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:

P Fusidic acid ■ Chronic bronchitis/allergic airway disease unless secondarily infected

rescribe only when necessary Culture essential to ensure effective Severe gingivitis and periodontitis: ■ Canine sino-nasal disease
This list is not comprehensive.
therapy Chlortetracycline
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 effect At risk group Recommendation
Culture strongly advised to guide therapy upper respiratory tract infection (Cat Flu):
nutritional imbalance, metabolic disorders) 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) Chlortetracycline pre-existing animals or when close
Ulcerative stomatitis: Doxycycline
without antibacterials renal disease, monitoring is not
Use your smartphone and a QR code Fusidic acid Metronidazole Amoxicillin/clavulanate
■ Offer a non-prescription form (see box bottom right) volume or available
reader to access extra information. Treat for 5–7 days Treat for 7–10 days electrolyte Do not exceed 7 days

R
Alternatively visit: Feline-specific disease: Treat chronic cat flu for 1 week beyond clinical plateau depletion treatment duration
educe prophylaxis bsavalibrary.com/protectme Chlamydophila felis SKIN AND EAR INFECTIONS Pneumonia:
Monitor urine for casts
Systemic doxycycline (amoxicillin/clavulanate in pregnant Ototoxicity Cats
■ Perioperative antibacterials are NOT a substitute for Antibacterials are not indicated for: Amoxicillin/clavulanate
queens and kittens) ■ Malassezia dermatitis
surgical asepsis Treat for 21–28 days For suspected Bordetella/Mycoplasma Amoxicillin/ Urticaria, hypotension Dogs under Caution with
■ Non-specific skin problems (e.g. pruritus)
■ Prophylactic antibacterials are only appropriate in some Doxycycline clavulanate Anaphylactoid reactions general intravenous use in
Mycoplasma felis
immunocompromised patients GASTROINTESTINAL INFECTIONS Bites and traumatic wounds: If antibacterial exposure in preceding 4 weeks or if hospitalized for >48 hours
(intravenous use) anaesthesia anaesthetized patients
Topical tetracycline
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

O ffer other options ■ Acute vomiting

■ Acute diarrhoea (including acute haemorrhagic cases)
■ Pancreatitis
Uncomplicated corneal ulceration:
Topical chloramphenicol
■ If systemically well and not pyrexic:
Topical treatment with 2–4% chlorhexidine
■ If systemically unwell and pyrexic
Fluoroquinolone + clindamycin
Treat for 4–6 weeks, based on C-reactive protein, or for 7–10 days beyond
clindamycin
Enrofloxacin
stricture
Retinal degeneration Cats
with food or water
Alternative
■ Consider therapeutic alternatives (lavage and Complicated corneal ulceration (infectious radiographic resolution leading to partial, fluoroquinolones
■ Most gastric Helicobacter infections
debridement of infected material, cough suppressants, keratitis): Systemic antibacterials based on cytology: temporary or total preferred in cats
■ Most Campylobacter, Salmonella, Clostridium perfringens Pyothorax:
fluid therapy, nutritional modification) Topical chloramphenicol AND For cocci blindness
or C. difficile infections Fluoroquinolone + amoxicillin (± clavulanate)
■ Using topical preparations reduces selection pressure ■ Chronic diarrhoea (except as part of a treatment trial) Topical gentamicin Clindamycin
Fluoroquinolones Defective cartilage Young dogs Avoid in growing
on resident intestinal flora (the microbiome) Topical ciprofloxacin Cefalexin Fluoroquinolone + clindamycin
development leading to animals
■ Use effective hygiene techniques and antiseptics to Acute diarrhoea with systemic signs indicating actual Treat for 4–6 weeks (and beyond radiographic/ultrasonographic resolution)
Topical ofloxacin Amoxicillin/clavulanate 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 first 48 hours – reduced once the neurotoxicity doses

T Amoxicillin/clavulanate For rods

reat effectively If acute diarrhoea with systemic signs
destructive corneal process has stopped
Consider systemic antibacterial if, e.g. ‘melting’, corneal Fluoroquinolones
SURGICAL USE Penicillins Immediate and delayed Dogs/cats Avoid in penicillin-
perforation, marked uveitis Antibacterials are not indicated for: hypersensitivity reactions sensitive animals/
■ Consider which bacteria are likely to be involved Amoxicillin/clavulanate 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 flushing with saline or
■ Use the shortest effective course and avoid underdosing 2–4% chlorhexidine Prophylactic (perioperative) antibacterials are appropriate: Potentiated Keratoconjunctivitis sicca Dogs esp. Avoid in specified
Trial treatment of chronic diarrhoea/chronic enteropathy Amoxicillin/clavulanate
■ Ensure compliance with appropriate formulation and ■ For prolonged clean surgery (>90 minutes) or surgery involving an sulphonamides Hepatic necrosis (rare) Dobermanns, breeds
(‘inflammatory bowel disease’): Cefalexin and metronidazole Amoxicillin/clavulanate (for 7 days)
implant Immune complex Samoyeds Monitor Schirmer Tear
provide clear instructions 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

E mploy narrow spectrum Oxytetracycline

Prior to antibacterial trial, perform appropriate diagnostics
Attempt drainage via most appropriate route, usually via
mouth
2–4% chlorhexidine
Fusidic acid ± glucocorticoid
■ Where there is an obvious break in asepsis causing contamination of
the wound
■ For all contaminated wounds or if there is a pre-existing infection
thrombocytopenia)

■ 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 effects Trial antibacterial treatment should not exceed 3–4 weeks SYSTEMIC INFECTIONS Superficial pyoderma:
on commensal bacteria ■ Topical treatment ONLY is appropriate In most cases
■ Use culture results to support de-escalation (switching
Cholangitis/cholangiohepatitis:
Amoxicillin/clavulanate
Neutropenia:
■ Mild (neutrophil count >1000/µl) – antibacterial
2–4% chlorhexidine Amoxicillin/clavulanate DO NOT USE
to a narrower spectrum antibacterial) If required: Cefuroxime Antibacterials with restricted use in human medicine
Ampicillin NOT required
■ Moderate (neutrophil count 500–999/µl) AND well Clindamycin Intravenously 60 minutes before the first incision, then every 90 minutes (e.g. imipenem, linezolid, teicoplanin, vancomycin)
C
Cefalexin until the end of surgery
ulture appropriately Add metronidazole (dogs) Cefalexin Cefalexin
Amoxicillin/clavulanate Where anaerobic involvement is highly likely:
should not be used in animals.
Amoxicillin/clavulanate
Treat for 2–4 weeks Trimethoprim/sulphonamide Add metronidazole
■ A sample for culture should be collected before starting Trimethoprim/sulphonamide
antibacterial therapy wherever possible ■ Culture if rods are seen on cytology Do not continue antibacterials after surgery, unless there is a therapeutic
Treat for 5–7 days indication as this will select for resistance
■ Culture is essential when prolonged (>1week) treatment or there is a history of MRSP/MRSA
courses are anticipated, when resistance is likely URINARY TRACT INFECTIONS
■ Severe (neutrophil count <500/µl) AND/OR unwell
Amoxicillin/clavulanate (OR cefuroxime) + fluoroquinolone
or multiple prior antibacterial courses
Therapeutic (postoperative) antibacterials are indicated: Highest priority critically important
(e.g. hospital acquired infections) and in life-threatening
infections
Antibacterials are not indicated for:
Septic peritonitis secondary to gastrointestinal
Treat for minimum 3 weeks or 1 week beyond
clinical cure
■ To treat a known bacterial infection
■ When the risk of a postoperative infection developing is
antibacterials
■ Feline idiopathic cystitis (FIC)
■ If first-line treatment fails, do not use another ■ Feline struvite urolithiasis and canine non-struvite
leakage: Repeat cytology to assess response high due to contamination or major break in asepsis Fluoroquinolones (enrofloxacin, marbofloxacin,
antibacterial without supportive culture and sensitivity Metronidazole + marbofloxacin Use doses at top end of range for better skin pradofloxacin, ciprofloxacin), and 3rd- and 4th-generation
urolithiasis
results (avoid cycling antibacterials) penetration
■ Urinary incontinence Ampicillin + amikacin + metronidazole cephalosporins (cefovecin) should only be used when
■ Subclinical bacteriuria (canine or feline) Amoxicillin/clavulanate + marbofloxacin Deep pyoderma: MISCELLANEOUS INFECTIONS first-line antibacterials are inappropriate or ineffective.
T ailor your practice policy
■ Juvenile canine vaginitis

Uncomplicated, symptomatic, canine urinary

Initially intravenously then orally when clinical signs improve
Treat for 2 weeks following resolution of signs/abdominal
effusion
■ Whilst culture pending, systemic
antibacterial therapy based on
cytology as for superficial pyoderma
Pyometra:
Antibacterials not required if stable and proceeding directly to OHE
If urgent treatment is required, then samples for culture
and sensitivity testing should be submitted before starting
■ A customized practice policy can guide antibacterial tract infection (cystitis):
Add topical treatment with 2–4% Surgically managed:
these agents, and then therapy adapted.
selection to address the bacterial infections and Amoxicillin (± clavulanate) Bacteraemia/sepsis (including peritonitis of chlorhexidine
resistance patterns that you encounter, minimizing Trimethoprim/sulphonamide non-gastrointestinal origin): Amoxicillin (± clavulanate)
inappropriate use Treat for minimum 4–6 weeks or 2 weeks
Treat for 7–10 days Clindamycin + marbofloxacin Cefalexin + enrofloxacin
beyond clinical cure
■ Complete the tick boxes in this poster to highlight your
practice’s first-line approach to each condition Complicated canine or feline urinary tract infection
Ampicillin + metronidazole + marbofloxacin Ideally repeat cytology Treatment discontinued after surgery (unless septic peritonitis) First-line antibacterials
Ampicillin + amikacin + marbofloxacin Limit the use of first-line antibacterials to times of genuine
Reinfection, recurrent and persistent urinary tract Otitis externa: Medically managed:
Amoxicillin/clavulanate + marbofloxacin

M onitor infections: ■ Topical treatment ONLY Amoxicillin (± clavulanate) clinical need and avoid all unnecessary use.
Amoxicillin (± clavulanate) Initially intravenously then orally when clinical signs improve ■ 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 Mastitis:
Trimethoprim/sulphonamide
■ Track and record culture profiles and update your effusion and prognosis Cefalexin
practice policy accordingly If reinfection occurs, use the SAME antibacterial if previously
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 offspring weaned (early weaning NOT advised)
Review predisposing factors (e.g. urolithasis, anatomical Discospondylitis: Polymyxin B
important antibacterials (fluoroquinolones/cefovecin),
e.g. using mySavsnet AMR
abnormalities)
Cefalexin If cocci
Suspected Mycoplasma haemofelis (feline infectious anaemia): Responsible antibacterial use under the Cascade
Doxycycline
Prostatitis (entire males): Amoxicillin/clavulanate Florfenicol It is justifiable, on a case-by-case basis, to prescribe an antibiotic on the cascade
Marbofloxacin

E
Fluoroquinolones (high dose – see QR code) in the interests of minimizing the development of resistance, particularly where
Trimethoprim/sulfadiazine Fusidic acid/framycetin
ducate others Trimethoprim/sulphonamide Clindamycin Polymyxin B/miconazole
Treat for 4 weeks culture and sensitivity data indicate that a particular antibiotic active substance is
effective against a bacterial pathogen and where knowledge of pharmacokinetics
■ Share this important message to reduce the threat from Treat for 4–6 weeks + medical/surgical castration Intravenously, if severe neurological compromise or signs May combine with antiseptic ear cleaner Suspected leptospirosis:
indicates that the selected product is likely to be safe and effective 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.
of pets and people Canine struvite urolithiasis (for dissolution) Treat for minimum 8 weeks (based on clinical response) Penicillin G
Anal sac inflammation/engorgement without
Amoxicillin (± clavulanate) until resolution of Infective/septic arthritis: Amoxicillin (± clavulanate)
abscessation:
urolithiasis confirmed ■ Topical treatment ONLY Doxycycline is necessary to address renal colonization/carrier state
Dietary modification and urine acidification Cefalexin
Amoxicillin/clavulanate
■ Manual evacuation, flushing with Treat for 2 weeks
alongside treatment
chlorhexidine + packing with topical
Consider surgical removal Treat for 4 weeks OR until synovial fluid neutrophils <3% Hepatic encephalopathy (HE):
polypharmacy ear product containing
aminoglycoside or florfenicol Diet and lactulose should be first line therapies in the management of
Suspected pyelonephritis: Osteomyelitis: 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
Amoxicillin/clavulanate Cefalexin If symptomatic: Use non-prescription For further information on
information available to the publishers, editors and contributors at the time of writing. It is given on the understanding that BSAVA,
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
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) forms. Available from individual drugs and dosages,
referred to in this publication. Details of this kind must be verified 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 Trimethoprim/sulphonamide Amoxicillin
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 first 2–3 days then orally
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:
Amoxicillin/clavulanate and SAMSoc.org. Formulary.
copyright holder, and may not be sold. ISBN: 978-1-910443-63-7
Treat for 2–4 weeks Treat for 6–8 weeks Guest (guest) Ampicillin
© BSAVA/SAMSoc 2018 6957PUBS18
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On: Mon, 22 Apr 2019 13:13:39