AUSTRALIAN VETERINARY PRESCRIBING DOGS & CATS
Transcript of AUSTRALIAN VETERINARY PRESCRIBING DOGS & CATS
DENTALSURGERY
ACUTEGASTROENTERITIS
PYODERMA
ACUTEHAEMORRHAGICDIARRHOEA
DIAGNOSTICSCytologicalevaluationisneededtoidentifytheexistenceofabacterialpyoderma
• Adhesivetape,directsmearorFNA(pustulesornodules)Cultureandsusceptibilitytestingstronglyencouragedwhen:
• Rodsarepresentoncytology• Lackofresponsetoantimicrobialtherapy• Newlesionsdevelopduringtreatment• Chronicorrecurrentpyoderma• Recommendedinallcasesofbacterialpyodermainwhichsystemic
antimicrobialsarebeingconsideredConsiderunderlyingdisease
TREATMENTSurface,superficial,andlocaliseddeeppyoderma
FIRSTLINEtopicalshampootreatment,allowcontactwithskinfor5-10mins
Systemicantimicrobials– incaseswherelargeareasofbodyaffectedorwhenhairfolliclesandsurroundingskininvolved:1st generationcephalosporinsoramoxycillin/clavulanate
CLINICPOLICYFIRSTLINE:_________________________________________________________________________
SECONDLINE:_______________________________________________________________________
3CATEGORIES1. Mildbloodydiarrhoea,normovolaemic andsystemicallywell2. Severebloodydiarrhoeawithhypovolaemiabutnotseptic3. Severebloodydiarrhoeawithhypovolaemiaandsepsis
FIRSTLINE Group1:noantimicrobialsGroup2:fluidtherapyandmonitorforsepsisGroup3:fluidtherapyandparenteralantimicrobials:
Amoxycillin&gentamicin&metronidazoleCLINICPOLICYGROUP1:____________________________________________________________________________
GROUP2:____________________________________________________________________________
GROUP3:____________________________________________________________________________
DOGS & CATSLOWERURINARYTRACTDISEASE
DIAGNOSTICSHistory,clinicalpresentation&cytologyCultureandsusceptibilitytestingrecommendedwhen:
Lackofresponsetoantimicrobialtherapy*Ifdoesn’trespondconsiderunderlyingdisease
TREATMENTFIRSTLINEDraining&flushingalone
Systemicantimicrobialsonlywhen:SystemicallyunwellDiffusetissueinvolvementPotentialjointinvolvementImmunosuppressedpatient
Amoxycillinorampicillinfor5-10days
CLINICPOLICYFIRSTLINE:_________________________________________________________________________
SECONDLINE:______________________________________________________________________
DIAGNOSTICSUrinalysisandcytologicalevaluationofstainedandunstainedurinesedimentCultureandsusceptibilitytestingrecommendedinallcases
• CollectviacystocentesisIfcomplicated,considerunderlyingdisease
TREATMENTREMEMBERinYOUNGCATSveryfewwithurinarytractsignswill
havebacterialcystitisinOLDERCATSwithpredisposingdiseasesonly10-22%will
havebacterialcystitisIDIOPATHICCYSTITISOFCATS:noantimicrobialtherapyUNCOMPLICATEDINDOGSANDCATS:amoxycillinor
trimethoprim/sulphonamideor1st generationcephalosporin(pendingcultureandsusceptibilitytesting)
Durationoftherapy:5-7daysUrinecultureshouldbeperformed7daysaftercessationoftreatmenttoconfirmsuccessandcheckforrecurrence
COMPLICATEDINDOGSANDCATS:amoxycillinortrimethoprim/sulphonamide(pendingcultureandsusceptibilitytesting)
Durationoftherapy:2-4weeksUrinecultureshouldbeperformedat5-7dayintervalsSideeffectscanoccurwithlongtermtrimethoprim/sulphonamideNoevidencetosupportuseofantimicrobialsbefore,duringorafterremovalofanindwellingurinarycatheterindogsorcats.Studiessuggestthismaypromoteresistance.Cultureurinebeforestartingtreatment
CLINICPOLICYFIRSTLINE:_______________________________________________________________________
SECONDLINE:_____________________________________________________________________
CELLULITIS,ABSCESS&TRAUMATICWOUNDS
CLEAN SURGERY,NOMITIGATINGFACTORSFIRSTLINENONEMITIGATINGFACTORS:amoxycillin/clavulanateor1st generation
cephalosporinMITIGATINGFACTORS:• Hypotension• Surgicalduration>90mins• Obesedogs• Endocrinedisorder• Bacterialdermatitis• Surgeryinvolvesimplant
Durationoftherapy:stopwithin24hours(exceptdermatitis[treatuntilcured]andimplants[7days])
CLEANCONTAMINATEDSURGERYFIRSTLINE amoxycillinor1st generationcephalosporin
Durationoftherapy:stopwithin24hours
CONTAMINATEDSURGERY (PYOMETRA,PROSTATICABSCESS,SIGNIFICANTBOWELLEAKAGE
FIRSTLINE amoxycillinor1st generationcephalosporinandmetronidazole
Durationoftherapy:noevidence,24-48hoursiscommoninhumanmedicine
CONTAMINATEDSURGERY:useantimicrobialappropriateforinfectionandtreatuntilcured
TIMINGIVantimicrobials:30-60minspriortosurgery,repeatcefazolin;every4hours,amoxycillin;every2hours.
SCamoxycillin/clavulanate:2hourspriortosurgery
CLINICPOLICYCLEAN:_________________________________________________________________________________________
CLEANCONTAMINATED:___________________________________________________________________
CONTAMINATED:____________________________________________________________________________
ROUTINEDENTALSNOANTIMICROBIALS
DENTALSWITHEXTRACTIONS:Bacteraemiaexpectedforapproximately20minsProphylacticantimicrobialsonlyinpatientsthatcannottoleratetransientbacteraemia(~20mins).Recommendedfor:
• Immunosuppressed• Geriatrics• Patientswithheartdisease• PatientswithsystemicillnessFIRSTLINEamoxycillinIVorIM30minspriortosurgery
Durationoftherapy:onedoseonlyor2nddose6hourslater
CLINICPOLICYFIRSTLINE:____________________________________________________________________________________
SECONDLINE:_________________________________________________________________________________
SURGERY
PNEUMONIADIAGNOSTICSTrachealwashforcytologyandculture&susceptibilitytestingisstronglyrecommendedpriortoantimicrobialtherapy.ConsiderunderlyingdiseaseprocessthatpredisposedtopneumoniaConsultwithmicrobiologisttointerpretingresults(airwaycontaminantspossible)
TREATMENTFIRSTLINE Mild:doxycycline
Mildaspiration:notreatmentoramoxycillinor1stgenerationcephalosporin
Pneumonia&sepsis:enrofloxacinandamoxycillinpendingcultureandsusceptibilityresults
Durationoftherapy:reviewafter10-14days
CLINICPOLICYMILD:_________________________________________________________________________________
MILDASPIRATION:_________________________________________________________________
PNEUMONIA&SEPSIS:_____________________________________________________________
DIAGNOSTICSCytologicalevaluationshouldalwaysbeperformedtoidentifypathogensandinflammatorycellsCultureandsusceptibilitytestingshouldbeperformedwhen:
• Rodsarepresentoncytology• Lackofresponsetoantimicrobialtherapy• Chronicotitis
Ensuretympanicmembraneisintact,earflushingunderGAmaybenecessaryCollectspecimensbeforeflushingIfrecurrentunderlyingdiseaseshouldbeinvestigated(foreignbody,atopy,anatomicalanomaly)
TREATMENTEarflushing(underGAifnecessary):warmsterilesalineundercontrolledpressure
FIRSTLINECoccionlyORcocci&rods:- Intacttympanicmembrane:earflushing,topicaltherapywith
fucidicacidandframycetincombinationorgentamicin
- Perforatedtympanicmembrane:earflushingandnon-ototoxiccleaners,avoidtopicalantimicrobials
Durationoftherapy:10-14daysRodsonly:- Intacttympanicmembrane:earflushing,topicaltherapywith
polymixinB,gentamicinormarbofloxacin
- Perforatedtympanicmembrane:earflushingandnon-ototoxiccleaners,avoidtopicalantimicrobials
Durationoftherapy:10-14daysSystemicantimicrobials– oftenineffectiveandusuallyonlyindicatedwhenmiddleorinnerearisinvolved.Basetherapyoncultureandsusceptibility.Non-ototoxicagents:chlorhexidine,Tris-EDTAOtotoxicagents:polymixinB,aminoglycosidesLessototoxicagents:fluoroquinolones(marbofloxacin,ciprofloxacin)
CLINICPOLICYFIRSTLINE:_______________________________________________________________________
SECONDLINE:_____________________________________________________________________
TREATMENT Antimicrobialsonlywhensignsofsepsisorconfirmationofspecificbacterialenteropathogens
FIRSTLINE NONESpecificbacterialenteropathogens:MetronidazoleSepsis:Amoxycillin+gentamicin+metronidazole
CLINICPOLICYFIRSTLINE:____________________________________________________________________________
SECONDLINE:_______________________________________________________________________________
OTITISEXTERNAUPPERRESPIRATORYDISEASEFELINERHINITIS≤10daysLimitedbenefitofcytologyorculture&susceptibilitytesting
Serousdischarge:NONEMucopurulentorpurulentbutsystemicallywell:noneMucopurulentorpurulentbutsystemicallyunwell:doxycycline
Durationoftherapy:7-10days
FELINERHINITIS>10daysAntimicrobialsshouldbeselectedbasedoncultureandsusceptibilitytestingNoevidencethat3rd generationcephalosporinsorfluoroquinolonesaremoreeffectivethandoxycyclineoramoxycillin.Durationoftherapy:1weekpastresolutionofclinicalsigns.
CLINICPOLICYACUTERHINITIS:__________________________________________________________________
CHRONICRHINITIS:_______________________________________________________________
CANINEINFECTIOUSRESPIRATORYDISEASECOMPLEXInterpretingcytologyandcultureandsusceptibilitytestingdifficult.
Noevidenceofpneumonia&clinicallywell:NONENoevidenceofpneumonia&clinicallyunwell:doxycyclineoramoxycillin7-10days
CLINICPOLICYFIRSTLINE:__________________________________________________________________________
SECONDLINE:_______________________________________________________________________
AUSTRALIANVETERINARY
PRESCRIBING GUIDELINES
FORMOREINFORMATION:www.fvas.unimelb.edu.au/vetantibiotics