Microsoft word - sava biennual f10 manuscript.doc

F10 : AN ALTERNATIVE LOCALISED THERAPY WITH EXTENDED CLINICAL APPLICATION
Le Roux FE, BVSc hons (Pret), Pfizer Animal Health, 102 Rivonia Road Sandton 2146,
ABSTRACT:

F10 is a complete spectrum virucidal, bactericidal, fungicidal and sporicidal, but aldehyde free compound of
six main synergistic active ingredients with long term stability characteristics. It drew veterinary attention as it not only outperformed other disinfectants, but it did so at extremely low concentrations, short contact times, without any corrosive effects on infrastructure, metal alloy nozzles or any tissue irritation on workers and animals. Due to this combination of characteristics, it is now feasible to regularly disinfect animal environments in their presence as a standard practice, with absolutely no negative side effects. The fact that “surface disinfection” can now be extended to include mucosal and skin surfaces in living animals, have created many exciting opportunities to develop protocols where F10 usage significantly lower the infectious challenge level (mucosae, wounds, skin etc). Amongst other applications F10 has proved beneficial in the management of upper and lower respiratory tract disease when administered as a localised therapy. Correct antibiotic usage reach target organisms inside the infected tissues and in conjunction with supportive therapy, achieve therapeutic successes even in notoriously difficult cases. The use of F10 in clinical cases will however never replace appropriate antibiotic therapy, but should be seen as the perfect combination with these to achieve the desired synergistic effects.
KEY WORDS:

F10, complete spectrum disinfectant, no negative side effects, mucosal and skin surfaces in living animals,

INTRODUCTION:

F10, a complete spectrum virucidal, bactericidal, fungicidal and sporicidal, but aldehyde free compound of six
main synergistic active ingredients was formulated in the UK for disinfection within pharmaceutical manufacture plants, particularly aseptic fill areas (intravenous catheters etc). Manufacture started in South Africa in 1994 and since then F10 has been tested against every significant/index animal/human pathogen. It is used in animal production and food manufacture as well as pharmaceutical manufacturing. In these environments, where microorganisms attach to surfaces and develop biofilms (microcolonies of bacterial
cells encased in an extra cellular polymeric substance) that affect product shelf life or even consumer health, only the highest disinfection and safety standards are acceptable. The product is very stable, both performance and chemical stability has been proven over many months when in diluted solution and over The ingredients are comprised of a new Quaternary Ammonium Compound (QAC) plus a new Biguanidine Complex; it is classified by Registration Authorities as such, but the exact formula remains for obvious reasons a commercial secret. It drew veterinary attention as it not only outperformed other disinfectants available during efficacy testing, over a range of temperatures (10 • C – 60 • C) and in the presence of moderate organic material, but it did so at extremely low concentrations, short contact times, without any corrosive effects on infrastructure, metal alloy nozzles or any tissue irritation on workers and animals. Due to this combination of characteristics, it is now feasible to regularly disinfect environments in the presence of the animals as a standard practice, lowering the environmental pathogen challenge significantly, with
absolutely no negative side effects to man or animal. In addition “surface disinfection” can now be
extended to include mucosal and skin surfaces in living animals, as part of an integrated treatment protocol. Amongst other applications F10 has proved beneficial an aid in the management of upper and lower respiratory tract disease when administered as a localised therapy.
CLINICAL USES:

The combination of F10 characteristics have created many exciting opportunities to develop integrated
treatment protocols where F10 usage significantly lower the levels of challenge from infectious organisms (mucosae, wounds, skin etc), correct antibiotic usage reach target organisms inside the infected tissues and in conjunction with supportive therapy, achieve therapeutic successes even in notoriously difficult cases.
Note that the use of F10 in clinical cases will never take the place of appropriate antibiotic therapy or
where relevant immunomodulation (through vaccination and/or immunostimulation), but should be
seen as the perfect combination with these to achieve the desired synergistic effects.
The following examples from literature and the Bird-and Exotic Clinic at Onderstepoort il ustrate this principle, and will hopefully stimulate even more, imaginative uses (* F10 Products other than F10SC Veterinary • Birds: sinusitis, air-saccullitis, Newcastle Disease Virus outbreaks, wounds, [Fogging, irrigation]
Respiratory disease is commonly seen in avian practice, including sinusitis, rhinoliths and air-
sacculitis. Therapy of these conditions usually involves drugs given systemically or by nebulisation. F10 has been used as a sinus flush for sinusitis (generally with no requirement for systemic therapy) and nebulised in lower respiratory disease.7 It appears safe and efficacious against aspergillosis in • Reptiles: skin & oral cavity infections, wounds, sinusitis [Fogging, irrigation, Barrier Ointment*]
Respiratory disease is commonly seen in reptiles. This may take the form of upper respiratory tract disease (URTD) or lower (LRTD). Both forms are seen commonly in chelonians while snakes are • Cats: sinusitis (“Snuffles”), abscesses, wounds, dermatophytoses [Fogging, irrigation, Shampoo*]
• Dogs: Sinusitis-tracheïtis (“Kennel Cough”), pyothorax, traumatic rupture of intestines, pyometra,
dermatophytoses, pododermatitis, wounds [Irrigation, large volume lavage, instillation, Shampoo*, • Cattle, sheep, antelopes, horses, camels: Pyometra, mastitis, dermatophytosis, wounds [Lavage,
irrigation, Udder Wash*, Teat Spray with Glycerine &/ Lanolin &/ Vit E *, Shampoo*, Barrier
SINUS FLUSH
Sinus flushing is very effective for treatment of URTD. A simple technique is described by Forbes (1996)5 In this technique a dilute solution of enrofloxacin is used. Naturally this is only effective for bacterial infections sensitive to this drug, and the description states that this is the drug of choice prior to culture/ sensitivity results. It is also important that underlying causes are addressed (hypovitaminosis A, airborne irritants/ Use of a 1:250 or 1:500 dilution of F10 Superconcentrate has resulted in resolution of URTD caused by bacteria and fungi, often without the need for systemic antimicrobial therapy. It has been especial y useful after rhinolith removal, where twice-weekly sinus flushing with F10 SC has been used without systemic therapy. Several of these cases in Grey parrots have been caused by infection with
FOGGING/NEBULISATION:
The delivery of antibiotics or antifungal drugs by aerosol to affected patients has been tried many times, usually with disappointing results. This has been related to the extremely irritating nature of most antifungal agents, causing severe erosive lesions on the sensitive mucosal surfaces of the respiratory system, thus defeating the objective. Alternative explanations of such therapeutic failures usually focus on the physical nature of micro droplets needed to penetrate to the furthest recesses and diverticulae of the airsac system. Recommended optimal sizes usually vary between 5-10 microns, necessitating the use of “nebulising“ systems. The practical realities of treatments in clinics, hospitals and farming environments dictate a Commercial “Foggers” can be used, suitable for the disinfection of rooms, incubators hospital wards, etc, that produce a wide range of micro droplet sizes and rapidly create a “standing fog “ under any environmental conditions. This system of aerosol delivery using very low concentrations of F10, has also been used to treat, as well as prevent, a wide range of respiratory conditions in many species. Particularly respiratory conditions in poultry & ostriches (including prevention of Newcastle Disease Virus transmission during outbreaks in the former and complicated fungal airsacculitis in the latter) and exotic birds (including falcons)
EXAMPLES
• Individual patients have been treated in home-made Perspex boxes fitted with human nebulisers for 20-30 minutes at a time, 2-3 times a day, with a solution containing 0.2 % (1:500) to 0.4% (1:250) F10 Superconcentrate. Larger numbers of birds, especially if hooded (falcons) or otherwise kept in the dark, have been treated by this “ cold fogging” (in contrast to hot/steam fogging as commonly used in the disinfection of abattoirs) with commercial portable Foggers in designated rooms. Air-conditioners are switched off for the 30-40 minutes needed to empty the 5 litre container of the model used, once or twice a day4. • Gyrfalcons undergoing predictable stress periods (initial manning/training, returning from initial training in the desert) have undergone this treatment during the 1999/2000 season in Dubai, with no side- effects, and none of the usual previous pattern of falcons sick or dying from aspergil osis. Early diagnosed cases have made remarkably quick recoveries with this treatment regime, but advanced cases, especially those from Russia, seemed to be beyond any recovery4. • 10ml of a 1:250 dilution F10 Superconcentrate is nebulised over 20-30 minutes three times daily. Nebulization is used as part of a combined therapy in these cases. It has proven of great use in treating aspergillosis in Grey parrots in combination with oral terbinafine. This combination, used over 3-4 months has resulted in clinical cure in several birds. Nebulized F10 has been very well tolerated by patients. It is also non-corrosive to metal or plastic and non-irritant to tissues.1 These properties, alongside its broad spectrum of antimicrobial activity make it an ideal agent to nebulize2. In the author of this paper’s practice all birds presenting with signs of respiratory disease are nebulized with F10 as part of the initial stabilization prior to diagnostic investigation. Nebulization will be continued using the protocol described above as part of any antimicrobial • Psittacine beak and feather disease (PBFD) is caused by a circovirus and can infect most species of psitticine birds. The virus affects rapidly growing cells in young birds. Interferon in combination with F10 nebulisation was found to be a potential treatment for PBFD in approximately 25% of cases.6,7 The study continues but at the time of publication no new cases have been reported in the author of this reference’s practice. INTRA-TRACHEAL
Following endoscopic removal of syringeal aspergillomata, flushing of the operation site with a 1:250 dilution of F10 Superconcentrate has been performed. Follow-up therapy involving systemic anti-fungal drugs and F10 nebulization has resulted in clinical cure2.
ADVERSE REACTIONS
Using dilutions of 1:250 and 1:500 of F10 Superconcentrate no adverse reactions have been reported with any of the above techniques. Only one situation described: A Indian Ring-necked parakeet (Psittacula krameri) had swelling of the head and respiratory distress after sinus flushing with a 1:50 dilution of F10 Superconcentrate. Symptoms quickly abated after re-flushing with a solution of 0.5mg betamethasone sodium phosphate (Betsolan Soluble) in 10ml sterile water for injection. The sinuses were flushed again a few days later using a correct dilution of 1:250 F10 and there were no adverse effects2.
NASAL FLUSH:

In cases of URTD in terrestrial chelonians F10 Superconcentrate has been used at a concentration of 1:250
as a nasal flush. 0.1ml is used in each nostril daily. Environmental correction is used where indicated. Most cases resolve in a few days though some persist with a permanent clear discharge.3
NEBULISATION:

F10 Superconcentrate at a concentration of 1:250 is used once daily for 30-60 minutes in both snake and
chelonian LRTD. In general it is used as an adjunct to systemic antimicrobials though some snakes have
INTRA-PNEUMONIC:

In chelonian LRTD where there are focal pneumonic lesions, a hole is drilled in the carapace into the lesion.
F10 Superconcentrate (at 1:250 concentration) is given directly into the lesion (0.2ml once daily) and by daily nebulisation. Appropriate systemic anti-microbials are also given.3
BIOFILMS & SURFACES:

Surfaces in the animal production environment (poultry & pig houses, milking machines & bulk tanks etc) as
well as hospital and keeping cages in Vet Hospitals, Kennels and Catteries often develop a microfilm fatty layer under which pathogenic micro-organisms escape general surface washing/disinfection and therefore act as a reservoir population to infect the next batch of animals, patients, milk etc. Similar principles apply to the biofilms that coat the inside surfaces of water reticulation systems used in intensive animal production. Several primary pathogens associate and even grow in biofilms , including S.aureus, Listeria monocytogenes, Campylobacter spp , Salmonella typhimurium and Vibrio cholerae. Experimental evidence indicate that the normal biofilm flora in such water systems provide niche conditions capable of supporting the growth conditions of these organisms. This area of research is very dynamic and has indicated several possible mechanisms and characteristics that can be important in infectious disease • Detachment of cells or biofilm aggregates may result in bloodstream or urinary tract infections or in the production of emboli (e.g. with indwelling medical devices) • Cel s may exchange resistance plasmids within biofilms • Cel s in biofilms have dramatically reduced susceptibility to antimicrobial agents • Biofilm associated gram negative bacteria may produce endotoxins • Biofilms are resistant to host immune system clearance In such situations it can be extremely beneficial if the chosen disinfectant also has additional detergent properties (such as in the F10 SC XD formulation, however a two stage cleaning with a degreaser/detergent which is rinsed off and followed by the disinfectant application must be the preferred method in the case of
CONCLUSION:
Due to the combination of F10’s very favourable characteristics, the localised therapy and clinical applications of this product can real y be as varied as the clinician’s imagination.
It is also worth mentioning that the manufacturers of F10 have extended the range using the products core
actives and now included (all products are registered in terms of the South African Dept of Agriculture’s Act 36 of 1947): - F10SC Veterinary Disinfectant - F10SCXD Veterinary Disinfectant/Cleanser - F10 Germicidal Barrier Ointment (used successfully in bumble foot cases and on open - F10 Germicidial Shampoo (being used successfully in ringworm/ Dermatophytoses - F10 Udder wash and Teat Spray with Glycerine &/ Lanolin &/ Vit E
FURTHER READING:
Donlan R M (2002) Biofilms: Microbial Life on Surfaces. Emerging Infectious Diseases .Vol 8, No. 9 Sept

REFERENCES:
1. Verwoerd DJ Aerosol use of a novel disinfectant as part of an integrated approach to preventing and treating aspergil osis in falcons in the UAE. Falco. 2001; 17:15-18 2. Chitty JR 2002a A novel disinfectant in psittacine respiratory disease. Proc 23rd Ann. Conf. Expo. 3. Chitty JR 2002b Use of a new disinfectant agent in the management of upper respiratory tract disease in chelonia. Proc 45th Ann. Congr. Brit. Small Anim. Vet. Assoc.: 634 4. Verwoerd DJ F10:Clinical uses in an Avian Model with individual [Aspergillosis in Gyrfalcons] & population [Fungal & Bacterial airsaccullitis in ostriches] examples/case studies. British Veterinary Zoological Society Ann. Conf. Edinburgh 2001 5. Forbes NA Respiratory Problems. In: Beynon PH, Forbes NA, Lawton MPC. Shurdington, UK. 6. Stanford M Recombinant Omega Interferon in combination with F10 Nebulisation for the treatment and prevention of Circovirus Infection in African Grey Parrots Veterinary Record (2004) 154, 435-436 7. Stanford M Use of F10 in Psittacines Exotic DVM, vol 3.4 Aug/Sept 2001

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