Antibacterial use in our practice The antibiotic 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 gingivitis and periodontitis: ■ rescribe only when necessary Chlortetracycline Canine sino-nasal disease P therapy Amoxicillin/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 Pneumonia: Systemic doxycycline (amoxicillin/clavulanate in pregnant Ototoxicity Cats ■ Antibacterials are not indicated for: Amoxicillin/clavulanate 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 vomiting 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 Cefalexin 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 Penicillins Immediate and delayed Dogs/cats Avoid in penicillin- perforation, marked uveitis Antibacterials are not indicated for: hypersensitivity reactions sensitive animals/ ■ Amoxicillin/clavulanate 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 cellulitis: 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: Cefuroxime Ampicillin 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. imipenem, linezolid, teicoplanin, vancomycin) 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