Each intramammary syringe of 3g contains:

Active Ingredients:
Amoxicillin (as Amoxicillin trihydrate)	200 mg
Clavulanic acid (as Potassium clavulanate)	50 mg
Prednisolone	10 mg
Excipients:
For a full list of excipients, see section Pharmaceutical Particulars

Intramammary suspension.

Cream to buff oily suspension.

Cattle (lactating cows).

For the treatment of clinical mastitis caused by the following bacteria susceptible to the combination of amoxicillin and clavulanic acid:

Do not use in cases of hypersensitivity to the active substances, or to any of the excipients.

Do not use in cases associated with Pseudomonas

Swab teat end before treatment, with cleaning towels provided.

The product should be used for treatment of clinical mastitis only.

Use of the product should be based on susceptibility testing of the bacteria isolated from the animal. If this is not possible, therapy should be based on local (regional, farm level) epidemiological information about susceptibility of the target bacteria.

Official, national and regional antimicrobial policies should be taken into account when the product is used.

The combination of amoxicillin and clavulanic acid should be reserved for the treatment of clinical conditions which have responded poorly, or are expected to respond poorly, to other classes of antimicrobials.

Avoid use of the product in herds where no β-lactamase producing staphylococci strains have been isolated. E.coli mastitis with mild to moderate clinical signs, a non-antimicrobial approach should be the first option. Veterinarians should strive to use narrow spectrum antibiotics if possible. Inappropriate use of the product may increase the prevalence of bacteria resistant to β-lactam antibiotics and may decrease the effectiveness of treatment with β-lactam antibiotics, due to the potential for cross-resistance. Most of the ESBLs and AmpC β-lactamases producing E.coli strains may not be inhibited by the combination of amoxicillin/clavulanic acid.

The feeding of waste milk containing residues of antibiotics to calves should be avoided up to the end of the milk withdrawal period, except during colostral phase, because it could select antimicrobial resistant bacteria within the intestinal microbiota of the calf and increase the faecal shedding of these bacteria.

This product may cause skin and eye irritation. Avoid contact with the skin and eyes. In the event of skin or eye contact rinse with plenty of clean water.

The cleaning towels supplied with the product contain isopropyl alcohol, which many cause skin or eye irritation in some people.

The wearing of gloves is recommended during administration of the product and when handling the cleaning towels.

Penicillins and cephalosporins may cause hypersensitivity (allergy) following injection, inhalation, ingestion, or skin contact.

Hypersensitivity to penicillins may lead to cross reactions to cephalosporins and vice versa. Allergic reactions to these substances may occasionally be serious.

Do not handle this product if you know you are sensitised, or if you have been advised not to work with such preparations.

Handle this product with great care to avoid exposure, taking all recommended precautions.

If you develop symptoms following exposure such as a skin rash, you should seek medical advice and show the doctor this warning.

Swelling of the face, lips or eyes or difficulty with breathing, are more serious symptoms and require urgent medical attention.

Wash hands after use.

Due to the endocrine-disrupting potential of prednisolone, the product may be dangerous to fish and other aquatic organisms. Consequently treated animals should not have access to watercourses during the first 12 hours after treatment.

In very rare cases, immediate hypersensitivity reactions may occur (less than 1 animal in 10,000 animals treated, including isolated reports).

No special precautions

None known

Intramammary use.

The syringe must only be used once. Partly emptied syringes due to the unsuccessful use should be discarded.

The content of one syringe should be infused gently into the teat of the infected quarter every 12 hours after each of three consecutive milkings.

Milk out the infected quarters. After thoroughly cleaning and disinfecting the teat and teat orifice with the cleaning towels provided, gently infuse the contents of one syringe into each affected quarter. Disperse the product by gentle massage of the teat and udder of the affected animal.

In cases of infections caused by Staphylococcus aureus, a longer course of antibacterial therapy may be required. Therefore overall treatment length must be at the veterinarian’s discretion but should be long enough to ensure complete resolution of intramammary infection.

Combined therapy for the treatment of bovine mastitis. In the situation where systemic treatment as well as intramammary treatment is necessary, especially in cases of serious clinical mastitis Combiclav Injection can be administered in combination with this product.

For Combined Therapy the following minimum treatment regime should be followed:

Potentiated Penicillin Injection		Potentiated Penicillin Intramammary Suspension for Lactating Cows
Intramuscular injection at a dose rate of 8.75 mg/kg bodyweight (7,0 amoxicillin and 1,75 mg clavulanic acid) which corresponds to 1 ml of product/20 kg bodyweight daily for 3 days as follows: 8.75 mg/kg bodyweight (7.0 mg amoxicillin, 1.75 mg clavulanic acid) i.e. 1 ml/20 kg bodyweight		The content of one syringe should be infused gently into the teat of the infected quarter every 12 hours after each of three consecutive milkings as follows: One syringe gently infused into the teat of the infected quarter
24 hours		12 hours
8.75 mg/kg bodyweight (7.0 mg amoxicillin, 1.75 mg clavulanic acid) i.e. 1 ml/20 kg bodyweight.		One syringe gently infused into the teat of the infected quarter
24 hours		12 hours
8.75 mg/kg bodyweight (7.0 mg amoxicillin, 1.75 mg clavulanic acid) i.e. 1 ml/20 kg bodyweight.		One syringe gently infused into the teat of the infected quarter
Where necessary Potentiated Penicillin Injection may be administered for an additional two days for a total of 5 daily injections.

No adverse reactions are to be expected from an accidental overdose

Meat & Offal: 7 days

Milk: 84 hours

When using this product and Combiclav Injection in combination:

Meat and offal: 42 days

Milk: 84 hours

From the last treatment of Combiclav Injection following the minimum posology regime.

Pharmacotherapeutic group: Antibacterials for intramammary use – antibacterials and corticosteroids

ATC Vet Code: QJ51RV01

Amoxicillin is a broad spectrum bactericidal β-lactam antibiotic. Clavulanic acid inactivates β-lactamases. This combination is effective against β-lactamase producing organisms.

Prednisolone is an anti-inflammatory corticosteroid.

In vitro, clavulanic acid and amoxicillin in combination are active against a wide range of clinically important bacteria including the following organisms which are commonly associated with bovine mastitis:

Staphylococci (including β-lactamase producing strains)

Streptococci (including S. agalactiae, S. dysgalactiae and S. uberis)

Escherichia coli (including β-lactamase producing strains)

The Minimum Inhibitory Concentrations (MICs) of these target organisms determined from samples collected in nine EU countries (namely Belgium, Czech Republic, Denmark, France, Germany, Italy, Netherlands, Spain, and the UK)1, show susceptibility to amoxicillin and clavulanic acid used in combination in accordance with the Clinical and Laboratory Standards Institute (CLSI) guidelines2 on breakpoints (Table 1 and 2).

Table 1: Minimum Inhibitory Concentrations (mg/L) of Amoxicillin/Clavulanic Acid against strains from mastitis in dairy cattle in nine EU countries

Table 2: Clinical Laboratory Standards Institute (CLSI) resistance breakpoints (mg/L) for target bacteria

1Antimicrobial susceptibility of mastitis pathogens isolated from diseased dairy cows across Europe: VetPath monitoring results, European society of clinical microbiology and infectious diseases (ECCMID), 2015.

2Clinical and Laboratory Standards Institute (2013). Approved standards- fourth edition, CLSI document VETO01-A4, Wayne, PA, USA.

3CNS – Coagulase Negative Staphylococci

The mechanisms underlying antimicrobial resistance in Streptococcus can be acquired through the mutation of intrinsic genes or horizontal exchange of genetic material encoding resistance determinants. Mastitic strains of E. coli and Staphylococcus, are known to acquire resistance through horizontal gene transfer and bacteriophages/plasmid transfer, and also through their ability to form a biofilm.

Acquired resistance prevalence in particular to be high in E. coli. In some strains of Staphylococcus aureus (methicillin-resistant S. aureus, MRSA), and of Staphylococcus pseudintermedius, resistance to all β-lactams is conferred by the alteration of the cell wall target proteins (penicillin-binding proteins). This is often associated with resistance to multiple other antimicrobial compounds with cross resistance.

Mastitic strains of E. coli and Staphylococcus are known to acquire resistance through horizontal gene transfer and bacteriophages/plasmid transfer, and also through their own ability to form a biofilm.

It has been documented that the pharmacokinetic characteristics of penicillins (including amoxicillin) after intramammary administration indicate rapid elimination of the drug from milk. The mean residence time has a several-fold lower value than the designated elimination half-life and amounts to only 3.4 h. The concentration of the drug in the milk drop relatively quickly and the process is very dynamic.

Not applicable.

Shelf life of the veterinary medicinal product as packaged for sale: 2 Year

Do not store above 25°C.
Store in a dry place.

Single dose 3g white LDPE syringes with a white LDPE dual push-fit cap.

Cartons of 3, 12, and 24 syringes, or buckets of 120 syringes including 3, 12, 24, or 120 individually wrapped teat cleaning towels containing isopropyl alcohol.

Not all pack sizes may be marketed.

Extremely dangerous for fish and aquatic life. Do not contaminate ponds, waterways or ditches with the product or used container.

Any unused veterinary medicinal product or waste materials derived from such veterinary medicinal products should be disposed of in accordance with local requirements.

Norbrook Laboratories Limited, Station Works, Camlough Road, Newry, Co. Down, BT35 6JP Northern Ireland

3rd October 2018

March 2023

Nil.