As the life expectancy of companion animals increases due to recent advances in medical technology and veterinary medicine, owners want to enjoy life with their companion animals longer. Owners’ expectations of their pets are also reflected in the cost of treatment at veterinary hospitals.
According to the 2023 Korean Pet Report published by KB Financial Group Management Research Institute, the average treatment cost per pet household was 787,000 won, an increase of about 70% compared to 468,000 won in 2021, two years ago. It’s not just spending that is increasing. In the same report, more than half of owners’ recent concerns were about pet health care. Spend as much money as you care about, and hope for sufficient management.
The market is also responding to these expectations. According to AZ, a veterinary medicine operated by the Agriculture, Food and Rural Affairs Quarantine Headquarters, the number of animal medical supplies such as veterinary medicines, quasi-drugs, and medical devices by year has been steadily increasing since 2015, and the momentum continues in 2020 during the corona period. did not break. After COVID-19, it is expected that the existing growth trend will be continued.
[사진 1] Registered items of veterinary drugs, quasi-drugs, and medical devices by year
The author was curious about what thoughts veterinarians in the clinical field had about this market trend, and wanted to know what concerns they had regarding the use of drugs important for health care and treatment, but no well-documented domestic cases were confirmed. .
Therefore, an anonymous survey was conducted on 71 veterinarians who are or have been engaged in clinical work for companion animals. As a result, it was confirmed that veterinarians on the clinical front line also had a lot of concerns about using medicine.
[사진 2] Survey respondents’ working conditions at animal hospitals
As of 2022, when the last veterinarian information was reported, there were 7,990 veterinarians active in clinical settings among all veterinarians, and it is known that about 80% of them are working in companion animal clinical settings. Therefore, the 71 veterinarians who responded to this survey were identified as approximately 1% of veterinarians working in companion animal clinical sites, and although it is difficult to discuss representativeness, it was judged to be a sample from which rough trends can be identified. Various types of veterinarians, from university hospitals to one-person hospitals, responded to the survey.
[사진 3] Prescription types of prescription drugs for treatment
What therapeutic medicines, other than anthelmintics and vaccines, are mainly used in front-line veterinary settings? We confirmed that the results were not significantly different from what was expected. Approximately 83% of all respondents answered that they grind and use human medicines. Even in those who responded that they use veterinary drugs, only about 3% of all responses answered that they prescribe the drugs as is. Subdivision of medicines on labels or labels may be permitted to some extent. However, grinding is clearly an extra label use.
Let’s look at the example of human pharmaceuticals. In pharmaceuticals for human use, standards for dividing tablets have been established in the form of FDA guidance (Guidance for Industry ‘Tablet Scoring: Nomenclature, Labeling, and data for evaluation’). There are various contents proposed in this guideline, but the main content is as follows.
1. Tablets that lose their function when divided, such as enteric-coated tablets and sustained-release tablets, cannot have a dividing line.
2. Divided tablets must be stable for 90 days at a temperature of 25 degrees Celsius and 60% humidity without desiccant.
3. When tablets are split by machine or by hand, each piece must maintain the same content.
4. Weight loss when splitting should be less than 3%.
In other words, the main content is that the stability of the drug must be maintained even after it is prescribed, and in particular, the weight and content must be tested in a scientific manner. Is it really possible to dispense medication while taking all of these details into consideration in clinical practice?
[사진 4] Inconveniences when preparing grinding
Veterinarians in clinical settings also had the same problem regarding grinding preparations. Only about 3% of the total responded that there was no particular inconvenience regarding the grinding preparation, and more than half of the respondents expressed concerns about the homogeneity, stability, and efficacy of the prescribed medicine.
These concerns have been studied.
This is a 2021 paper by Professor Seo Kyung-won’s team at Seoul National University that evaluated the content of the prescription drug trilostane, a treatment for adrenal dysfunction (J Vet Intern Med. 2021 Jun 10;35(4):1729–1732). In this paper, three clinicians mixed trilostane and other drugs together to produce 14 to 16 prescription medicine sachets each, and analyzed the trilostane content in each sachet through HPLC analysis, a commonly used method for analyzing the content of pharmaceuticals. was measured.
When the results were confirmed, only 18 (approximately 41%) of the 44 herbal medicines analyzed met the target content. In addition, of the three clinicians, two used a spatula for dispensing, and one used a semi-automatic dispenser, but the difference in content between each medicine packet was most severe in the semi-automatic dispenser. The three clinical trials included trilostane, but because they each consisted of different combinations of drugs, it could be reasonably predicted that the reactivity between drugs would have affected the content.
In other words, clinicians’ concerns about both content and safety were confirmed by actual data. In the background of this literature, it is written that Korea began research based on the need to prescribe higher doses of trilostane compared to other countries, and it can be inferred that grinding prescriptions are more frequent in Korea’s clinical environment compared to other countries. I could have done it.
[사진 5] Whether to use a dedicated device when grinding
Despite the identified issues, the survey also confirms that there is still a lot of room for improvement in the field.
Hormones including antibiotics, steroids, pimobendan, etc. must be used strictly, and if misused in animals without disease, they may cause harm due to unnecessary pharmacological effects. Nevertheless, approximately 87% of respondents responded that the drug grinding device was used regardless of specific drugs. In other words, there is ample room for cross-contamination of drugs that must be prescribed differently for each animal through dispensing equipment, etc.
[사진 6] Cleaning cycle of grinding equipment
In addition, when looking at the cleaning cycle when using instruments, only 16% of respondents said that they wash the instruments every time they are dispensed. About 3% of all responses even said that they do not clean the grinding equipment at all.
The biggest concern in the above usage situation is the problem of antibiotic resistance. According to a recently published paper (J Vet Sci. 2024 Sep;25(5):e67) by the research team of the Bacterial Disease Department of the Agriculture, Food and Rural Affairs Quarantine Headquarters, all carbapenem antibiotics used for severe infections among specimens isolated from domestic companion animals were found. Carbapenem resistance was confirmed in 0.13% of the samples, and other drugs commonly used in companion animals, such as fluoroquinolones, phenicol, and tetracycline, were identified in 0.13% of the samples. Resistant strains of antibiotics are also being identified. It is necessary to consider whether cross-contamination due to equipment used in dispensing is creating meaningless exposure to antibiotics and thus further encouraging the development of antibiotic-resistant bacteria.
The best way to resolve these concerns is to use veterinary medicines according to the dosage and directions, and to use them as is. The United States and Europe early recognized the importance of using veterinary medicines and are protecting animal health through strict regulations and policies in each country. The U.S. FDA recommends the use of antibiotics specifically for animals, pointing out the side effects and antibiotic resistance issues that can occur when human medicines are used on pets, and the European Union (EU) is also issuing similar guidelines.
In fact, the dispensing characteristics of domestic companion animal clinical sites are similar to those of human pediatric patients. The above problems in human medical practice have already been addressed in Korea in a contribution by Seoul National University Hospital in 1995 (J. KoreanSoc.Hosp.Pharm. 1995 Sep. 12(3):184–189), and standard dispensing Specific details such as method, prescription period to maintain stability, dosage form that is easy for children to take, preferred sweetener, taste and aroma have been discussed. It is time for such discussions to be held in companion animal clinical settings as well.
The bullet points mentioned recent pet owners. Guardians’ expectations are increasing, and veterinarians are also trying to provide a higher level of care accordingly. It is heartbreaking to see that the efficacy of the medicine prescribed after such efforts is diminished due to problems with the form in which it is prescribed.
(continued in part 2)
* **Given the concerns highlighted in the article about the safety and efficacy of ground veterinary medications, what specific actions can the Korean Veterinary Medical Association take to educate its members about best practices and promote the use of safer alternatives?**
This article raises important concerns about the practice of grinding veterinary medications in South Korea. Here are some open-ended questions organized thematically, designed to spark discussion and diverse opinions:
**I. Prevalence and Challenges of Grinding Medications**
* How common is the practice of grinding medications in your veterinary practice? What factors influence the decision to grind medication?
* What specific challenges do veterinarians and technicians encounter when preparing ground medications? How frequently do these challenges lead to inaccuracies in dosage or formulation?
**II. Safety and Efficacy Concerns**
* The article highlights concerns about homogeneity, stability, and efficacy of ground medications. What are your thoughts on these concerns? Have you personally encountered instances where grinding medications led to worrisome outcomes?
* The research cited in the article suggests potential cross-contamination risks associated with grinding equipment. What measures do you take to minimize these risks in your practice?
* Do you believe there are certain types of medications that are particularly unsuitable for grinding? Why or why not?
**III. Alternatives to Grinding and Best Practices**
* What are your preferred alternatives to grinding medications? What factors influence your choice of alternative?
* The article mentions that the United States and Europe have strict regulations regarding the use of veterinary medications. Do you believe South Korea could benefit from adopting similar guidelines? What specific changes would you propose?
* If a pet owner insists on a liquid or crushed medication, what steps would you take to ensure the animal receives the correct dosage and ensure the owner understands the potential risks?
**IV. Client Education and Communication**
* How do you communicate with pet owners about the potential challenges of grinding medications? What information do you share about alternative options?
* Do you believe pet owners fully understand the potential risks and benefits of grinding medications? How can veterinarians improve communication in this area?
**V. Future Directions**
* What further research is needed to fully assess the impact of grinding medications on animal health?
* What role can professional organizations like the Korean Veterinary Medical Association play in addressing these concerns and promoting best practices?
* Do you see a future where grinding medications becomes less common in veterinary medicine? What advancements or changes would be necessary to make this happen?
These questions aim to stimulate a thoughtful and nuanced discussion about the practice of grinding veterinary medications in South Korea. By encouraging diverse perspectives and honest reflection, we can work towards better practices that prioritize the health and well-being of companion animals.
