Choice of treatment for infected cat bites

RE: Choice of treatment for infected cat bites

Richard Carter — Wed, 19 Oct 2016 18:32:13 GMT

[quote user="Clive Ansell"]I'm not keen on Convenia. I don't like the idea of a third generation cephalosporin being used for a standard cba unless a swab indicates otherwise[/quote]

Convenia in my hands has been a disaster in cat bite abscesses - one very pedigreed cat with owner to match turned into a festering mess on the new super just give one injection antibiotic when amox/clav sorted in 5 days.

In fact I cannot think of a single reason to use it in cats - marboflox/ doxycycline for respiratory, amox/clav penicillin for uti, orthopaedic and traumatic infections, clindamycin abscesses, pyoderma, dental infections?

RE: Choice of treatment for infected cat bites

Martin Atkinson — Wed, 19 Oct 2016 16:23:27 GMT

[quote user="Evelyn Barbour-Hill"]Why would you want to give more than 24 hours worth of antibiotic for a cat bite abscess?[/quote] I have not been follwoing these threads a) becaue I have other things to do and b) my browser froze and didn't show an y new threads for 48 hours.

Maybe I'm barking up the wrong tree here but in answer to the question I would pose another: why give any antibiotic if you're not going to give a complete course and thereby risk poor response and antibiotic resistance?

RE: Choice of treatment for infected cat bites

Christina Smith — Tue, 18 Oct 2016 21:58:48 GMT

If it's pyrexic antibiotics if not just drain. i usually see them after the pyrexic stage when it has burst and strangely the cat is eating again for the first time in 3 days

RE: Choice of treatment for infected cat bites

Iain Richards — Tue, 18 Oct 2016 21:39:01 GMT

Ah! but who remembers streptovin???

RE: Choice of treatment for infected cat bites

Anthony Todd — Tue, 18 Oct 2016 19:38:35 GMT

[quote user="Evelyn Barbour-Hill"]Anthony, this thread has been about cat bite abscesses. Not about recent bites or cellulitis.[/quote]

I just assumed we were following the thread title?

[quote user="Anthony Todd"]Sometimes it's just a lame cat with or without a temp. Back in the day a CBA was "assumed"[/quote]

Well not with me it wasn't. In the absence of any definite findings a bite (not an abscess) might betentatively assumed as a working hypothesis, and the analgesic and 24-hour antibiotic given. Before we had carprofen, just the antibiotic. Maybe a phenylbutazone tablet. (You can generally find the puncture if you look hard enough.)

So roughly what I did then, except Rimadyl was just a glint in someone's eye, back in that day.

RE: Choice of treatment for infected cat bites

Evelyn Barbour-Hill — Tue, 18 Oct 2016 18:01:42 GMT

[quote user="Anthony Todd"]

Usually or often you get a swollen painful puncture so no chance of lancing etc.......

Sometimes it's just a lame cat with or without a temp. Back in the day a CBA was "assumed"and Pen given with considerable success rather than "dunno" or the modern multi-test barrage.

[/quote]

Anthony, this thread has been about cat bite abscesses. Not about recent bites or cellulitis.

But since you raise the separate question of cellulitis, that from me would also get a dose of Synulox, a dose of carprofen and an appointment to check the next day.

[quote user="Anthony Todd"]Sometimes it's just a lame cat with or without a temp. Back in the day a CBA was "assumed"[/quote]

Well not with me it wasn't. In the absence of any definite findings a bite (not an abscess) might be tentatively assumed as a working hypothesis, and the analgesic and 24-hour antibiotic given. Before we had carprofen, just the antibiotic. Maybe a phenylbutazone tablet. (You can generally find the puncture if you look hard enough.)

Back in the day, as you say, we did house visits and many an abscess have I lanced in the owner's home without benefit of GA....... when I write my book one chapter is going to be "Places I Have Sprayed Pus"

"Ah but I was so much older then, I'm younger than that now....."

RE: Choice of treatment for infected cat bites

Anthony Dennison — Tue, 18 Oct 2016 17:24:39 GMT

I had a cat once come in for a booster and when I examined the cat he had a huge abscess right where I would have injected - no obvious external wounds, cat was fine and well in himself, no temp!

Lanced,drained flushed, 5 days of Antirobe and was fine a couple of weeks later for his booster.

RE: Choice of treatment for infected cat bites

Anthony Todd — Tue, 18 Oct 2016 16:17:09 GMT

[quote user="Clive Ansell"]I prefer to treat by lance and drainage, debriding as needed,[/quote]

Usually or often you get a swollen painful puncture so no chance of lancing etc.......

Sometimes it's just a lame cat with or without a temp. Back in the day a CBA was "assumed"and Pen given with considerable success rather than "dunno" or the modern multi-test barrage.

PS or even B12, Bets, and pen, with a credible success rate. [awaits **it storm]

RE: Choice of treatment for infected cat bites

Kate Richardson — Tue, 18 Oct 2016 16:10:18 GMT

Convenia comes in a smaller 3 or 4ml size now if you want to keep it but minimise use. (I rarely use it)

RE: Choice of treatment for infected cat bites

Thomas Johnson — Tue, 18 Oct 2016 15:22:31 GMT

[quote user="Evelyn Barbour-Hill"]Yes, "pen and strep" was procaine penicillin and streptomycin.[/quote]

And it still is:

http://www.norbrook.com/farm-animal-health/products/pen-strep-suspension-for-injection

RE: Choice of treatment for infected cat bites

Iain Richards — Tue, 18 Oct 2016 15:14:29 GMT

I attended and excellent One Health seminar on AMR in 2014 and one of the great unanswered questions was, "How long is appropriate?" I seems to recall from micro lectures that 3 days was a minimum for G+ve and penicillins, as it ensured all bacteria went through binary fission that exposed the cell wall to the penicillin. Never reconcilled this with 24 hours to cover an agar plate! I'll confess to somewhat empirical dosing 3, 5, 7 days depending on how it looked. Clam LA still does for most though, especially with some NSAID so the cat feels better (or rhus tox!)

RE: Choice of treatment for infected cat bites

Clive Ansell — Tue, 18 Oct 2016 12:43:08 GMT

[quote user="Evelyn Barbour-Hill"]I wonder how often in Convenia practices it gets used because the bottle's been opened and they don't want to waste it.[/quote]

It certainly does.

I was working earlier in the year within a group of 6 practices, we would often have internal messages from (Non veterinary qualified) management encouraging Convenia usage as not to waste it.

They made a fundamental error by under pricing it: they encourage use based on cost, it was about the same price as a 7 day Synulox course for a cat. Secondly, because it was under priced, if any was disposed of they would actually lose money on each vial, so there would be pressure to use it.

RE: Choice of treatment for infected cat bites

Clive Ansell — Tue, 18 Oct 2016 12:31:33 GMT

I prefer to treat by lance and drainage, debriding as needed, then Amoxycillin. Most often it is not available, so amox/clav. I usually prescribe a weeks worth. Usual use an nsaid too.

For cats that are difficult to mediate I prefer injecting every other day with Amox LA. I agree with Evelyn that in many cases a much shorter course is often sufficient. I've had many not return for follow up Amox LA injections, because they are better.

I'm not keen on Convenia. I don't like the idea of a third generation cephalosporin being used for a standard cba unless a swab indicates otherwise. That said, I do occasionally use it for very difficult cats or where owners cannot medicate at all. I don't like giving owners the choice based on cost comparison, it should be a veterinary led decision, not a consumer choice one.

RE: Choice of treatment for infected cat bites

Evelyn Barbour-Hill — Tue, 18 Oct 2016 12:00:23 GMT

[quote user="Neil Wheadon"]

[quote user="Evelyn Barbour-Hill"]Convenia would be hideously expensive[/quote]

Depends on the mark up (yes really) and it lasts 28 days when broached, so lots of cats in a bottle

[/quote]

There's no way a bottle would get used up in 28 days by me. I wonder how often in Convenia practices it gets used because the bottle's been opened and they don't want to waste it.

[quote user="Neil Wheadon"]

[quote user="Evelyn Barbour-Hill"]and others far more qualified than I in pharmacology and the science of antibacterial drug resistance have pointed out the dubious ethics of using this drug.[/quote]

Yet the makers are now pushing it in dogs....

[/quote]

From which one may conclude.........

I don't know whether to or

RE: Choice of treatment for infected cat bites

Anthony Dennison — Tue, 18 Oct 2016 10:32:47 GMT

[quote user="Evelyn Barbour-Hill"]Synulox and carprofen by injection, review the next day, repeat either by injection or per os for a couple of days only if necessary. That's a good tip about Antirobe, Id agree there (but not for cat bite abscesses!)[/quote]

This is what I do - I maybe see 5-10% of cases back.

[quote user="Neil Wheadon"]I was also told by the rep that if you fridge it, it takes the taste away. When I tell this to clients I add humour, saying that I've never tried it myself[/quote]

I've been told this too, and tell clients regularly. We've switched over to Zodon, and for cats it comes in a liquid which is even easier to give.

RE: Choice of treatment for infected cat bites

Neil Wheadon — Tue, 18 Oct 2016 08:15:45 GMT

The power of Vetsurgeon which is underused is thousands of cases treated by vets in practice that have a start and end point and this illustrates.

[quote user="Evelyn Barbour-Hill"]Synulox and carprofen by injection, review the next day, repeat either by injection or per os for a couple of days only if necessary.[/quote]

OK I'll try that

[quote user="Evelyn Barbour-Hill"]That's a good tip about Antirobe,[/quote]

Thanks!!

I was also told by the rep that if you fridge it, it takes the taste away. When I tell this to clients I add humour, saying that I've never tried it myself

[quote user="Evelyn Barbour-Hill"]Convenia would be hideously expensive[/quote]

Depends on the mark up (yes really) and it lasts 28 days when broached, so lots of cats in a bottle

[quote user="Evelyn Barbour-Hill"]and others far more qualified than I in pharmacology and the science of antibacterial drug resistance have pointed out the dubious ethics of using this drug.[/quote]

Yet the makers are now pushing it in dogs....

[quote user="Evelyn Barbour-Hill"]Anecdote! I had an abscess develop in my armpit. I had it excised and the surgeon left a huge hole open into which I was supposed to pack alginate rope every day ( I didn't, and it healed very quickly). Anyway the surgeon made a point of telling me that he would "withhold antibiotics"[/quote]

Neil

RE: Choice of treatment for infected cat bites

Evelyn Barbour-Hill — Mon, 17 Oct 2016 23:27:01 GMT

I do apologise for turbo-posting but for some reason (either vetsurgeon or my browser) I can't quote when I "review entire thread".

[quote user="Neil Wheadon"]So what do you do with pyrexic cats?[/quote]

Synulox and carprofen by injection, review the next day, repeat either by injection or per os for a couple of days only if necessary. That's a good tip about Antirobe, Id agree there (but not for cat bite abscesses!)

[quote user="Neil Wheadon"]For owners that can't pill cats I inject and admit to using Convenia (as do many other vets)[/quote]

I'd rather have them back and inject every day if we really can't get anything in per os.

Convenia would be hideously expensive (the owner would have to pay for a whole bottle) and others far more qualified than I in pharmacology and the science of antibacterial drug resistance have pointed out the dubious ethics of using this drug.

[quote user="Neil Wheadon"]It's a quandary as I believe that it's been shown that once an abscess is lanced you don't need antibiotics, but you'd be a brave vet to do that. I'll also add that I had my thumb lanced following a cat bite this year, loads of pus and yes a weeks penicillin.[/quote]

Well maybe I'm moderately brave.

Anecdote! I had an abscess develop in my armpit. I had it excised and the surgeon left a huge hole open into which I was supposed to pack alginate rope every day ( I didn't, and it healed very quickly). Anyway the surgeon made a point of telling me that he would "withhold antibiotics".

RE: Choice of treatment for infected cat bites

Evelyn Barbour-Hill — Mon, 17 Oct 2016 23:05:50 GMT

[quote user="John Wessels"]

''44 years ago we used pen and strep.''

Streptomycin?

[/quote]

Yes, "pen and strep" was procaine penicillin and streptomycin.

Or did we use straight penicillin for cats? The memory is going. That would have been Propen of course. (We had no qualms about dropping a "mastitis tube"( intramammary cerate) of whatever there was an open box of lying about, often pen and strep, into a cat spay. We'd have to start another tangent about that......)

RE: Choice of treatment for infected cat bites

Neil Wheadon — Mon, 17 Oct 2016 22:43:49 GMT

OK technically I started this, talking about using Convenia.

It's a quandary as I believe that it's been shown that once an abscess is lanced you don't need antibiotics, but you'd be a brave vet to do that. I'll also add that I had my thumb lanced following a cat bite this year, loads of pus and yes a weeks penicillin.

So what do you do with pyrexic cats? My first line is 7 x antirobe 75mg SID as I think this promotes compliance rather than BID. For owners that can't pill cats I inject and admit to using Convenia (as do many other vets) I'm not saying I'm right....

Neil

RE: Choice of treatment for infected cat bites

John Wessels — Mon, 17 Oct 2016 22:35:40 GMT

''44 years ago we used pen and strep.''

Streptomycin?

RE: Choice of treatment for infected cat bites

Evelyn Barbour-Hill — Mon, 17 Oct 2016 22:26:13 GMT

A cat bite abscess needs drainage.

Lancing and probing. Where necessary,mild curettage, excision of obviously necrotic skin or other tissue. Where necessary (deep tail bite for instance) possibly comparatively forceful expression of fibrin, and irrigation. Maybe cold poulticing (again on the tail).

One dollop of antibiotic "to make sure" (very scientific, that). And analgesic: at the least a dose of NSAID.

44 years ago we used pen and strep. Then Synulox got fashionable.

(Of course, all done under GA. Why would you not want a GA?)

The only time I'd use a longer course of antibacterial is in a deep tail bite or similar. Might use 3 days for that.

RE: Choice of treatment for infected cat bites

Anthony Todd — Mon, 17 Oct 2016 19:48:34 GMT

[quote user="Beats"]I would always use more than 24hrs amoxicillin in, for example, dorsal lumbar region cat bite abscesses (after lancing and flushing under sedation if needed). This may not be rationale, but is what I do.[/quote]

Back in the day I always had to change from amoxicillin, given by others, to penLA when the response was inadequate, measured by swelling, pain and pus. This gave an obvious dramatic improvement in 24hrs such that on revisit I couldn't in conscience charge a fee for a well cat!

I can't say that ordinary 24 hr. penicillin [can't remember the name] wouldn't do as well but I gave them 300000 IU [1ml], which used to be an overdose, but seemed to give excellent results with no come-backs.

This seemed rational. so it's what I did.

I was never convinced that lancing and flushing under sedation or GA did anything much more but owners seemed to appreciate it.

How on earth you can justify 14days worth of a broad-spectrum A/B for a specific simple infection. particularly in this day when a scientific, rational approach is gospel, is beyond me, added to which is, what, 50 years evidence of original penicillin's being totally effective.

And they wonder why bugs become resistant....