Search NIOSH | NIOSH Home | NIOSH Topics | Site Index | Databases and Information Resources | NIOSH Products | Contact Us |
NIOSH Publication No. 2007-124:Preventing Worker Deaths and Injuries When Handling Micotil 300® |
April 2007 |
|
SummaryLivestock producers, veterinarians, and other workers may be exposed to the toxic hazards of the animal antibiotic Micotil 300® through needlestick injuries, skin cuts, puncture wounds, and contact with skin and mucous membranes. Cardio-toxic effects of Micotil 300® on the human heart, including a reduced cardiac contractility and tachycardia (rapid heart beat), can be severe enough to cause death. The National Institute for Occupational Safety and Health (NIOSH) recommends that extreme care be given to following safe drug handling and injection procedures to avoid the possibility of self injection. Although no antidote exists for Micotil 300®, exposed persons should seek immediate medical intervention as the drug’s cardiotoxic effects may be reversed. Description of ExposureTilmicosin phosphate, sold under the trade name Micotil 300®, is an animal antibiotic developed to treat “shipping fever,” a bovine and ovine respiratory disease. In the United States, veterinarians give Micotil 300® to animals, but more frequently prescribe it for their clients to use on cattle and sheep at livestock facilities. The 2002 Census of Agriculture reported 80,743 U.S. farms with cattle feed operations involving 14.9 million head of cat-tle [USDA 2004]. Thousands of workers on these farms could be exposed when they inject cattle with Micotil 300®. Elanco, the company that developed and produces Micotil 300®, received 2,392 reports of human exposures worldwide to Mi-cotil 300® between 1992 and 2000 [Elanco 2002]. Thirteen confirmed Micotil 300®-associated human fatalities have been re-corded worldwide since 1995, most associated with suicides [FDA 2006]. Case StudiesThe Nebraska Fatality Assessment and Control Evaluation Program (NE FACE) investigated two separate incidents involving unintentional injection of Micotil 300®. Case 1On March 8, 2003, a 38-year-old cattleman was preparing to inject Micotil 300® into a heifer secured in a squeeze chute inside a barn. The cattleman was carrying a 12-cc plastic disposable syringe in his right hand. The man was knocked to the ground when a cow in an adjacent pen charged, striking the fence panel. As a result of either the strike or the fall, the cattleman was injected with an unknown amount of the antibiotic. He immediately began to feel dizzy and nauseated. He was able to call for help, and his wife, in the house nearby, called an ambulance. The victim was rushed to a nearby hospital where he died an hour and a half later. The death certificate indicated the cause of death was respiratory failure as a consequence of cardiac arrest caused by a lethal injection [Nebraska Department of Labor 2003]. Case 2On November 16, 2004, a 41-year-old cattle rancher was preparing to inject two calves with Micotil 300® using a 20-cc plastic disposable syringe. The calves were in an outside lot squeeze chute. After injecting the first calf, the rancher placed the syringe in his mouth to hold it, freeing his hands to open the squeeze chute gate. At the same instant, the injected calf lunged forward, flinging open the end doors and causing the handle to strike the victim’s left hand, driving it backwards into the needle. The rancher was injected between his left thumb and first finger with 1 to 1.5 cc of Micotil 300®. He immediately felt a burning sensation at the injection site. Within a few minutes, he developed a severe ringing in his ears and felt as though his tongue and lips were swollen. He called out for help, and his wife called the Rocky Mountain Poison Control Center. They advised her to place ice on the injection site and immediately get her husband to an emergency room. As his condition worsened in the emergency department, he was airlifted to a regional medical center and treated in the intensive care unit for 2 days. After his condition stabilized, he was discharged [Nebraska Department of Labor 2005]. ControlsWorkers and employers should take the following steps to protect themselves and others when handling or administering Micotil 300®. In the case of human injection, consult a physician immediately and apply ice to the injection site. Transport the victim immediately to a hospital and call 1–800–722–0987 for further emergency information. Veterinarians
Employers
WorkersDrug handling and preparation
Injection of livestock
AcknowledgmentsThe principal contributors to this publication were Doloris Higgins, NIOSH Division of Safety Research; William Hetzler and Arthur Davis, Nebraska Workforce Development; Susanna Von Essen, MD, MPH, Nebraska Medical Center; Kelley Donham, DVM, MS, Professor and Associate Department Head for Agricultural Medicine, College of Public Health, University of Iowa, Great Plains Agricultural Center; Dan McChesney, Ph.D., FDA; Victoria Hampshire, VMD, FDA; John Baker, DVM, FDA. References
For More InformationFor more information about intervention after human exposure to injected Micotil 300®, contact Elanco Animal Health, a Division of Eli Lilly & Company: P.O. Box 707, 2001 W. Main St., Greenfield, IN 46140; telephone 1–800–722–0987. For Micotil 300® safe handling and use materials, visit the Elanco Web site at www.elanco.com. The information in this document is based on fatality investigations, literature, and expert review. More information about the Fatality Assessment and Control Evaluation Program is available at www.cdc.gov/niosh/face/. To receive documents or other information about occupational safety and health topics, contact NIOSH at: NIOSH—Publications Dissemination or visit the NIOSH Web site at www.cdc.gov/niosh/ For a monthly update on news at NIOSH, subscribe to NIOSH eNews by visiting www.cdc.gov/niosh/eNews/. DHHS (NIOSH) Publication No. 2007–124 April 2007 |
|
||||||||||||||