Antibiotics and dentals

Re: Antibiotics and dentals

Tony Knapp — Sun, 06 Jul 2014 23:31:00 GMT

Thanks for all your replies I'll see if I can convince my boss, best get a cup of tea first...

Re: Antibiotics and dentals

Rob Loxley — Thu, 03 Jul 2014 00:04:37 GMT

[quote user="bob lehner"]Perhaps we should rethink what we use - I can't believe the bugs involved in a cat bite have evolved that much in 40 years?[/quote]

Ampicillin 50mg (amfipen) disappeared long ago. Tribrissen comes in sizes suitable for cats, but with a lot of antibiotics there sometimes aren't simple drugs in convenient formulations (IMHO). And I would agree that a 14 day acting (and who knows how long hanging around) 3rd generation cephalosporin is rather overkill when a shot of amoxyLA usually fixes it...

Re: Antibiotics and dentals

Anthony Todd — Wed, 02 Jul 2014 21:47:30 GMT

[quote user="John Flynn"]Perhaps we should rethink what we use [/quote]

I found 300k of penicillin seemed to work [in CBAs] the best by far but I've no evidence and I'm a dinovet.

What I am interested in is the relationship, oft quoted, between gingivitis/pyorrhoea and systemic infection viz renal disease.

Is this actually true, if so surely the antibiotic, if necessary, should be targeted at the bug causing the renal infection rather than every bug in the mouth?

Re: Antibiotics and dentals

John Flynn — Wed, 02 Jul 2014 19:54:42 GMT

[quote user="bob lehner"]

Perhaps we should rethink what we use - I can't believe the bugs involved in a cat bite have evolved that much in 40 years?

[/quote]

I use amoxicillin when indicated for cat bite abscesses - I don't remember a recent case of suspected resistance. but then maybe the bugs in Ireland are as backwards as us vets who have also failed to evolve often

You can get 'palatable' amoxicillin drops also - I rather like the Norbrook one for cats (smells like child's calpol, but cat's seem to take them on ham or whatever all right and can always squirt in mouth if stuck), but I haven't compared to alternatives in recent years so I can't really say. (http://www.norbrook.com/products/betamox-palatable-drops-powder-for-oral-suspension-50mg-ml)

Re: Antibiotics and dentals

bob lehner — Wed, 02 Jul 2014 09:29:58 GMT

[quote user="John Flynn"]But effectively my opinion is that staying away from the antibiotics higher up the pyramid is more important than reducing your use of those lower down?[/quote]

Very interesting point indeed.

I'm somewhat bemused how over the years amoxy-clav has more or less become the automatic a/b of first choice for many small animal practitioners - often for trivial/everyday infections.

When I graduated we had penicillin/ LA penicillin/streptomycin/ oxytet and possibly tribrissen. All cat bites etc. got straight penicillin and there never seemed to be a problem with resistance. Then ampicillin arrived, followed by amoxycillin then amoxy-clav - then all the cephs etc etc.

I think it was the very clever marketing of Synulox ('palatable' tabs - tho' not every cat seems to read the label) that brainwashed us into thinking this was the a/b of first choice for virtually everything.

Perhaps we should rethink what we use - I can't believe the bugs involved in a cat bite have evolved that much in 40 years?

Re: Antibiotics and dentals

John Flynn — Tue, 01 Jul 2014 08:23:38 GMT

[quote user="Evelyn Barbour-Hill"]What I know is that amoxy-clav was shown to be just as good as clindamycin in suppressing periodontal pathogens (or rather, the periodontal flora, but it's much the same thing). Presumably amoxicillin was not employed in the experiment because the experimenters knew they had to nail the beta-lactamase producers. Maybe they were just too lazy to try amoxicillin, I've no idea.[/quote]

Or the trial you refer to was sponsored by the manufacturer of an over-priced amox/clav mix? I'm only speculating.

The spectrum of activity of clindamycin and amox/clav is rather different, the former having virtually no effect on gram negatives for instance.

The suggestion that the normal oral flora has a common problem with aminopenicillin-resistance (other than perhaps in dogs treated by dermatologists) seems unlikely to me.

[quote user="Evelyn Barbour-Hill"]Do you have a bee in your bonnet about clavulanate?[/quote]

I guess so. With virtually no PK/PD data in dogs/cats, I think there are a lot of unknowns, however its the general premise that I would reserve amox/clav for resistant infections (prefarably post-culture) rather than as a first-line antibiotic, especially in an instance where I expect amox alone to do just fine.

[quote user="Evelyn Barbour-Hill"]Or do you have a thing about clindamycin? [/quote]

No, I'd use amoxicillin in preference generally re the suppression of oral flora.

Re: Antibiotics and dentals

Evelyn Barbour-Hill — Mon, 30 Jun 2014 22:39:55 GMT

[quote user="John Flynn"]

Does it reach therapeutic concentrations in dogs/cats to achieve this effect in the periodontal space [or wherever it was that started this chat]?

If not, then it's useless other than helping to cobble the gut bugs that don't have effective work-arounds, thus exerting a selection pressure by leaving those that do.

What makes you think amoxicillin has inadequate spectrum of activity to start with?

[/quote]

What I know is that amoxy-clav was shown to be just as good as clindamycin in suppressing periodontal pathogens (or rather, the periodontal flora, but it's much the same thing). Presumably amoxicillin was not employed in the experiment because the experimenters knew they had to nail the beta-lactamase producers. Maybe they were just too lazy to try amoxicillin, I've no idea.

[quote user="John Flynn"]If not, then it's useless other than helping to cobble the gut bugs that don't have effective work-arounds, thus exerting a selection pressure by leaving those that do.[/quote]

Well, of course. You could say the same of any antibacterial for any indication: if it doesn't reach adequate concentration in that site, if it does but it doesn't kill the bacteria you want to kill, all it will do is apply selection pressure for resistance.

A key to reducing selection pressure for resistance is to not use antibacterials unnecessarily.

What's your point? Do you have a bee in your bonnet about clavulanate? Or do you have a thing about clindamycin?

Re: Antibiotics and dentals

John Flynn — Mon, 30 Jun 2014 21:44:48 GMT

I found this from our learned European colleagues to provoke further discussion:

But effectively my opinion is that staying away from the antibiotics higher up the pyramid is more important than reducing your use of those lower down?

Re: Antibiotics and dentals

John Flynn — Mon, 30 Jun 2014 21:06:56 GMT

Does it reach therapeutic concentrations in dogs/cats to achieve this effect in the periodontal space [or wherever it was that started this chat]?

If not, then it's useless other than helping to cobble the gut bugs that don't have effective work-arounds, thus exerting a selection pressure by leaving those that do.

What makes you think amoxicillin has inadequate spectrum of activity to start with?

Re: Antibiotics and dentals

Evelyn Barbour-Hill — Mon, 30 Jun 2014 19:37:51 GMT

[quote user="John Flynn"]

[quote user="Evelyn Barbour-Hill"]clindamycin has no advantage over amoxy-clav in efficacy in this situation.[/quote]

I'm not sure what the 'clav' is bringing to the party (other than an increased selection-pressure for nasty resistant bugs)?

[/quote]

A good point.

The clavulanate is there to overcome resistance via beta-lactamase to penicillins (it's a beta-lactam similar to but not the same as penicillin, and it nobly throws itself upon the enzyme and suicidally inactivates it..... but you knew that ) thus considerably extending the usefulness of amoxycillin. It's use of an antibiotic that exerts selection pressure for resistance to that antibiotic. The most important answer is to not use it unnecessarily (as in straightforward dental procedures, heavens help us); I don't see the value of using one of inadequate spectrum of activity on the occasions when an antibiotic is indicated.

Re: Antibiotics and dentals

John Flynn — Mon, 30 Jun 2014 19:12:53 GMT

[quote user="Evelyn Barbour-Hill"]clindamycin has no advantage over amoxy-clav in efficacy in this situation.[/quote]

I'm not sure what the 'clav' is bringing to the party (other than an increased selection-pressure for nasty resistant bugs)?

Re: Antibiotics and dentals

Evelyn Barbour-Hill — Mon, 30 Jun 2014 18:58:44 GMT

[quote user="Neil Wheadon"]

[quote user="Evelyn Barbour-Hill"]

That's assuming that you need an antibiotic.

Which you don't.

[/quote]

Did I mention using it for a dental? (Winking smiley face - as smilies thing is kaput on this computer)

Neil

[/quote]

N-n-n--no, sir. Oo gosh nees tremble.

Re: Antibiotics and dentals

Neil Wheadon — Mon, 30 Jun 2014 18:33:50 GMT

[quote user="Evelyn Barbour-Hill"]

That's assuming that you need an antibiotic.

Which you don't.

[/quote]

Did I mention using it for a dental? (Winking smiley face - as smilies thing is kaput on this computer)

Neil

Re: Antibiotics and dentals

Evelyn Barbour-Hill — Mon, 30 Jun 2014 16:37:45 GMT

[quote user="Neil Wheadon"]

[quote user="Martin Atkinson"]7-10 days Antirobe [/quote]

For compliance

1) 75mg SID

2) Put them in the fridge and open the capsule and put this on food. It takes the taste away!!?? Sure the rep told me this and I have asked clients how they got on and it seems to work, but haven't tried it myself

Neil

[/quote]

Or use one of the palatable amoxy-clavs. It's been shown (no I can't quote chapter and verse, you know me) that clindamycin has no advantage over amoxy-clav in efficacy in this situation.

That's assuming that you need an antibiotic.

Which you don't.

Re: Antibiotics and dentals

Neil Wheadon — Mon, 30 Jun 2014 16:30:09 GMT

[quote user="Martin Atkinson"]7-10 days Antirobe [/quote]

For compliance

1) 75mg SID

Neil

Re: Antibiotics and dentals

Rob Davis — Mon, 30 Jun 2014 15:17:26 GMT

[quote user="Evelyn Barbour-Hill"]To which I would add, in the cases Tony describes, there is no need for any antibiotic whatsoever.[/quote]

I would agree - I rarely use antibiotics for my dental procedures.

[quote user="Martin Atkinson"]You're absolutely right, a single short acting antibiotic injection is pointless and irresponsible.[/quote]

However, this I would disagree with. For patients who are potentially at an increased risk from bacteraemia (eg endocardiosis, orthopaedic implants etc) then some dental specialists would advise a single IV injection of ampicillin, repeated every 2 hours during surgery. Post - operative antibiosis is unnecessary (you are only trying to provide therapeutic plasma concentration of antibiotic during the bacteraemia phase, which occurs during mastication as well as during oral surgery, and which normal self-resolves within around 20 minutes).

Re: Antibiotics and dentals

Evelyn Barbour-Hill — Mon, 30 Jun 2014 11:46:07 GMT

Wot Martin said.

To which I would add, in the cases Tony describes, there is no need for any antibiotic whatsoever.

Re: Antibiotics and dentals

Martin Atkinson — Mon, 30 Jun 2014 09:35:51 GMT

You're absolutely right, a single short acting antibiotic injection is pointless and irresponsible. Cefovecin has little or no anaerobic action so is not indicated for dentals. 7-10 days Antirobe (or amoxyclav at a push) or nothing for me