with atropine had no diarrhea, but 6 had signs of abdominal pain. Only 1 horse that received butylscopolammonium-metamizole pretreatment had signs of abdominal pain and 3 had diarrhea, which was numerically but not significantly different than the control group. Of horses pretreated with flunixin, 3 had signs of abdominal pain and 3 had diarrhea. CONCLUSIONS AND CLINICAL RELEVANCE: A combination of butylscopolammonium bromide and metamizole sodium may be useful to ameliorate the adverse effects of imidocarb dipropionate in horses, although group size was small and significant differences from the control group were not found.

Comparison of glycopyrrolate and atropine in ameliorating the adverse effects of imidocarb dipropionate in horses.

REASONS FOR PERFORMING STUDY: Imidocarb, an effective treatment for piroplasmosis, may cause colic and diarrhoea in horses. Atropine and glycopyrrolate are anticholinergics that could reduce the adverse effects of imidocarb. However, atropine and glycopyrrolate inhibit gastrointestinal motility, potentially causing ileus and colic. OBJECTIVES: To compare glycopyrrolate and atropine in ameliorating the adverse effects of imidocarb dipropionate in horses and to determine the effect of combinations of these drugs on the gastrointestinal tract. METHODS: A blinded, randomised, crossover study was performed in 8 healthy horses. Each horse received 0.9% saline i.m and i.v. (CON), and imidocarb 2.4 mg/kg bwt i.m. with one of 3 treatments i.v.: 0.9% saline (IMI), atropine 0.02 mg/kg bwt (IMATROP) and glycopyrrolate 0.0025 mg/kg bwt (IMGLYCO). Clinical data, gastrointestinal motility via borborygmi and frequency of contractions in the duodenum, caecum and right dorsal colon assessed with transabdominal ultrasound, and faecal data were measured. RESULTS: After imidocarb/saline treatment colic and diarrhoea were noted in 3 and 4 horses, respectively, faecal production and defaecation were increased for 3 h and faecal water percentage for 6 h. Colic was noted after atropine treatment in 4 horses, borborygmi and frequency of right dorsal colon contractions were significantly decreased for 2 h 15 min, and faecal production was not significantly different from CON. After glycopyrrolate treatment, colic was seen in one horse, frequency of intestinal contractions and faecal data were not significantly different from CON, and borborygmi was significantly decreased from CON at 1 h 15 min. CONCLUSIONS: Results of this study suggest that glycopyrrolate is superior to atropine in ameliorating the adverse effects of imidocarb. POTENTIAL RELEVANCE: Glycopyrrolate could be administered with imidocarb in horses with piroplasmosis to reduce the adverse effects of imidocarb.

Residual effect of antibabesial drugs on the live redwater blood vaccines.

It has been demonstrated that the attenuated organisms used in the unfrozen South African Babesia bovis and B. bigemina (redwater) vaccines are susceptible for longer periods to the residual effect of the anti-babesial drugs diminazene and imidocarb dipropionate than the virulent field strains. Reports of vaccine failures in some animals vaccinated with the frozen South African redwater vaccines after prophylactic treatment with imidocarb dipropionate have led us to reinvestigate the validity of the recommended prescribed waiting periods. Results indicated that waiting periods before administration of the frozen B. bovis and B. bigemina vaccines in animals that have been treated with diminazene at 3.5 mg/kg live weight, compare favorably with results initially obtained for the unfrozen vaccines at 4 and 8 weeks, respectively. However, the inhibitory effect of imidocarb dipropionate at 3.0 mg/kg live weight on the infectivity of both frozen B. bovis and B. bigemina vaccines is longer than previously anticipated and necessitated changing the minimum waiting periods before administration of these vaccines from 8 to 12 weeks and 16 to 24 weeks, respectively.

Massive hepatic necrosis associated with accidental imidocarb dipropionate toxicosis in a dog.

A 7-year-old dog was accidentally given 10 times the recommended dose of imidocarb dipropionate for suspected babesiosis. Twenty-four hours later, the dog developed severe depression, tachycardia with premature ventricular contractions, cyanosis and hind limb tremors. Shortly thereafter, the dog collapsed and died. Death was due to massive hepatic necrosis.

Efficacy, toxicity and metabolism of imidocarb dipropionate in the treatment of Babesia ovis infection in sheep.

An intramuscular dose of 1.2 mg kg-1 of imidocarb dipropionate (IMDP) was effective in controlling fatal infections with Babesia ovis in sheep. The sheep were infected by the intravenous injection of sheep blood containing B ovis. A severe recrudescence of infection occurred in most sheep 10 to 14 days after therapy but this could be controlled by a second dose of 1.2 mg kg-1 IMDP. Studies on the toxicology, residues and metabolism of IMDP showed this to be a safe dosage regimen. Transient or mild signs of toxicity were seen at 2.4 and 4.8 mg kg-1 IMDP. Severe toxicity was observed in sheep treated with 9.6 mg kg-1.

Effect of induced hypomagnesaemia on the toxicity of imidocarb in calves.

The hypothesis that the toxic effects of imidocarb mediated by reduced cholinesterase activity might be intensified by hypomagnesaemia was tested in calves. Hypomagnesaemia was induced in 12 males (50 kg) using an artificial milk based on a commercial nondairy coffee creamer. Although plasma magnesium levels reached 0.33 mmol litre-1 in two weeks no clinical signs were detected. In 12 control calves a daily magnesium supplement of 0.6 g was inadequate although the published requirement is 0.45 g; it was raised to 1.2 g to keep plasma magnesium normal. Lighter calves developed hypomagnesaemia more readily and fast-growing calves had lower plasma urea concentrations. Plasma calcium, but not plasma magnesium, showed significant positive correlation with plasma albumin. The only statistically significant effects of hypomagnesaemia were slight elevations of white cell count and plasma sodium. The hypomagnesaemic and normomagnesaemic calves were divided into two equal groups and treated with 3.3 mg kg-1 of imidocarb dipropionate or a placebo. The drug produced the expected clinical signs of mild toxicity and depression of cholinesterase but no other adverse effects. Transient slight depressions of plasma calcium and potassium concentration, a transient rise of plasma sodium and elevation of creatine kinase occurred. None of the effects of imidocarb treatment was intensified by hypomagnesaemia except, perhaps, constriction of the pupils; generally, hypomagnesaemic animals were affected less.

Adverse effects of imidocarb dipropionate (Imizol) in a dog.

One of 13 healthy dogs used in a pharmacokinetic study of imidocarb dipropionate died due to difficulty in breathing, tachycardia, weakness and profuse diarrhoea. Autopsy findings showed marked pulmonary congestion and oedema. Kidneys were grossly enlarged and markedly congested with extensive haemorrhage in the cortex and medulla. Marked tubulonephrosis was also exhibited microscopically. Liver and spleen were moderately enlarged and congested. The adverse effects of imidocarb may be due to excessive acetylcholine action.