The World Small Animal Veterinary Association ( <scp>WSAVA</scp> )

MEMBERS OF THE WSAVA THERAPEUTIC GUIDELINES GROUP (TGG) VERSION 1; JANUARY 20TH, 2020 This list of essential medicines is presented by members of the WSAVA Therapeutic Guidelines Group (TGG) following extensive internal and external peer-review. Internal peer-review was provided by TGG members and its subcommittees, whereas external peer-review was performed by board-certified individuals and other WSAVA working/guideline groups. The first draft of this document was presented at the WSAVA annual meeting in Toronto (2019) followed by a three-month audit during which WSAVA member affiliates were asked to provide comments, suggestions and overall feedback. These were then carefully considered by the TGG. The final list is a product of several rounds of revision and based on expert consensus. This list of essential medicines should allow veterinarians to provide proper preventive care and treatment of the most frequent and important diseases in dogs and cats while maintaining appropriate animal welfare standards. The purpose of the list is to improve and facilitate regulatory oversight for ensuring appropriate medicines availability, drug quality, use and pharmacovigilance, while mitigating the growing black/counterfeit market of pharmaceutical products. The list of essential medicines is not intended to define what medicines should be always available within the clinic/hospital; rather that veterinarians should have ready access to these (medicines) if required for the prevention and treatment of specific diseases and conditions. Additionally, the committee understands that there is no “one-size fits all” and that there may be specific medicines used for endemic/epidemic diseases in some countries that the list does not cover. For example, the essential antimicrobials were defined as those medicines that are recommended as first line agents for treatment of at least one common disease condition. Essential medicines are those that satisfy the primary health care and welfare needs of cats and dogs. The definitions of essential medicines were based on a similar list of essential medicines in human medicine by the World Health Organization.11 1https://www.who.int/medicines/publications/essentialmedicines/en/ From a regulatory standpoint, it should be adapted in accordance with specific regional or national needs and conditions. The presence of a medicine in the essential medicines list carries no assurance as to the pharmaceutical quality of products containing that medicine. It is the responsibility of the relevant national or regional drug regulatory authority to ensure that each product is of appropriate pharmaceutical quality (including stability) and that, when relevant, bioequivalent products can be interchangeable. Individuals should be also aware of potential different concentrations and formulations of each compound/medicine, and possible drug combinations present in a commercial product. Additionally, this list is not meant to be used as a reference for dosage regimens, drug interactions, indications or contra-indications, adverse effects or description of pharmacologic effects. It does not describe what medicines require monitoring, specific means of disposal/elimination/record keeping or follow-up consultations as the list should not be used as guidance for therapy. Essential medicines are presented in alphabetical order and divided by either drug category (anaesthetic, analgesics, immunomodulators, oncology drugs, sedatives, vaccines, antiparasitics and antimicrobials, including antibacterial, antifungal, antiprotozoal and antiviral drugs) or organ system/specialty (cardiorespiratory and renal, endocrinology, gastrointestinal, neurology, ophthalmology or reproduction). The essential list of medicines for dermatology is presented in other sections of the document (e.g. immunomodulators, antimicrobials, antiparasitics, etc.). Cross-reference between a drug category and an organ system is acknowledged where appropriate. Some veterinary specialties may not be listed as their lists of essential medicines have been merged into another drug category or organ system. Essential medicines are selected with due regard to disease prevalence and public/animal health relevance, evidence of clinical efficacy and safety, and comparative costs and cost-effectiveness. These medicines can be rarely replaced by other medicines and their absence could compromise public/animal health and welfare. The core list presents a list of minimum medicine needs for a basic healthcare system, listing the most efficacious, safe and cost-effective medicines for priority conditions. Priority conditions are selected based on current and estimated future public/animal health relevance, and potential for safe and cost-effective treatment. The complementary list presents essential medicines for priority diseases, for which specialized diagnostic or monitoring facilities, and/or specialist medical care, and/or specialist training are needed. In case of doubt, medicines may also be listed as complementary based on consistently higher cost or less attractive cost-effectiveness in a variety of settings and wide availability in the profession. Oral (PO) formulations are used in the treatment of rodenticide (e.g. warfarin, pindone, bromadiolone, etc.) toxicosis. These fat emulsion solutions are used as a source of calories and essential fatty acids in parenteral nutrition. However, they are also used for the treatment of different toxicoses including local anaesthetic and ivermectin overdose. These fluoroquinolones are the first choices for treatment of prostatitis and meningitis due to their ability to penetrate the blood/prostate and blood/brain barriers, respectively. Injectable preparations are needed for treatment of life-threatening infections such as pyelonephritis, or sepsis and acute pneumonia when used in combination with clindamycin or a penicillin. They are also useful for treatment of infections caused by bacteria that are resistant to first line agents. This iodophor antiseptic is widely used as an alternative of chlorhexidine gluconate for perioperative skin antisepsis, post-operative application to surgical incisions, and emergency antisepsis in patients with minor lacerations, abrasions and burns. This drug binds to fungal cell membrane ergosterol leading to increased permeability and intracellular cation loss. Amphotericin B has poor oral availability and is administered intravenously. Antifungal activity is highly dependent on the formulation administered. They are incorporated into DNA as a thymidine analogue and used to treat viral infections affecting the ocular surface and include idoxuridine and trifluridine. This blocks the reverse transcriptase of retroviruses. It has been shown to inhibit FIV (feline immunodeficiency virus) replication in vitro and in vivo and can reduce plasma virus load, improve immunological and clinical status of FIV-infected cats, and increase quality of life. These drugs interact with and activate invertebrate glutamate-gated chloride channels conveying antinematodal activity and, for some agents, ectoparasite control with activity against fleas, mites and ticks (e.g. selamectin). These drugs are agonists of nematode acetylcholine nicotinic receptors with drug specific spectrum of activity against gastrointestinal nematodes. The trivalent arsenical melarsomine is a Dirofilaria immitis adulticide. Spironolactone reverses cardiac remodelling in chronic cardiac disease and can be combined with other antihypertensive drugs for refractory systemic hypertension. It can be used judiciously alongside loop diuretics for its anti-aldosterone effect and potassium-sparing activity. This is an inhaled synthetic corticosteroid with profound anti-inflammatory effects that is used in several upper respiratory tract and pulmonary disorders in dogs and cats including rhinitis, bronchitis, asthma and eosinophilic pneumonia. Metered dose inhalers combined with a spacer and appropriate mask should be used for administration. Synthetic thyroxine is used to treat thyroid hormone deficiency in canine hypothyroidism. Levothyroxine is the most common form of this medication. Functions as an agonist of oestrogen receptors to increase urethral sphincter tone. Oestriol is used in cases of urinary incontinence. This is also used for humane euthanasia once the animal is under general anaesthesia. See also Anaesthetic, analgesic, sedative and emergency drugs. For the treatment of gastrointestinal toxicosis since this is not absorbed from the gastrointestinal tract. It adsorbs many, but not all, toxic substances. The two recommended molecules for dogs and cats using the oral route of administration are prednisone and prednisolone. Dexamethasone can be used intravenously when the oral route is compromised. This drug is used in specific conditions for immunosuppression. In ophthalmology, the drug is used for keratoconjunctivitis sicca refractory to treatment with other immunosuppressants/ immunomodulators. For emergency treatment of hypoglycaemia and fluid supplementation in case of acid–base disturbance associated encephalopathy; see anaesthetic, analgesic, sedative and emergency drugs. Multi-antiepileptic-drug-therapy is often required as refractory cases of epilepsy are not uncommon. Potassium bromide is inexpensive and can be used in dogs with hepatic dysfunction. Loading doses of potassium bromide are required to reach a steady state faster. Loading doses are associated with a higher prevalence of adverse effects. This drug should not be administered to cats. Imepitoin is approved in the veterinary market for use in dogs. Levetiracetam should be administered as an adjunct to other antiepileptic drugs. Gabapentin is also an anti-epileptic drug that can be used for the treatment of painful conditions including neuropathic pain. Prednisolone is the most routinely used corticosteroid for the treatment of almost all round cell tumours. Mostly used to treat polycythaemia vera and can be considered for certain forms of leukaemia. Drugs that increase osmolality of the blood can be used intravenously to help decreasing intraocular pressure during glaucoma crisis (see anaesthetic, analgesics, sedative and emergency drugs). Proteinase inhibitors (EDTA, N-acetylcysteine and tetracycline antibiotics) are to be considered when the activity of matrix metalloproteinases is excessive, resulting in corneal melting, which can be common in geriatric dogs. This is used for the IV treatment of periparturient hypocalcaemia (see anaesthetic, analgesics, sedative and emergency drugs). These induce abortion and enhance foetal maturation just before caesarean section. All veterinary practices should be able to develop a core vaccine program for dogs and cats as recommended by the WSAVA Vaccination Guidelines Group or the other veterinary species or speciality organizations or academic institutions that have published science-based policies, guidelines, or principles. Recommended vaccination schedules for puppies and kittens, and adult dogs and cats, as well as animals in a shelter environment, may be found in the WSAVA Vaccination Guidelines.77 7https://www.wsava.org/guidelines/vaccination-guidelines Core vaccines for the dog, as described in these guidelines, are those that protect against canine distemper virus (CDV), canine adenovirus (CAV) and canine parvovirus-2 (CPV). In any country in which canine rabies is an endemic disease, the vaccine for rabies is also considered core for the dog. Likewise, core vaccines for the cat are those that protect against feline parvovirus (FPV), feline herpesvirus-1 (FHV) and feline calicivirus (FCV). In any country in which canine rabies is an endemic disease, the vaccine for rabies is also considered core for the cat. These vaccines are ideally delivered as trivalent modified live virus combination products including CDV, CAV and CPV for the dog and FPV, FHV and FCV for the cat. In areas of high infectious disease prevalence, the availability of a bivalent product containing CDV and CPV antigens, designed for administration to puppies, allows earlier puppy core vaccination. Rabies vaccine is ideally delivered as a separate vaccine component. The WSAVA Vaccination Guidelines Group does NOT recommend the use of non-core canine enteric coronavirus vaccine or Giardia vaccine. The WSAVA Vaccination Guidelines Group does NOT recommend the use of non-core feline infectious peritonitis virus or vaccines against dermatophytes. *The WSAVA Vaccination Guidelines refer to the use of “international” companion animal vaccines of high quality that are produced by major global manufacturers. The Guidelines do not apply to nationally or regionally produced products of unknown quality. The issue facing veterinarians in many parts of the world (particularly in emerging economies) is that manufacturers and/or licensing authorities do not make available trivalent core vaccines that are easily accessed in the developed world. Practices in many countries sometimes only have access to multicomponent products including up to 10 different antigens (mixed core, non-core and not recommended), which makes it impossible to vaccinate according to WSAVA Vaccination global guidelines. **Veterinary practices would ideally offer clients a range of non-core vaccines that would be decided by knowledge of the regional prevalence of an infectious disease and by the lifestyle and exposure risk of that individual animal. Non-core vaccines would ideally be available as monovalent products or limited component products that could be selected for use in the individual animal. Availability and formulation of non-core vaccines will differ between regions and they could be as important as core vaccines depending on the prevalence of a specific disease in a region. WSAVA guidelines refer to such vaccines as supplied by major international manufacturers. This document would not have been possible without the contribution of Drs (in alphabetical order) Filipe Espinheira, Michael Day, Marilyn Dunn, Walt Ingwersen, Roberta Portela, Hélène Ruel, the Theriogenology service of the École nationale vétérinaire d'Alfort and the WSAVA Global Pain Council. This WSAVA List of Essential Medicines for Cats and Dogs has been published as submitted to JSAP and has not gone through the usual full peer-review process.

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