IV Antibiotic availability

RE: IV Antibiotic availability

Evelyn Barbour-Hill — Mon, 08 Feb 2016 00:21:42 GMT

[quote user="KathW"] or do you send everything home with 2 - 6 days of oral antibiotics? [/quote]

Good heavens, no.

RE: IV Antibiotic availability

KathW — Sun, 07 Feb 2016 18:31:53 GMT

[quote user="Mark Hedberg"]This is why i don't tend to use IV augmentin - I just don't think the evidence is there; and if you're that keen to get antibiotics in the patient, why not inject s/c amox+clav 30 minutes before the op? [/quote]

I'm not a fan of I/v Augmentin either - I would use s/c amoxyclav 30 minutes pre op . What about the argument for short doses of antibiotics though? DO people use iv Augmentin peri op and then stop antibiotics or do they send patients home with oral antibiotics as a follow up? Thinking about an orthopaedic operation lasting 2-3 hours or a mammary lump removal with no drains placed for example.

If you use s/c amoxyclav do you stop at that for some cases (ie 24 hrs treatment) or do you send everything home with 2 - 6 days of oral antibiotics? Just wondering as I'm trying to use less antibiotics and shorter courses these days.

RE: IV Antibiotic availability

Michael Woodhouse — Wed, 03 Feb 2016 22:30:04 GMT

I've never felt the need to give a small animal Buscopan - I don't really recognise 'colic' in dogs like in horses and cattle.

Betamox doesn't sting. I warn with Cerenia - keeping it in the fridge helps, but people keep opening new bottles. We had 5 bottles open so it's back on the open shelf now!

With vaccines I use whatever needle comes with the vaccine to draw up and inject. Think with the Eurican its a 23G. The trick to animals not feeling it is a tight grip on the skin - so it is tight. That way the animal never feels or reacts to the needle. Same with horse vaccines.

I used to love it when the owners ask if you are going to give the booster and you've already done it an neither the dog or owner noticed!

RE: IV Antibiotic availability

Catriona MacIntyre — Wed, 03 Feb 2016 22:21:16 GMT

[quote user="Virginia Campbell"]Really? The animal mightn't think so. The first dog I ever gave Buscopan to was a little Yorkie with a crampy colicky tummy. I read the label "IM or IV". In consult room not inpatient, no nurse to hold up a vein (and even so probably not worth the fight with a little wriggly dog). Right ho, into the muscle it goes. The dog screamed solidly for about 15 minutes and didn't put its foot down on that quarter for about an hour. Since then, if I want to use it and have no IV line in I ignore the licensed route and give it SQ (unless quiet dog with good veins). It still stings a bit and I warn the owner about this.[/quote]

I did this very same thing as a new grad, also in a Yorkie. Horrible! Rarely have problems with sc amoxy'clav though (we use Noroclav). Cerenia - occasionally animals react. Storing the bottle in the fridge is said to reduce the stinging. I use B12 quite a lot and always warn owners that it can be sore. A few of them are on IM B12 themselves and are amazed at how brave their wee pet is

RE: IV Antibiotic availability

Virginia Campbell — Wed, 03 Feb 2016 22:10:42 GMT

[quote user="Virginia Campbell"]it stings[/quote]

[quote user="Michael Woodhouse"]Crap reason[/quote]

Really? The animal mightn't think so. The first dog I ever gave Buscopan to was a little Yorkie with a crampy colicky tummy. I read the label "IM or IV". In consult room not inpatient, no nurse to hold up a vein (and even so probably not worth the fight with a little wriggly dog). Right ho, into the muscle it goes. The dog screamed solidly for about 15 minutes and didn't put its foot down on that quarter for about an hour. Since then, if I want to use it and have no IV line in I ignore the licensed route and give it SQ (unless quiet dog with good veins). It still stings a bit and I warn the owner about this.

Same thing with Cerenia, Synulox and B12 - if I'm using them in consult I will give the stingiest last and explain to the owner that they sting before I give them.

[quote user="Virginia Campbell"]it has to go through a 21G needle,[/quote]

[quote user="Michael Woodhouse"]Crap reason. I inject everything into small animals with a 21G needle.[/quote]

I used to do this, then started drawing up with a 21G needle then swapping onto a fresh 25G needle. First with puppy vaxes, now with any creatures- anything that will go through a 25G needle does. The owners notice the difference and I often get expressions of surprise when then animal doesn't react ("oh he screamed last time, I wondered if the other vet had done it wrong"). Of course I still get some react to the needle, but not as many. I'll often inject as I chat and quite often have to show the owners the empty bottle to prove I've done it as they haven't noticed.

I don't know if everyone else in the practice warms the vaxes in their pocket during the consult or not so that might contribute but I'm sure some of the improvement is due to the smaller needle.

RE: IV Antibiotic availability

Virginia Campbell — Wed, 03 Feb 2016 21:49:35 GMT

[quote user="Mark Hedberg"]If I had to pick between stinging and anaphylaxis, I'm probably going to go with stinging, thanks ;)[/quote]

Yes, me too - as I said at the start of the thread. I used to use Augmentin before we saw the increase in incidence of reactions.

[quote user="Virginia Campbell"]I don't routinely use antibiotics for dentals but if the mouth is pretty disgusting I used to like giving Augmentin at induction. I'm not happy with the risk of reaction just as the animal is being anaesthetised though, so tend to use sq Synulox (I'm a trifle happier about this since we had a conversation here a while ago about SQ vs IV and somebody said the Synulox reached decently high tissue levels within 15minutes or something)[/quote]

RE: IV Antibiotic availability

Robin Grimmer — Wed, 03 Feb 2016 18:47:42 GMT

Similar thing with Previcox. There is no injectable form but you can give a tablet pre op for post op analgesia .

RE: IV Antibiotic availability

Clive Ansell — Wed, 03 Feb 2016 18:28:56 GMT

I was at a cpd meeting promoting, I think, Onsior where they were telling us oral administration achieves therapeutic levels quicker through gastric mucoscal absorption, than the injectable.

RE: IV Antibiotic availability

Bob Russell — Wed, 03 Feb 2016 16:53:42 GMT

When Clamoxyl first came out on the market, there was no injectable produced as Beechams did not consider it necessary. The tablets produced therapeutic levels within minutes!

Clearly their R&D department was not staffed with cat owners!!!

RE: IV Antibiotic availability

Thomas Johnson — Wed, 03 Feb 2016 15:40:38 GMT

[quote user="Bob Russell"]

I think they are overused because this is 'what human surgeons do'. Augmentin is a human drug and probably easier to administer i/v than giving an i/m.

[/quote]

One of our nurses was bitten badly on the back of the hand by a cat a couple of years ago, we sent her straight off to the NHS walk-in centre which is just round the corner from the practice. She was seen by a nurse who cleaned and examined the wounds, and decided that she needed to go to A&E to have them assessed by a doctor, which is fair enough, but wouldn't give her oral antibiotics as the hospital would want to give her i/v antibiotics. The practice manager drove her to A&E, followed by waiting for a couple of hours and eventually i/v antibiotics. However she ended up with septic tendonitis and had to have her hand opened up for them to be flushed. I suspect if she had been given oral antibiotics straight away that could have been avoided.

RE: IV Antibiotic availability

Bob Russell — Wed, 03 Feb 2016 14:00:43 GMT

I think they are overused because this is 'what human surgeons do'. Augmentin is a human drug and probably easier to administer i/v than giving an i/m.

I am far from convinced that there is much justification for going off licence in this situation. I would hardly claim to be a worrier regarding cascade. It is more of an irritation than something I lose sleep over.

RE: IV Antibiotic availability

David Mills — Wed, 03 Feb 2016 11:31:56 GMT

Apologies if this story is mis-remembered but Malcolm Ness off of here used to set his interns a task shortly after starting to find the evidence for superior efficacy of IV amoxiclav over IM amoxiclav for serum or tissue values by time of surgery in animals. None such existed. As I understand it, IM amoxiclav reaches tissue values comparable to IV. SQ takes longer but certainly if given with premed 1-2h before cutting would be fine. IM is my preferred route after induction, as usually for anything serious will take 20-30m before animal is cut.

I think IV abx are vastly overused due to some skewed logic that the animal needs them fast. The only indication I can think of in companion animals is in an unstable, shocky animal, such as those with septic peritonitis, pyothorax or aggressive ST infection that is causing septic shock. Whether IV abx improves outcome in these animals no-one knows.

RE: IV Antibiotic availability

Mark Hedberg — Wed, 03 Feb 2016 11:16:40 GMT

[quote user="Virginia Campbell"]

[quote user="Mark Hedberg"]why not inject s/c amox+clav 30 minutes before the op? [/quote]

Cos it has to go through a 21G needle, and it stings.

[/quote]

If I had to pick between stinging and anaphylaxis, I'm probably going to go with stinging, thanks ;)

RE: IV Antibiotic availability

Glen McIntosh — Wed, 03 Feb 2016 01:52:02 GMT

[quote user="Clive Ansell"]

[quote user="KathW"]Wren - Cerenia (maropitant) is now licensed for I/v use in dogs and cats .[/quote]

It is, but according to the data sheet it is to be given as a bolus and not mixed with other fluids. Can we therefore put it in a drip line?

[/quote]

We've been doing this for some time now and it is great to have administration to cats and the iv method of administration finally "legitimised".

The data sheet says "Intravenous administration of Cerenia should be given as a single bolus without mixing the product with any other fluids".

I think that this statement has been included because when people were using Cerenia off label by giving it IV, it was the received wisdom that you should dilute it first with normal saline (along with other well intentioned guidelines such as: administer it slowly, clap your hands 3 times, turn around twice, and spit). I would take this statement as meaning that you can safely administer it unadulterated, as an IV bolus straight out of the bottle.

The only other specific warning regarding Cerenia's compatibility with other substances is in the Pharmaceutical Precautions section which says: "In the absence of compatibility studies, Cerenia solution for injection must not be mixed with other veterinary medicinal products in the same syringe".

While there is no specific endorsement of compatibility with commonly used IV fluids, there is no specific mention about incompatibility with commonly used iv fluids either, and this is typical for data sheets of most IV administrable products (unless, of course, there is a specific known incompatibility, in which case it will be mentioned).

The reason for this, I guess, is that it is assumed that IV administered drugs will, as a typical practice (and this is certainly so in the large institutions and universities where these types of registration studies are performed), be administered in an iv drip line, typically running normal saline.

We have had no recognised problems administering Cerenia in IV lines running a variety of fluids including 0.9%NaCl, LRS/Hartmans, 0.9% NaCl + 5% dextrose, LRS + 5% dextrose and 0.45%Nacl + 2.5% dextrose. This has been over the past 2 or so years in a 25 vet specialist referral hospital averaging around 40 - 50 inpatients at any one time.

RE: IV Antibiotic availability

Michael Woodhouse — Tue, 02 Feb 2016 23:24:40 GMT

[quote user="Virginia Campbell"]Cos it has to go through a 21G needle, and it stings. [/quote]

Crap reason. I inject everything into small animals with a 21G needle.

Do we even need the clavulanic acid? We would use Betamox LA (straight amoxycillin) for such reasons. Remember it is AUC not concentration above MIC that determines beta-lactams efficacy.

Sub cut at pre-med seems to work swimmingly.

RE: IV Antibiotic availability

Virginia Campbell — Tue, 02 Feb 2016 23:07:45 GMT

[quote user="Mark Hedberg"]why not inject s/c amox+clav 30 minutes before the op? [/quote]

Cos it has to go through a 21G needle, and it stings.

RE: IV Antibiotic availability

Bob Russell — Tue, 02 Feb 2016 16:38:18 GMT

I have seen papers that suggest longer procedures come with higher infection risks. What I cannot see is why using a non-licenced human drug i/v is going to be better than an injectable with rapid absorption rates and good tissue penetration.

Clearly the i/v product is not without risk of adverse reactions compared to a well tried and tested injectable. These should provide several hours of antibiotic cover.

Genuine questions, not a criticism of those that do use it.

I will consider antibiotics with the really manky mouths but generally start a few days before treatment and for a very short period after.

(If someone is going to one star me, would they care to explain why I am so wrong in their opinion?)

RE: IV Antibiotic availability

Mark Hedberg — Tue, 02 Feb 2016 15:40:51 GMT

[quote user="Bob Russell"]

How often is an i/v antibiotic really that necessary in general practice? Seems to be quite routine with some specialists but is that them trying to be clever?

Is it really that superior to s/c Synulox? The body is perfectly well equipped to deal with a quick blast of haematogenous spread bugs released during dentistry.

Long and involved orthopaedic procedures might be a little different but not i am not that convinced.

[/quote]

This is why i don't tend to use IV augmentin - I just don't think the evidence is there; and if you're that keen to get antibiotics in the patient, why not inject s/c amox+clav 30 minutes before the op?

RE: IV Antibiotic availability

Bob Russell — Tue, 02 Feb 2016 14:20:24 GMT

How often is an i/v antibiotic really that necessary in general practice? Seems to be quite routine with some specialists but is that them trying to be clever?

Is it really that superior to s/c Synulox? The body is perfectly well equipped to deal with a quick blast of haematogenous spread bugs released during dentistry.

Long and involved orthopaedic procedures might be a little different but not i am not that convinced.

RE: IV Antibiotic availability

Clive Ansell — Tue, 02 Feb 2016 11:10:19 GMT

[quote user="KathW"]Wren - Cerenia (maropitant) is now licensed for I/v use in dogs and cats .[/quote]

It is, but according to the data sheet it is to be given as a bolus and not mixed with other fluids. Can we therefore put it in a drip line?

RE: IV Antibiotic availability

KathW — Tue, 02 Feb 2016 10:17:50 GMT

Wren - Cerenia (maropitant) is now licensed for I/v use in dogs and cats .

RE: IV Antibiotic availability

Hannah Wynne Richards — Mon, 01 Feb 2016 16:16:20 GMT

A former boss of mine kept saying pevidine when he meant pethidine, and vice-versa!

Wynne

RE: IV Antibiotic availability

Wren — Mon, 01 Feb 2016 15:33:05 GMT

Is it? Us poor horse vets currently can't get hold of Crystapen, depocillin or engemycin (and Excenel, though that is supposed to be temporary). When there are only about 6 licensed injectable abx for your species and most of them are currently long-term out of stock, leaving you with virtually only TMPS, then you can moan!

RE: IV Antibiotic availability

Wren — Mon, 01 Feb 2016 15:30:03 GMT

[quote user="Sarah Keir"]

Cerenia is licensed IV for dogs and cats. Soooo much better than stingy SC !

[/quote]

Do you mean Convenia? I had a colleague once who used to confuse the two when booking the work (I assume she actually GAVE the right one...) and you had to guess from the notes which it had had

Edited to add - actually maybe you do mean Cerenia as that is licensed IV. I am very confused!

RE: IV Antibiotic availability

Glenn Hodgson — Sun, 31 Jan 2016 18:17:17 GMT

Crystapen is still about.. :-)