Preventing Worker Deaths and 

Injuries When Handling Micotil 300® 

Summary 

Livestock producers, veterinarians, and other workers 

may be exposed to the toxic 

hazardsofthe animalantibiotic 

Micotil 300® through needlestick injuries, skin cuts, puncture wounds, and contact with 

skin and mucous membranes. 

Cardiotoxic 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 

Exposure 

Tilmicosin 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 cattle [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 Micotil 300® between 

1992 and 2000 [Elanco 2002]. Thirteen confirmed Micotil 300®-associated human fatalities have been recorded worldwide since 1995, most 

associated with suicides [FDA 2006]. 

Case Studies 

The Nebraska Fatality Assessment 

and Control Evaluation Program (NE 

FACE) investigated two separate incidents involving unintentional injection of Micotil 300®. 

Case 1 

On 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]. 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Centers for Disease Control and Prevention 

National Institute for Occupational Safety and Health 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Case 2 

On 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]. 

Controls 

Workers 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 

■	 Consider prescribing animal medications that do not 

have toxic effects on humans. 

■	 Do not administer Micotil 300® if animals cannot be 

restrained in an appropriate restraint, or if there is 

concern over operator skill. 

■	 Using the client information sheet attached to each 

bottle of Micotil 300®, verbally review Elanco’s revised user safety warnings with each purchaser. Use 

a co-signed Micotil 300® Client Dispensing Information form [Elanco 2006] to document that each purchaser understands that Micotil 300® has been fatal 

to humans. This form details the hazards associated 

with Micotil 300® and identifies safe administration 

methods, appropriate first aid treatment, and emergency phone numbers. 

■	 Provide guidance to purchasers on proper equipment 

for administration. Multiple dose dispensers are available and include specific handling instructions. 

Employers 

■	 Store Micotil 300® in a safe location that is not readily accessible by untrained persons. 

■	 Train workers assigned to handle Micotil 300® by using 

training videos, DVDs, laminated dosage sheets, material safety data sheets (MSDS), client information sheet, 

and safe handling cards. To obtain these materials, call 

Elanco at 1–800–428–4441 or visit Elanco’s Web site at 

www.elanco.com. 

■	 Ensure that proper handling procedures for Micotil 

300® are available at the worksite and are reviewed by 

all workers before they handle this drug. These procedures should be written in the primary language(s) 

of drug handlers and at their reading level. 

■	 Provide a means to adequately restrain animals during treatment. An animal that is adequately restrained 

will not be able to move in an unpredictable manner. 

Work with a veterinarian to determine what adequate 

restraint means for the particular operation. 

■	 Provide a sharps disposal container for safe handling 

and disposal of syringes and needles, and goggles and 

impermeable, needle-puncture-resistant gloves for personal protection. 

■	 Ensure that only persons trained in the hazards of Micotil 300® and safe handling procedures are allowed to 

handle this drug and that workers do not work alone 

while handling or injecting the drug. 

■	 Ensure that coldpacks and icepacks are available at 

the workplace where injections will be given. 

■	 Ensure that telephones are available to workers. Post 

the following telephone numbers in visible locations 

such as near the office, barn, and house telephones: 

—	 Emergency Medical Services 

911 or dial 0 (operator) and report the emergency and specific location 

—	 Rocky Mountain Poison Control and Drug Center 

1–800–332–3073 (This center has been trained 

by the drug manufacturer to handle emergencies 

specific to Micotil 300® exposure in both English 

and Spanish) 

—	 Elanco: 1–800–722–0987, medical emergency 

hotline; 1–800–428–4441 (English only) 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Workers ■	 Identify a useable exit route in case the animal breaks 

out of the restraint. 

Drug handling and preparation 

■	 Read, understand, and follow all directions located on 

the label and on the client information sheet that is 

provided with each bottle of Micotil 300®. 

■	 Wear goggles and impermeable, needle-punctureresistant gloves, and wash hands after handling. 

■	 Never work alone when handling or injecting Micotil 

300®. 

■	 Fill syringes in an area restricted for that purpose alone 

(preparation room). Never allow children in this area. 

■	 Do not smoke, eat, drink, or store food in the resticted area. 

■	 Never use automatically powered syringes. 

■	 Never fill one syringe with medication for injecting 

several animals. Use a separate syringe for each animal. If provided with a multiple dose dispenser, ask 

employer for specific handling instructions. 

■	 Always use a 16- to 18-gauge needle that is 1/2 inch 

to 5/8 inches long. 

■	 Keep a protective cover on needles until ready for use. 

■	 Place filled syringes in a puncture-proof carrying case 

before moving to the animal’s location. 

■	 Never place or carry a loaded syringe in a pocket, other clothing, or in the mouth. 

■	 Clean up spills immediately. 

■	 Call one of the emergency contact numbers if an exposure occurs, apply ice, proceed immediately to a 

hospital emergency room, or call 911 for emergency 

transport. 

Injection of livestock 

■	 Keep children and bystanders out of the area where 

Micotil 300® is to be given. 

■	 Wear goggles and impermeable, needle-punctureresistant gloves, and wash hands after handling. 

■	 Evaluate the animal to be injected as well as the animal’s surroundings to determine whether it is safe to 

give the drug. 

■	 Do not give the drug to an animal that cannot be adequately restrained. 

■	 Restrain animals in a restraint that the employer, in 

consultation with the veterinarian, has determined is 

adequate for the operation. 

■	 Inject Micotil 300® by holding the syringe in one hand 

while inserting the needle subcutaneously and at a 

top-down angle. Avoid penetrating the animal’s underlying muscle. 

■	 Do not replace the protective cap over the needle of 

the syringe after use. 

■	 Immediately after use, place the syringe with needle 

attached in a puncture-proof sharps disposal container. Return the disposal container to the preparation 

area for final disposal. 

Acknowledgments 

The 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 

Elanco [2002]. Timeline, an Elanco publication for veterinarians. Greenfield, IN: Issue no. 3, Winter 2002. 

Elanco [2006]. Micotil 300® client dispensing information. Greenfield, IN: Elanco Animal Health, Form No. 

AI9910. 

FDA [2006]. Unpublished FDA analysis of Center for 

Veterinary Medicine adverse drug event data base. 

Washington, DC: U.S. Food and Drug Administration, 

Center for Veterinary Medicine. 

Nebraska Department of Labor [2003]. Cattleman dies 

due to accidental injection. Omaha, NE: Nebraska Department of Labor, Nebraska Fatality Assessment and 

Control Evaluation Program (NE FACE) Report No. 

03NE004. 

Nebraska Department of Labor [2005]. Cattle rancher 

hospitalized after accidental injection of Micotil. Omaha, NE: Nebraska Department of Labor, Nebraska Fatality Assessment and Control Evaluation Program 

(NE FACE) Report No. 04NE99. 

USDA [2004]. 2002 Census of Agriculture: United 

States summary and State data. Volume 1. Geographical Area Series. Part S1. Washington, DC: U.S. Department of Agriculture, Agricultural Statistics Service, Report AL–02–4–51. 
 

 

 

 

 

 

 

 

 

For More Information 

For 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 

4676 Columbia Parkway 

Cincinnati, OH 45226–1998 

Telephone: 1–800–35–NIOSH (1–800–356–4674) 

Fax: 513–533–8573 ■ Email: pubstaft@cdc.gov 

or visit the NIOSH Web site at www.cdc.gov/niosh 

Preventing Worker Deaths and Injuries When 

Handling Micotil 300® 

For a monthly update on news at NIOSH, subscribe to 

NIOSH eNews by visiting www.cdc.gov/niosh/eNews. 

Mention of any company or product does not constitute endorsement by NIOSH. In addition, citations to Web sites external to NIOSH do not constitute NIOSH endorsement of 

the sponsoring organizations or their programs or products. 

Futhermore, NIOSH is not responsible for the content of 

these Web sites. 

This document is in the public domain and may be freely copied or reprinted. NIOSH encourages all readers of 

the Workplace Solutions to make them available to all 

interested employers and workers. 

As part of the Centers for Disease Control and Prevention, 

NIOSH is the Federal agency responsible for conducting research and making recommendations for preventing workrelated illnesses and injuries. All Workplace Solutions are 

based on research studies that show how worker exposures to 

hazardous agents or activities can be significantly reduced. 

DHHS (NIOSH) Publication No. 2007–124 

Safer · Healthier · PeopleTM April 2007 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Centers for Disease Control and Prevention 

National Institute for Occupational Safety and Health 

4676 Columbia Parkway 

Cincinnati, OH 45226–1998