Antibacterial use in our practice The guardian(s) of this practice is/are:

Select which antibacterials your practice EYE INFECTIONS ORAL INFECTIONS RESPIRATORY INFECTIONS uses in the boxes below ADVERSE REACTIONS TO ANTIBACTERIALS Canine conjunctivitis: Consider chlorhexidine mouthwash Antibacterials are not indicated for: ■ Chronic bronchitis/allergic airway disease unless secondarily infected Culture essential to ensure e ective Fusidic acid This list is not comprehensive. Severe and periodontitis: ■ rescribe only when necessary Chlortetracycline Canine sino-nasal disease P therapy /clavulanate ■ Consider non-bacterial disease (e.g. viral infection, Treat for 5–7 days Metronidazole Canine infectious respiratory disease complex (Kennel Cough) and Feline Antimicrobial Adverse e ect At risk group Recommendation upper respiratory tract infection (Cat Flu): nutritional imbalance, metabolic disorders) Culture strongly advised to guide therapy Feline conjunctivitis: Clindamycin (if periodontal bone infections) ONLY if clinical signs present >10 days and/or systemically unwell Aminoglycosides Nephrotoxicity Dogs/cats with Avoid in at risk ■ Remember that some bacterial diseases will self-resolve (where possible) pre-existing animals or when close Chlortetracycline Ulcerative stomatitis: Doxycycline without antibacterials renal disease, monitoring is not Fusidic acid ■ O er a non-prescription form (see box bottom right) Use your smartphone and a QR code Metronidazole Amoxicillin/clavulanate volume or available reader to access extra information. Treat for 5–7 days Treat for 7–10 days electrolyte Do not exceed 7 days Alternatively visit: Feline-specifi c disease: Treat chronic cat fl u for 1 week beyond clinical plateau depletion treatment duration educe prophylaxis bsavalibrary.com/protectme Chlamydophila felis SKIN AND EAR INFECTIONS Monitor urine for casts R : Systemic doxycycline (amoxicillin/clavulanate in pregnant ■ Antibacterials are not indicated for: Amoxicillin/clavulanate Ototoxicity Cats Perioperative antibacterials are NOT a substitute for queens and kittens) ■ Malassezia dermatitis surgical asepsis Treat for 21–28 days For suspected Bordetella/Mycoplasma Amoxicillin/ Urticaria, hypotension Dogs under Caution with ■ Non-specifi c skin problems (e.g. pruritus) ■ Prophylactic antibacterials are only appropriate in some Doxycycline clavulanate Anaphylactoid reactions general intravenous use in Mycoplasma felis (intravenous use) anaesthesia anaesthetized patients immunocompromised patients GASTROINTESTINAL INFECTIONS Bites and traumatic wounds: Topical tetracycline If antibacterial exposure in preceding 4 weeks or if hospitalized for >48 hours Antibacterials are not indicated for: ■ Debride and lavage prior to onset of respiratory signs (i.e. hospital-acquired infection) Doxycycline or Oesophageal irritation ± Cats (>dogs) Ensure administration ■ If systemically well and not pyrexic:  er other options ■ Acute Uncomplicated corneal ulceration: Fluoroquinolone + clindamycin clindamycin stricture with food or water ■ Acute diarrhoea (including acute haemorrhagic cases) Topical chloramphenicol Topical treatment with 2–4% chlorhexidine O Treat for 4–6 weeks, based on C-reactive protein, or for 7–10 days beyond Enrofl oxacin Retinal degeneration Cats Alternative ■ Pancreatitis ■ If systemically unwell and pyrexic ■ Consider therapeutic alternatives (lavage and Complicated corneal ulceration (infectious radiographic resolution leading to partial, fl uoroquinolones ■ Most gastric Helicobacter infections keratitis): Systemic antibacterials based on cytology: temporary or total preferred in cats debridement of infected material, cough suppressants, ■ Most Campylobacter, Salmonella, Clostridium perfringens Topical chloramphenicol AND For cocci Pyothorax: blindness fl uid therapy, nutritional modifi cation) or C. di cile infections ■ Clindamycin Fluoroquinolone + amoxicillin (± clavulanate) Using topical preparations reduces selection pressure ■ Chronic diarrhoea (except as part of a treatment trial) Topical gentamicin Fluoroquinolones Defective cartilage Young dogs Avoid in growing Fluoroquinolone + clindamycin on resident intestinal fl ora (the microbiome) Topical ciprofl oxacin development leading to animals Acute diarrhoea with systemic signs indicating actual ■ Use e ective hygiene techniques and antiseptics to Topical ofl oxacin Amoxicillin/clavulanate Treat for 4–6 weeks (and beyond radiographic/ultrasonographic resolution) severe lameness prevent infections (or risk of) bacteraemia or sepsis: Treat until the corneal defect has re-epithelialized Trimethoprim/sulphonamide Suspected parvovirus Metronidazole Dose-dependent Dogs Caution with higher q4 hours for the fi rst 48 hours – reduced once the For rods neurotoxicity doses reat e ectively Amoxicillin/clavulanate destructive corneal process has stopped SURGICAL USE T If acute diarrhoea with systemic signs Consider systemic antibacterial if, e.g. ‘melting’, corneal Fluoroquinolones Immediate and delayed Dogs/cats Avoid in - Antibacterials are not indicated for: hypersensitivity reactions sensitive animals/ ■ Amoxicillin/clavulanate perforation, marked uveitis Consider which bacteria are likely to be involved Acute bite wound prophylaxis: ■ Clean (elective surgery, no entry into hollow viscus) surgical procedures owners ■ Consider drug penetration of the target site Cefalexin Orbital abscessation/bacterial : Thorough fl ushing with saline or ■ Prophylactic (perioperative) antibacterials are appropriate: Potentiated Keratoconjunctivitis sicca Dogs esp. Avoid in specifi ed Use the shortest e ective course and avoid underdosing Trial treatment of chronic diarrhoea/chronic enteropathy Amoxicillin/clavulanate 2–4% chlorhexidine ■ ■ For prolonged clean surgery (>90 minutes) or surgery involving an sulphonamides Hepatic necrosis (rare) Dobermanns, breeds Ensure compliance with appropriate formulation and (‘infl ammatory bowel disease’): Cefalexin and metronidazole Amoxicillin/clavulanate (for 7 days) provide clear instructions implant Immune complex Samoyeds Monitor Schirmer Tear Metronidazole Cefalexin and clindamycin Surface pyoderma (hot spots, intertrigo): ■ For all surgery involving entry into a hollow viscus (e.g. gastrointestinal reactions and Miniature Test before and during Tylosin Treat for 2 weeks ■ Topical treatment ONLY tract, urinary tract) (polyarthritis, anaemia, Schnauzers use thrombocytopenia) mploy narrow spectrum Oxytetracycline Attempt drainage via most appropriate route, usually via 2–4% chlorhexidine ■ Where there is an obvious break in asepsis causing contamination of E mouth the wound Prior to antibacterial trial, perform appropriate diagnostics Fusidic acid ± glucocorticoid ■ For all contaminated wounds or if there is a pre-existing infection ■ Unnecessarily broad-spectrum antibacterials could and consider other treatments including Giardia treatment, Silver sulphadiazine (if rods) ■ For debilitated or immunosuppressed patients promote antibacterial resistance dietary change or prednisolone trial. ■ Where infections would be catastrophic (e.g. in CNS) ■ The use of narrow-spectrum antibacterials limits e ects Trial antibacterial treatment should not exceed 3–4 weeks SYSTEMIC INFECTIONS Superfi cial pyoderma: on commensal bacteria ■ Topical treatment ONLY is appropriate In most cases Cholangitis/cholangiohepatitis: ■ Use culture results to support de-escalation (switching Neutropenia: 2–4% chlorhexidine Amoxicillin/clavulanate DO NOT USE Amoxicillin/clavulanate ■ Mild (neutrophil count >1000/µl) – antibacterial to a narrower spectrum antibacterial) If required: NOT required Antibacterials with restricted use in human medicine ■ Moderate (neutrophil count 500–999/µl) AND well Clindamycin Intravenously 60 minutes before the fi rst incision, then every 90 minutes (e.g. , linezolid, , ) Cefalexin until the end of surgery Cefalexin Cefalexin ulture appropriately Add metronidazole (dogs) Where anaerobic involvement is highly likely: should not be used in animals. C Amoxicillin/clavulanate Amoxicillin/clavulanate Treat for 2–4 weeks Add metronidazole ■ A sample for culture should be collected before starting Trimethoprim/sulphonamide Trimethoprim/sulphonamide ■ Culture if rods are seen on cytology Do not continue antibacterials after surgery, unless there is a therapeutic antibacterial therapy wherever possible Treat for 5–7 days ■ or there is a history of MRSP/MRSA indication as this will select for resistance Culture is essential when prolonged (>1week) treatment ■ Severe (neutrophil count <500/µl) AND/OR unwell courses are anticipated, when resistance is likely or multiple prior antibacterial courses URINARY TRACT INFECTIONS Amoxicillin/clavulanate (OR cefuroxime) + fl uoroquinolone Therapeutic (postoperative) antibacterials are indicated: Highest priority critically important (e.g. hospital acquired infections) and in life-threatening Treat for minimum 3 weeks or 1 week beyond Antibacterials are not indicated for: ■ To treat a known bacterial infection infections Septic peritonitis secondary to gastrointestinal clinical cure ■ antibacterials ■ Feline idiopathic cystitis (FIC) When the risk of a postoperative infection developing is ■ If fi rst-line treatment fails, do not use another leakage: Repeat cytology to assess response ■ Feline struvite urolithiasis and canine non-struvite high due to contamination or major break in asepsis Fluoroquinolones (enrofl oxacin, marbofl oxacin, Use doses at top end of range for better skin antibacterial without supportive culture and sensitivity urolithiasis Metronidazole + marbofl oxacin pradofl oxacin, ciprofl oxacin), and 3rd- and 4th-generation penetration results (avoid cycling antibacterials) ■ Urinary incontinence Ampicillin + amikacin + metronidazole () should only be used when ■ Subclinical bacteriuria (canine or feline) Amoxicillin/clavulanate + marbofl oxacin Deep pyoderma: MISCELLANEOUS INFECTIONS fi rst-line antibacterials are inappropriate or ine ective. ■ Juvenile canine vaginitis Initially intravenously then orally when clinical signs improve ■ Whilst culture pending, systemic If urgent treatment is required, then samples for culture ailor your practice policy antibacterial therapy based on Pyometra: T Uncomplicated, symptomatic, canine urinary Treat for 2 weeks following resolution of signs/abdominal cytology as for superfi cial pyoderma Antibacterials not required if stable and proceeding directly to OHE and sensitivity testing should be submitted before starting ■ A customized practice policy can guide antibacterial tract infection (cystitis): e usion Add topical treatment with 2–4% these agents, and then therapy adapted. selection to address the bacterial infections and Amoxicillin (± clavulanate) Surgically managed: Bacteraemia/sepsis (including peritonitis of chlorhexidine resistance patterns that you encounter, minimizing Trimethoprim/sulphonamide non-gastrointestinal origin): Amoxicillin (± clavulanate) Treat for minimum 4–6 weeks or 2 weeks inappropriate use Treat for 7–10 days Clindamycin + marbofl oxacin Cefalexin + enrofl oxacin ■ Complete the tick boxes in this poster to highlight your beyond clinical cure Ampicillin + metronidazole + marbofl oxacin Ideally repeat cytology Treatment discontinued after surgery (unless septic peritonitis) First-line antibacterials practice’s fi rst-line approach to each condition Complicated canine or feline Ampicillin + amikacin + marbofl oxacin Reinfection, recurrent and persistent urinary tract Otitis externa: Medically managed: Limit the use of fi rst-line antibacterials to times of genuine Amoxicillin/clavulanate + marbofl oxacin infections: ■ Topical treatment ONLY Amoxicillin (± clavulanate) clinical need and avoid all unnecessary use. onitor Initially intravenously then orally when clinical signs improve ■ M Amoxicillin (± clavulanate) No authorized products if ear drums not intact Treat for 2 weeks following resolution of signs/abdominal ■ Use in-house cytology to guide drug choice : Trimethoprim/sulphonamide ■ Track and record culture profi les and update your e usion and prognosis Cefalexin If reinfection occurs, use the SAME antibacterial if previously practice policy accordingly If rods Amoxicillin/clavulanate ■ Monitor for preventable infections (e.g. postoperative) successful If recurrent/persistent infection, modify therapy on basis of Framycetin Trimethoprim/sulphonamide and alter practices if needed ORTHOPAEDIC INFECTIONS ■ Audit your own antibacterial use, particularly of critically sensitivity data Gentamicin Treat for 2–3 weeks or until o spring weaned (early weaning NOT advised) important antibacterials (fl uoroquinolones/cefovecin), Review predisposing factors (e.g. urolithasis, anatomical Discospondylitis: B abnormalities) Suspected Mycoplasma haemofelis (feline infectious anaemia): e.g. using mySavsnet AMR Responsible antibacterial use under the Cascade Cefalexin If cocci Doxycycline Prostatitis (entire males): Amoxicillin/clavulanate Florfenicol It is justifi able, on a case-by-case basis, to prescribe an antibiotic on the cascade Marbofl oxacin in the interests of minimiz ing the development of resistance, particularly where Fluoroquinolones (high dose – see QR code) Trimethoprim/sulfadiazine Fusidic acid/framycetin ducate others Treat for 4 weeks culture and sensitivity data indicate that a particular antibiotic active substance is Trimethoprim/sulphonamide Clindamycin /miconazole E e ective against a bacterial pathogen and where knowledge of Treat for 4–6 weeks + medical/surgical castration Suspected leptospirosis: ■ Share this important message to reduce the threat from Intravenously, if severe neurological compromise or signs May combine with antiseptic ear cleaner indicates that the selected product is likely to be safe and e ective for the animal multi-resistant strains of bacteria and improve the health Urolithiasis (≠ crystalluria): of sepsis Treat until cytology is negative Doxycycline species and condition being treated. Canine struvite urolithiasis (for dissolution) Treat for minimum 8 weeks (based on clinical response) Penicillin G of pets and people Anal sac infl ammation/engorgement without Amoxicillin (± clavulanate) until resolution of Amoxicillin (± clavulanate) Infective/: abscessation: urolithiasis confi rmed ■ Topical treatment ONLY Doxycycline is necessary to address renal colonization/carrier state Dietary modifi cation and urine acidifi cation Cefalexin ■ Manual evacuation, fl ushing with Treat for 2 weeks alongside treatment Amoxicillin/clavulanate chlorhexidine + packing with topical Consider surgical removal Treat for 4 weeks OR until synovial fl uid neutrophils <3% polypharmacy ear product containing Hepatic encephalopathy (HE): aminoglycoside or fl orfenicol Diet and lactulose should be fi rst line therapies in the management of Suspected pyelonephritis: : patients with HE This information on the use of antibacterials in veterinary practice is given to individual users in good faith and on the basis of information available to the publishers, editors and contributors at the time of writing. It is given on the understanding that BSAVA, Amoxicillin/clavulanate Cefalexin If symptomatic: Use non-prescription For further information on SAMSoc and the contributors accept no responsibility for any errors, omissions or inaccuracy in the information or for any loss or Anal sac abscessation: damage that may result from reliance being placed on it by individuals, organisations or any third party. In particular, BSAVA, SAMSoc forms. Available from individual drugs and dosages, and the contributors cannot take responsibility for information provided on dosages and methods of application of drugs mentioned or Fluoroquinolones Amoxicillin/clavulanate ■ ONLY if signs of cellulitis Metronidazole (decreased dose) referred to in this publication. Details of this kind must be verifi ed in each case by individual users from up to date literature published by the manufacturers or suppliers of those drugs. Veterinary surgeons are reminded that in each case they must follow all appropriate Trimethoprim/sulphonamide the BSAVA Library see BSAVA Small Animal national legislation and regulations (for example, in the United Kingdom, the prescribing cascade) from time to time in force. Other than Intravenously for fi rst 2–3 days then orally Trimethoprim/sulphonamide Amoxicillin adding practice policy, the poster may not be altered in any way or used for any other purpose without prior written permission of the Delivered by BSAVA to: copyright holder, and may not be sold. ISBN: 978-1-910443-63-7 and SAMSoc.org. Formulary. Treat for 2–4 weeks Treat for 6–8 weeks Amoxicillin/clavulanate Guest (guest) Ampicillin © BSAVA/SAMSoc 2018 6957PUBS18 IP: 91.84.218.190 On: Fri, 04 Jan 2019 14:54:38