DISEASE FACT SHEETS
CONTENTS Canine cystitis Bacterial urinary tract infection in cats with ckd Metritis and pyometra Mastitis Canine rhinitis Canine tracheobronchitis Feline rhinitis and tracheobronchitis Surface and superficial pyoderma Deep pyoderma Otitis externa and media Conjunctivitis and keratitis Osteomyelitis Wound infections and abscesses Post operative infections Prevention of surgical complications (including peritonitis and abscesses)
CANINE CYSTITIS Therapeutic approach Urinary cytology - Empirical treatment Bacilli (assume) Escherichia coli Amoxicillin+clavulanate, trimethoprim sulfonamides Cocci (assume) Staphylococcus spp. Amoxicillin, trimethoprim sulfonamides Culture and sensitivity Escherichia coli Amoxicillin ± clavulanate, trimethoprim sulfonamides Staphylococcus spp. Amoxicillin ± clavulanate, trimethoprim sulfonamides Cefalexin, marbofloxacin, enrofloxacin, cefovecin, nitrofurantoin Cefalexin, marbofloxacin, enrofloxacin, cefovecin, nitrofurantoin Pradofloxacin, gentamicin Pradofloxacin, gentamicin
CANINE CYSTITIS Treatment recommendations First choice antibiotic Escherichia coli Staphylococcus spp. Amoxicillin + clavulanate Trimethoprim sulfonamides a Amoxicillin Trimethoprim sulfonamides a 12.-2 mg/kg/12h PO 1 mg/kg/12h PO 1 mg/kg/8-12h PO 1 mg/kg/12h PO 10-1 mg/kg/2 SC in 7 dogs days (uncomplicated cystitis) 28 days (complicated cystitis) Second choice antibiotic (with culture and sensitivity testing and only if first choice is not an option) Amoxicillin ± clavulanate 10-2 mg/kg/12h PO Escherichia coli Staphylococcus spp. Cefalexin Marbofloxacin b Enrofloxacin b Nitrofurantoin d Cefovecin c 1-30 mg/kg/12h PO 2 mg/kg/2h PO mg/kg/2h PO.- mg/kg/8h PO 8 mg/kg SC for 1d (for complicated UTIs repeat dose after 1d) 7 days (uncomplicated cystitis) 28 days (complicated cystitis) a Avoid use longer than 3 weeks as risk of keratoconjunctivitis sicca (KCS) and nephrotoxicity. Schirmer tear testing is recommended if use > 3 weeks6. b Avoid use in growing dogs of large breeds. c Cefovecin is a third generation cephalosporin and therefore a last resort antibiotic. It should only be used if sensitivity testing indicates that other antibiotics would be ineffective or if oral administration of medication is not possible. d Nitrofurantoin is a human preparation useful in multi-drug resistant UTIs; use should be guided by culture and sensitivity testing and by cascade guidelines.
BACTERIAL URINARY TRACT INFECTION IN CATS WITH CKD Therapeutic approach Urine dipstick, cytology Gram-negative rod (suspicion of Escherichia coli ) Culture and sensitivity Empirical treatment while awaiting results Amoxicillin ± clavulanate, trimethoprim sulfonamides Gram-positive cocci (suspicion of Enterococcus spp.) Amoxicillin Results of culture and sensitivity De-escalate if possible, adapt if necessary E. coli Amoxicillin ± clavulanate, trimethoprim sulfonamides Enterococcus spp. Amoxicillin Cefalexin, marbofloxacin, enrofloxacin, cefovecin Amoxicillin + clavulanate, marbofloxacin, enrofloxacin Pradofloxacin Pradofloxacin
Culture and sensitivity testing should be performed to select the most appropriate antibiotic and hence reduce the potential for further irreversible damage to the kidney. First choice antibiotic Escherichia coli BACTERIAL URINARY TRACT INFECTION IN CATS WITH CKD Treatment recommendations Amoxicillin Amoxicillin + clavulanate Trimethoprim sulfonamides a 10-2 mg/kg/8h IV 10-1 mg/kg/8h PO 10 mg/kg/8h IV 12.-2 mg/kg/8-12h PO 1 mg/kg/12h PO 10-1 mg/kg/2 SC in dogs 28 days complicated UTI Enterococcus spp. Amoxicillin 10-2 mg/kg/8h IV 10-1 mg/kg/8h PO Second choice antibiotic (with culture and sensitivity testing) Cefalexin Marbofloxacin Consider adjustment for Stage 3& IRIS 1-30 mg/kg/12h PO 2 mg/kg/2h IV, SC, PO 10-1 mg/kg/2 SC in dogs Escherichia coli Enterococcus spp. Enrofloxacin b Cefovecin c Amoxicillin + clavulanate f Marbofloxacin mg/kg/2h SC, PO 8 mg/kg single dose SC (1d) 20 mg/kg/8h IV 12.-2 mg/kg/8-12h PO 2 mg/kg/2h IV, SC, PO 28 days complicated UTI Enrofloxacin b mg/kg/2h SC, PO a Avoid use longer than 3 weeks as risk of keratoconjunctivitis sicca (KCS) and nephrotoxicity. Schirmer tear testing is recommended if use > 3 weeks7. b In cats, use of enrofloxacin has been associated with a risk of retinal toxicity. Do not exceed mg/kg. c Cefovecin is a third generation cephalosporin and therefore a last resort antibiotic. It should only be used if sensitivity testing indicates that other antibiotics would be ineffective or if oral administration of medication is not possible. f Use of a ß-lactamase inhibitor (clavulanate) is not usually required for treatment of Enterococcus spp. infections hence amoxicillin+clavulanate is designated as 2nd choice, however its use may be a compromise to achieve patient/owner compliance.
METRITIS AND PYOMETRA Therapeutic approach Culture and sensitivity Empirical treatment while awaiting results Amoxicillin ± clavulanate, trimethoprim sulfonamides Results of culture and sensitivity De-escalate if possible, adapt if necessary Escherichia coli Amoxicillin, trimethoprim sulfonamides Staphylococcus/Streptococcus Amoxicillin, trimethoprim sulfonamides Amoxicillin + clavulanate, cefalexin, marbofloxacin, enrofloxacin Amoxicillin + clavulanate, cefalexin, marbofloxacin, enrofloxacin
METRITIS AND PYOMETRA Treatment recommendations First choice antibiotic Escherichia coli Staphylococcus spp. Streptococcus spp. Amoxicillin ± clavulanate Trimethoprim sulfonamides a 10-2 mg/kg/12h PO, SC, IV 1 mg/kg/12h PO, IV 2-3 weeks Second choice antibiotic (with culture and sensitivity testing) Escherichia coli Staphylococcus spp. Streptococcus spp. Cefalexin Marbofloxacin b Enrofloxacin b,c 1-30 mg/kg/12h PO 2 mg/kg/2h PO, SC, IV mg/kg/2h PO, SC 10-1 mg/kg/2 SC in dogs 2-3 weeks a Avoid use longer than 3 weeks as risk of keratoconjunctivitis sicca (KCS) and nephrotoxicity. Schirmer tear testing is recommended if use > 3 weeks3. b Avoid use in growing dogs of large breeds. c In cats, use of enrofloxacin has been associated with a risk of retinal toxicity. Do not exceed mg/kg.
MASTITIS Therapeutic approach Culture and sensitivity Escherichia coli Amoxicillin ± clavulanate, trimethoprim sulfonamides Staphylococcus Amoxicillin ± clavulanate, trimethoprim sulfonamides Cefalexin, marbofloxacin, enrofloxacin Cefalexin, marbofloxacin, enrofloxacin
MASTITIS Treatment recommendations In nursing bitches and queens, only amoxicillin ± clavulanate and cefalexin should be used. First choice antibiotic Escherichia coli Staphylococcus spp. Streptococcus spp. Amoxicillin ± clavulanate Trimethoprim sulfonamides a 10-2 mg/kg/12h PO, SC, IV 12.-2 mg/kg/12h PO, SC, IV 10-1 days Second choice antibiotic (with culture and sensitivity testing) Escherichia coli Staphylococcus spp. Streptococcus spp. Cefalexin Marbofloxacin b Enrofloxacin b,c 1-30 mg/kg/12h PO 2 mg/kg/2h PO, SC, IV mg/kg/2h PO, SC 10-1 mg/kg/2 SC in dogs 10-1 days a Avoid use longer than 3 weeks as risk of keratoconjunctivitis sicca (KCS) and nephrotoxicity. Schirmer tear testing is recommended if use > 3 weeks2. b Avoid use in growing dogs of large breeds. c In cats, use of enrofloxacin has been associated with a risk of retinal toxicity. Do not exceed mg/kg.
CANINE RHINITIS Therapeutic approach Empirical treatment ONLY IF antibiotherapy is necessary Amoxicillin+clavulanate, doxycycline Marbofloxacin, enrofloxacin If insufficient improvement, consider culture and AST of nasal biopsy or nasal flush
CANINE RHINITIS Treatment recommendations Culture and sensitivity testing is not justified in most cases of canine nasal disease, but antibiotic treatment of secondary bacterial infections can be necessary. First choice antibiotic Culture not recommended Amoxicillin + clavulanate Doxycycline 12.-2 mg/kg/12h PO, SC, IV mg/kg/12h or 10 mg/kg/2h PO 2-3 weeks Second choice antibiotic (with culture and sensitivity testing) Culture not recommended Marbofloxacin a Enrofloxacin a 2 mg/kg/2h PO, SC mg/kg/2h PO, SC 10-1 mg/kg/2 SC in dogs 2-3 weeks a Avoid use in growing dogs of large breeds.
CANINE TRACHEOBRONCHITIS Therapeutic approach Empirical treatment ONLY IF antibiotherapy is necessary Amoxicillin+clavulanate, doxycycline Marbofloxacin, enrofloxacin If insufficient improvement, perform tracheal or bronchial lavage, cytology and C&AST
CANINE TRACHEOBRONCHITIS Treatment recommendations First choice antibiotic Bordetella bronchiseptica Streptococcus spp. Amoxicillin + clavulanate Doxycycline Amoxicillin 12.-2 mg/kg/12h PO, SC, IV 10 mg/kg/2h PO 10-1 mg/kg/12h PO 7-10 days, until clinical and radiographic cure Second choice antibiotic (with culture and sensitivity testing) Bordetella bronchiseptica Trimethoprim sulfonamides a Marbofloxacin b 1-30 mg/kg/12h PO, IV 2 mg/kg/2h PO, SC Streptococcus spp. Enrofloxacin b Cefalexin Doxycycline Marbofloxacin b mg/kg/2h PO, SC 1-30 mg/kg/12h PO 10 mg/kg/2h PO 2 mg/kg/2h PO, SC 7-10 days, until clinical and radiographic cure Enrofloxacin b mg/kg/2h PO, SC a Avoid use longer than 3 weeks as risk of keratoconjunctivitis sicca (KCS) and nephrotoxicity. Schirmer tear testing is recommended if use > 3 weeks3. b Avoid use in growing dogs of large breeds.
FELINE RHINITIS AND TRACHEOBRONCHITIS Therapeutic approach Yes Upper respiratory tract signs Since < 10 days? No Acute disease Chronic disease Address any underlying illness, e.g. viral infection Supportive treatment usually suffices Empirical treatment if severe clinical signs (mucopurulent discharge, fever, lethargy, inappetence) Doxycycline If no improvement Diagnostic tests*: cytology and C&AST Bordetella bronchiseptica Doxycycline Pasteurella spp. Doxycycline Mycoplasma spp. Doxycycline Amoxicillin + clavulanate, marbofloxacin, enrofloxacin Amoxicillin Marbofloxacin, enrofloxacin Pradofloxacin Amoxicillin + clavulanate, marbofloxacin, enrofloxacin, pradofloxacin Clindamycin, pradofloxacin
FELINE RHINITIS AND TRACHEOBRONCHITIS Treatment recommendations First choice antibiotic (empirical or with culture and sensitivity testing) Acute rhinitis & tracheobronchitis with Bordetella bronchiseptica, Mycoplasma spp. or secondary bacterial infection: 7-10 days; Chlamydia felis: weeks Bordetella bronchiseptica, Mycoplasma spp., (Chlamydia felis) Pasteurella spp. Doxycycline c 10 mg/kg/2h PO Chronic rhinitis 6 weeks d Chronic bronchitis/asthma with Mycoplasma spp. infection: 6 weeks d Chronic bronchitis with Pasteurella spp. infection: 2- weeks Second choice antibiotic (with culture and sensitivity testing) Bordetella bronchiseptica, Mycoplasma spp. Marbofloxacin Enrofloxacin a 2 mg/kg/2h PO mg/kg/2h PO Acute rhinitis & tracheobronchitis with Bordetella bronchiseptica or Mycoplasma spp. infection: 7-10 days Chronic bronchitis/asthma with Mycoplasma spp. infection: 6 weeks d Pasteurella spp. Amoxicillin Amoxicillin + clavulanate e 10-2 mg/kg/8h IV, PO 20 mg/kg/8h IV 12.-2 mg/kg/8-12h PO Acute rhinitis & tracheobronchitis 7-10 days; Chronic rhinitis 6 weeks d Chronic bronchitis with Pasteurella spp. infection: 2- weeks a In cats, use of enrofloxacin has been associated with a risk of retinal toxicity. Do not exceed mg/kg. b Pradofloxacin is a last resort choice due to its very extended spectrum of activity and should only be used if a narrower spectrum antibiotic cannot be used (based on sensitivity testing results). c Doxycycline hyclate/hydrochloride tablets must be followed with water or food to ensure passage into the stomach to prevent development of oesophagitis and/or strictures3. d Note: initial treatment course for chronic rhinitis is prolonged (e.g. 6 weeks), subsequent flare-ups may be managed with shorter courses e.g. 2- weeks. e Use of a ß-lactamase inhibitor (clavulanate) is not usually required for treatment of Pasteurella spp. infections hence amoxicillin+clavulanate is designated as 3rd choice earlier, however use may be a compromise to achieve patient/owner compliance.
SURFACE AND SUPERFICIAL PYODERMA Therapeutic approach Localised lesions Widespread lesions Cytology for diagnosis Surface pyoderma: Bacterial overgrowth ± Malassezia without neutrophils Superficial pyoderma: Presence of neutrophils with intracellular bacteria Daily disinfectant gel, spray, creams mousse, wipes Shampoo twice weekly + daily disinfectant spray, mousse, wipes Treat ly until clinically cured and cytology is negative (usually 2-3 weeks) In case of treatment failure, consider fucidic acid or systemic antibiotics (see Deep pyoderma) In case of treatment failure, consider systemic antibiotics (see Deep pyoderma)
SURFACE AND SUPERFICIAL PYODERMA Treatment recommendations Antiseptics that Antibiotics should preferably not be used in cases of surface and superficial pyoderma. Antiseptics should be used instead. Antiseptic that Chlorhexidine 2-% shampoo Chlorh.* wipes, mousse, spray Benzoyl peroxide 2.% Ethyl lactate 10% Triclosan Hypochlorous acid Bleach % Benzalconium chloride Medical honey Fusidic acid Mupirocin * Chlorhexidine In vitro sensitivity 3 3 Tissue distribution Treatment choice Limited clinical evidence No clinical evidence No residual efficacy, use daily Daily soak No clinical evidence Do not mix with other s For localized lesions only Not licensed for animal use Sensitivity and distribution 1 = nil 2 = weak 3 = average = good = excellent Treatment choice 1 st line 2 nd line Last resort Excluded for this indication
DEEP PYODERMA Therapeutic approach Therapeutic approach for deep pyoderma and for superficial pyoderma that is unresponsive to treatment. Cytology for diagnosis - presence of intracellular bacteria (pyoderma) - identification of cocci and/or rods Empirical treatment only in case of: - superficial pyoderma with failed treatment - first occurence of superficial coccal infections Culture & AST in case of: - deep pyoderma - presence of rods - relapsing pyoderma (cocci and rods) - failure of empirical treatment - previous antibiotic treatment Amoxicillin + clavulanate, cefalexin, cefadroxil, clindamycin Amoxicillin + clavulanate cefalexin, cefadroxil, clindamycin Enrofloxacin, marbofloxacin, cefovecin In case of treatment failure, perform culture and AST Pradofloxacin, rifampicin, chloramphenicol, fosfomycin, aminoglycosides Treat until one week beyond clinical cure for superficial pyoderma and two weeks beyond clinical cure for deep pyoderma (usually at least 3- weeks) a Cefovecin is a third generation cephalosporin and therefore a last resort antibiotic. It should only be used if sensitivity testing indicates that other antibiotics would be ineffective or if oral administration of medication is not possible. b Avoid use longer than 3 weeks as risk of keratoconjunctivitis sicca (KCS) and nephrotoxicity. Schirmer tear testing is recommended if use > 3 weeks 28. c Avoid use in growing dogs of large breeds. d In cats, use of enrofloxacin has been associated with a risk of retinal toxicity. Do not exceed mg/kg. e Pradofloxacin is a last resort choice due to its very extended spectrum of activity and should only be used if a narrower spectrum antibiotic cannot be used (based on sensitivity testing results). f Hepatotoxic, refer to National regulations regarding use. g Aminoglycosides are potentially ototoxic and nephrotoxic; do not use in patients with renal dysfunction (see www.iris-kidney.com/education/prevention.html).
DEEP PYODERMA Treatment recommendations First choice antibiotic Meticillin sensitive Staphylococcus spp. Amoxicillin+clavulanate 12.-2 mg/kg/12h PO Cefalexin Cefadroxil Clindamycin 1-30 mg/kg/12h PO 1-30 mg/kg/12h PO or 30-0 mg/kg/2h PO.-11 mg/kg/12h PO 10-1 mg/kg/2 SC in dogs 1 week beyond cure for superficial pyoderma, 2 weeks beyond cure for deep pyoderma. Second choice antibiotic (following culture and sensitivity testing): only if bacteria are resistant to the first-choice antibiotics Trimethoprim sulfonamides b Marbofloxacin c 1-30 mg/kg/12h PO 2 mg/kg/2h PO 10-1 mg/kg/2 SC in dogs Meticillin-resistant, multidrug-resistant Staphylococcus spp. E. coli Ps. aeruginosa Enrofloxacin c,d Doxycycline Minocycline Rifampin f Chloramphenicol Fosfomycin Gentamicin g Amikacin g Cefovecin a mg/kg/2h PO 10 mg/kg/2 h PO 20 mg/kg/12h PO -10 mg/kg/12h PO 0 mg/kg/8h PO 0 mg/kg/12h PO 10-1 mg/kg/2h SC in dogs -8 mg/kg/2h SC in cats 1-30 mg/kg/2h SC in dogs 10-1 mg/kg/2h SC in cats 8 mg/kg single dose SC (1d) 1 week beyond cure for superficial pyoderma, 2 weeks beyond cure for deep pyoderma. Minimum 2 injections, suitable only in case of compliance problems
OTITIS EXTERNA AND MEDIA Therapeutic approach MANAGEMENT OF OTITIS Identification and correction of underlying cause Evaluation of tympanic membrane and middle ear Tympanic membrane intact, no evidence of otitis media Ruptured tympanic membrane and/or evidence of otitis media Cytology Culture and sensitivity Treat TOPICALLY until cytological testing is negative. Flush daily with disinfectant, at least one hour prior to applying the TOPICAL antibiotic. SYSTEMIC antibiotic (see Deep pyoderma, p.138) for 3-6 weeks Yeasts Rods (bacilli) Cocci Antifungals Polymixin B, silver sulfadiazine Neomycin, fusidic acid, framycetin, florfenicol Gentamicin, marbofloxacin, enrofloxacin Pradofloxacin, ticarcillin, amikacin Gentamicin, marbofloxacin, enrofloxacin Pradofloxacin, amikacin
OTITIS EXTERNA AND MEDIA Treatment recommendations Topical antibiotics are only to be used if there is no evidence of a ruptured tympanic membrane and/or otitis media. Systemic antibiotics should be used only following bacterial culture and susceptibility testing in case of a ruptured tympanic membrane and/or otitis media. In this case refer to antibiotics described in Deep pyoderma. Pathogen 1: Staphylococcus spp. Neomycin Fusidic acid Framycetin Florfenicol Gentamicin a Marbofloxacin / Enrofloxacin Pradofloxacin Amikacin a a Do not mix with acidic cleaners. In vitro sensitivity Tissue distribution ; Inactivated in pus Treatment choice Sensitivity and distribution 1 = nil 2 = weak 3 = average = good = excellent Treatment choice Pathogen 2: Pseudomonas aeruginosa 1 st line Polymixin B Silver sulfadiazine Gentamicin a Marbofloxacin / Enrofloxacin Pradofloxacin Amikacin a Ticarcillin Ceftazidime a Do not mix with acidic cleaners. In vitro sensitivity Tissue distribution ; Inactivated in pus Treatment choice 2 nd line Last resort Excluded for this indication
CONJUNCTIVITIS AND KERATITIS Therapeutic approach Dogs Corneal smear (cytology ± culture) Escherichia coli (Gram-negative rod) Staphylococcus/ Streptococcus spp. (Gram-positive cocci) Neomycin + bacitracin + polymyxin B Neomycin + bacitracin + polymyxin B, Fucidic acid Chloramphenicol Chloramphenicol Cats Corneal smear (cytology ± culture)* Chlamydophila Doxycycline Staphylococcus/ Streptococcus spp. (Gram-positive cocci) Neomycin + bacitracin + polymyxin B, Fucidic acid Amoxicillin + clavulanate Chloramphenicol * Mycoplasma spp. cannot be diagnosed using a corneal smear or the usual culture techniques. For this pathogen, PCR is the gold standard diagnostic test.
CONJUNCTIVITIS AND KERATITIS Treatment recommendations First choice antibiotic (whilst waiting for culture and sensitivity testing) Staphylococcus spp. Streptococcus spp. Fusidic acid (eye drops/ointment) Neomycin - bacitracin polymyxin (eye drops) 1-2 times/day -6 times/day 8-10 days Chlamydophila spp. Doxycycline (oral) 10 mg/kg/2h 30 days Mycoplasma spp.* Doxycycline (oral) 10 mg/kg/2h 2- weeks Second choice antibiotic (following culture and sensitivity testing) Staphylococcus spp. Streptococcus spp. Chloramphenicol (eye drops) 2-3 times/day 8-10 days Mycoplasma spp.* Chlamydophila spp. Amoxicillin + clavulanate (oral) 12.-2 mg/kg/12h PO 30 days 9 * Mycoplasma spp. cannot be diagnosed using a corneal smear or the usual culture techniques. For this pathogen, PCR is the gold standard diagnostic test.
OSTEOMYELITIS Therapeutic approach Culture and sensitivity Empirical treatment while awaiting results Implant removal if possible Amoxicillin+clavulanate, cefalexin, cefadroxil, clindamycin Results of culture and sensitivity De-escalate if possible, adapt if necessary Implant removal if possible Placement of antibiotic-impregnated implants if needed Amoxicillin ± clavulanate, cefalexin, cefadroxil, clindamycin Enrofloxacin, marbofloxacin Gentamicin, cefovecin
OSTEOMYELITIS Treatment recommendations n Non-antibiotic treatment: remove infected implants, review unstable fixation, curettage of sequestra/abscesses. n Local antibiotic treatment: placement of antibiotic-impregnated implants. First choice antibiotic Cefalexin 1-30 mg/kg/12h PO Staphylococcus spp. Streptococcus spp. E.coli Cefadroxil Amoxicillin + clavulanate 10-20 mg/kg/12h PO 12. -2 mg/kg/8-12h PO Up to 2 weeks beyond clinical and radiographic resolution of the infection. Clindamycin 11 mg/kg/12h PO Second choice antibiotic (with culture and sensitivity testing) Staphylococcus spp. Streptococcus spp. E.coli Marbofloxacin a Enrofloxacin a,b Gentamicin d Cefovecin c 2 mg/kg/2h PO mg/kg/2h PO 7 mg/kg/2h-iv Local beads e 8 mg/kg single dose SC (1 days) Up to 2 weeks beyond clinical and radiographic resolution of the infection. Up to 2 weeks beyond clinical and radiographic resolution of the infection. (1 injection per 1 days) a Avoid use in growing dogs of large breeds. b In cats, use of enrofloxacin has been associated with a risk of retinal toxicity. Do not exceed mg/kg. c Cefovecin is a third generation cephalosporin and therefore a last resort antibiotic. It should only be used if sensitivity testing indicates that other antibiotics would be ineffective or if oral administration of medication is not possible. d Aminoglycosides are potentially ototoxic and nephrotoxic; do not use in patients with renal dysfunction (see www.iris-kidney.com/education/prevention.html). e Unsuitable for long-term treatment (potentially nephrotoxic, systemic diffusion possible) - see www.iriskidney.com/guidelines/index.html
WOUND INFECTIONS AND ABSCESSES Therapeutic approach Abscesses: No antibiotic unless fever or severe systemic infection. Surgical debridement, abscess drainage and lavage usually suffice. Clean (contaminated) Direct closure Amoxicillin+clavulanate, cefalexin, cefadroxil (- days) If fully granulated, open management No need for antibiotics Infected Culture and sensitivity Empirical treatment while awaiting results Amoxicillin+clavulanate, cefalexin, cefadroxil Results of culture and sensitivity De-escalate if possible, adapt if necessary Amoxicillin ± clavulanate, cefalexin, cefadroxil, clindamycin, metronidazole Enrofloxacin, marbofloxacin Cefovecin, pradofloxacin
WOUND INFECTIONS AND ABSCESSES Treatment recommendations First choice antibiotic Pasteurella multocida (cats) Staphylococcus Escherichia coli Pasteurella Anaerobes Anaerobes Amoxicillin Amoxicillin + clavulanate Cefalexin Clindamycin 11-22 mg/kg/12h 12.-2 mg/kg/12h 1-30 mg/kg/12h.-11 mg/kg/12h Clean: - days if closure. Dirty or deep: until establishment of healthy granulated tissue, usually 7-10 days. Second choice antibiotic (with culture and sensitivity testing) Pasteurella Staphylococcus Pseudomonas Marbofloxacin a Enrofloxacin a,b 2 mg/kg/2h mg/kg/2h (Up to 11-20 mg/kg/12 h for resistant Pseudomonas) Clean: - days if closure. Dirty or deep: until establishment of healthy granulated tissue, usually 7-10 days. a Avoid use in growing dogs of large breeds. b In cats, use of enrofloxacin has been associated with a risk of retinal toxicity. Do not exceed mg/kg.
POST OPERATIVE INFECTIONS Therapeutic approach Culture and sensitivity Empirical treatment while awaiting results Amoxicillin+clavulanate, cefalexin, clindamycin Results of culture and sensitivity De-escalate if possible, adapt if necessary Staphylococcus Amoxicillin+clavulanate, cefalexin, clindamycin Gram-negative Amoxicillin+clavulanate Enrofloxacin, marbofloxacin Cefalexin, clindamycin, enrofloxacin, marbofloxacin Cefovecin, aminoglycosides Cefovecin, aminoglycosides
POST OPERATIVE INFECTIONS Treatment recommendations n The antibiotic should be available in an IV formulation for acute and potentially lifethreatening infection (see below). Amoxicillin+clavulanate and pradofloxacin have better anti-anaerobic activity than other ß-lactams and fluoroquinolones, but metronidazole can be considered where there is specific concern over anaerobic contamination. First choice antibiotic Amoxicillin + clavulanate 12.-2 mg/kg/12h Gram-positive (Staphylococcus) Cefalexin Clindamycin 1-30 mg/kg/12h.-11 mg/kg/12h Until evidence of healing Gram-negative Amoxicillin + clavulanate 12.-2 mg/kg/12h Second choice antibiotic (after culture and sensitivity testing) Marbofloxacin a 2 mg/kg/2h Gram-positive (Staphylococcus) or Gram-negative Enrofloxacin a,b Cefovecin c Gentamicin d mg/kg/2h 8 mg/kg/1j-sc 8 mg/kg/2h Until evidence of healing Amikacin d 10-1 mg/kg/2h a Avoid use in growing dogs of large breeds. b In cats, use of enrofloxacin has been associated with a risk of retinal toxicity. Do not exceed mg/kg. c Cefovecin is a third generation cephalosporin and therefore a last resort antibiotic. It should only be used if sensitivity testing indicates that other antibiotics would be ineffective or if oral administration of medication is not possible. d Aminoglycosides are potentially ototoxic and nephrotoxic; do not use in patients with renal dysfunction (see www.iris-kidney.com/education/prevention.html).
PREVENTION OF SURGICAL COMPLICATIONS (INCLUDING PERITONITIS AND ABSCESSES) Therapeutic approach Perioperative or postoperative antibiotic therapy is not justified. Exceptions: surgery > 90 minutes, orthopaedic procedures involving implants and/or contaminated sites. Pre-surgery considerations Clean surgery <60 minutes without implants Clean surgery 60-90 min without implants - Clean surgery > 90 min - Cleancontaminated surgery - Clean surgery with implants Contaminateddirty surgery Antibiotics contraindicated Perioperative antibiotics may be indicated considering the risk factors in each case - Perioperative antibiotics indicated - Conflicting evidence for postoperative antibiotics Peri and postoperative antibiotics indicated
PREVENTION OF SURGICAL COMPLICATIONS (INCLUDING PERITONITIS AND ABSCESSES) Therapeutic approach Pathogen 1: Staphylococcus pseudintermedius In vitro Tissue sensitivity distribution Amoxicillin + clavulanate Clindamycin Cefalexin / Cefadroxil Marbofloxacin a / Enrofloxacin a,b Cefovecin c Aminoglycosides d 3 3 3 3 Pathogen 2: E. coli and Klebsiella In vitro Tissue sensitivity distribution Amoxicillin / Ampicillin Amoxicillin + clavulanate Cefalexin / Cefadroxil Marbofloxacin a / Enrofloxacin a,b Cefovecin c Aminoglycosides d 3 3 Pathogen 3: Pseudomonas In vitro Tissue sensitivity distribution Marbofloxacin a / Enrofloxacin a,b Aminoglycosides d Ceftazidime 3 3 Pathogen : Enterococcus In vitro Tissue sensitivity distribution Amoxicillin / Ampicillin Amoxicillin + clavulanate Marbofloxacin a / Enrofloxacin a,b 3 3 Pathogen : Anaerobes Amoxicillin / Ampicillin Amoxicillin + clavulanate Metronidazole Pradofloxacin a,e In vitro Tissue sensitivity distribution 3 3 3 Treatment choice Treatment choice Treatment choice Treatment choice Treatment choice Sensitivity and distribution 1 = nil 2 = weak 3 = average = good = excellent Treatment choice 1 st line 2 nd line Last resort Excluded for this indication a Avoid use in growing dogs of large breeds. b In cats, use of enrofloxacin has been associated with a risk of retinal toxicity. Do not exceed mg/kg. c Cefovecin is a third generation cephalosporin and therefore a last resort antibiotic. It should only be used if sensitivity testing indicates that other antibiotics would be ineffective or if oral administration of medication is not possible. d Aminoglycosides are potentially ototoxic and nephrotoxic; do not use in patients with renal dysfunction (see www.iris-kidney.com/ education/prevention. html). e Pradofloxacin is a last resort choice due to its very extended spectrum of activity and should only be used if a narrower spectrum antibiotic cannot be used (based on sensitivity testing results).
DELICAMENT Ceva s unique solution n Our range of antibiotics is tailored for veterinary use. Our products are available in two and four-way break tablets as well as a liquid clindamycin. The flavoured and chewable tablets have been designed to improve acceptance and compliance. Amoxicillin + clavulanic acid available in 0mg, 62.mg, 20mg, 00mg, 62mg Cefalexin available in 7mg, 300mg and 70mg Clindamycin available in 88mg, 26mg and 2mg oral solution Marbofloxacin available in 10mg, 0mg, 100mg Achieving dosing accuracy over a wide weight range has never been easier. Enrofloxacin available in 1mg, 0mg, 10mg and 200mg
n Because antibiotics should only be used when necessary to limit the development of resistance, Ceva has a range of dermatology products for all skin types. A range of shampoos, waterless mousses, pads, spoton and serum to maintain the skin barrier. Chlorehexidine digluconate and miconazole shampoo for dogs available in 200ml and 00ml bottles. Ciclosporin oral solution for dogs. Available in ml, 1ml, 30ml and 0ml bottles. To find out more about our products, please visit ceva.co.uk or contact your territory manager.
Kesium chewable tablets for cats and dogs. Active substances: amoxicillin (as amoxicillin trihydrate) and clavulanic acid (as potassium clavulanate). Indications for Use: For the treatment of the following infections caused by ß lactamase producing strains of bacteria sensitive to amoxicillin in combination with clavulanic acid and where clinical experience and/or sensitivity testing indicates the product as the drug of choice. For the treatment of skin infections (including superficial and deep pyodermas) associated with Staphylococcus spp., urinary tract infections associated with Staphylococcus spp., Streptococcus spp., Escherichia coli and Proteus mirabilis, respiratory tract infections associated with Staphylococcus spp., Streptococcus spp. and Pasteurella spp., digestive tract infections associated with Escherichia coli. Infections of the oral cavity (mucous membrane) associated with Pasteurella spp., Streptococcus spp., Escherichia coli. Efex chewable tablets for cats and dogs. Active substance: marbofloxacin. Indications for use: In cats marbofloxacin is indicated in the treatment of skin and soft tissue infections (wounds, abscesses, phlegmons) caused by susceptible strains of organisms. Upper respiratory tract infections caused by susceptible strains of organisms. In dogs marbofloxacin is indicated in the treatment of: skin and soft tissue infections (skinfold pyoderma, impetigo, folliculitis, furunculosis, cellulitis) caused by susceptible strains of organisms, urinary tract infections (UTI) caused by susceptible strains of organisms associated or not with prostatitis or epididymitis, respiratory tract infections caused by susceptible strains of organisms. Therios palatable tablets for dogs or chewable tablets for cats. Active substance: cefalexin (as cefalexin monohydrate). Indications for use: In cats: Infections caused by bacteria susceptible to cefalexin: Lower urinary tract infections due to Escherichia coli and Proteus mirabilis, treatment of cutaneous and subcutaneous infections: pyoderma due to Staphylococcus spp. and wounds and abscesses due to Pasteurella spp. In dogs: For the treatment of bacterial skin infections in dogs (including deep and superficial pyoderma) caused by organisms sensitive to cefalexin, for the treatment of urinary tract infections in dogs (including nephritis and cystitis) caused by organisms sensitive to cefalexin. XeDen tablets for cats and dogs. Active substance: Enrofloxacin. Indications for use: In cats: treatment of upper respiratory tract infections. In dogs: treatment of lower urinary tract infections (associated or not with prostatitis) and upper urinary tract infections caused by Escherichia coli or Proteus mirabilis, treatment of superficial and deep pyoderma. Zodon chewable tablets for dogs and oral solution for cats and dogs. Active substance: Clindamycin (as hydrochloride). Indications for use: Infections caused by clindamycin sensitive organisms. In cats: For the treatment of infected wounds and abscesses caused by clindamycin sensitive species of Staphylococcu spp. and Streptococcus spp. In dogs: For the treatment of infected wounds, abscesses and oral cavity/dental infections caused by or associated with clindamycin sensitive species of Staphylococcus spp., Streptococcus spp., (except Streptococcus faecalis), Bacteroides spp., Fusobacterium necrophorum, Clostridium perfringens, for the treatment of superficial pyoderma associated with Staphylococcus pseudintermedius, for the treatment of osteomyelitis caused by Staphylococcus aureus. Adaxio Shampoo for dogs. Active substance: Chlorhexidine digluconate 20 mg (equivalent to chlorhexidine 11.26 mg), miconazole nitrate 20 mg (equivalent to miconazole 17.37 mg). Indications for use: For the treatment and control of seborrhoeic dermatitis associated with Malassezia pachydermatis and/or Staphylococcus pseudintermedius. Contraindications: Do not use in case of hypersensitivity to the active substances or to any of the excipients. Modulis 100 mg/ml oral solution for dogs. Active Substance: Ciclosporin 100mg/ml. Indications for use: Treatment of chronic manifestations of atopic dermatitis in dogs. Contraindications: Do not use in cases of hypersensitivity to ciclosporin or one of the excipients. Do not use in dogs less than six months of age or less than 2 kg in weight. Do not use in cases with a history of malignant disorders or progressive malignant disorders. Do not vaccinate with a live vaccine during treatment or within a two week interval before or after treatment. For further information on contraindications, side effects, precautions and warnings, please refer to product packaging and leaflet. Further information is available from the SPCs. Use medicines responsibly (www.noah.co.uk/responsible). Legal category: POM-V UK POM IE