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