Antibiotics and cat bites

RE: Antibiotics and cat bites

Rob Loxley — Thu, 17 Aug 2017 19:56:37 GMT

[quote user="Martin Atkinson"]I wonder how much longer given current thinking is not to give a predetermined course but stop when the patient feels better[/quote]

Is this adopted, or just a recent BBC news headline? http://www.nhs.uk/news/2017/07July/Pages/Advice-that-a-course-of-antibiotics-should-be-finished-questioned.aspx

[quote user="Martin Atkinson"]When her arm didn't go down in 24 hrs she was hospitalised on IV antibiotics[/quote]

I suspect the intensification of treatment was as much to cover against septicaemia that just treating the arm, which can (if takes hold) have devastating consequences?

RE: Antibiotics and cat bites

Martin Atkinson — Thu, 17 Aug 2017 17:26:15 GMT

[quote user="robloxley"]Out of interest, NHS policy is to prescribe prophylactic antibiotics (usually 5 days co-amox) to people with cat bites if the wound is less than 48 hours old.[/quote]I wonder how much longer given current thinking is not to give a predetermined course but stop when the patient feels better to reduce the risk of antibiotic resistance which flies in the face of all we have previously been taught.

I had a client a few weeks ago who was bitten on her arm by her own cat so I dispatched her to her GP with the report sheet, her arm swelled up like a balloon within a couple of hrs and the GP gave her oral amoxyclav. When her arm didn't go down in 24 hrs she was hospitalised on IV antibiotics 'which took 3 days to work'.

My take on this is that no infection from a bite could possibly take hold that quickly and the acute swelling was an acute inflammatory cytokine reaction which would have been better managed with antihistamine/corticosteroids. She even said that she always reacts really badly to any insect bite or injury. I do wonder about the medical profession if they they actually understand how pathogens or even the body works.

RE: Antibiotics and cat bites

Iain Richards — Tue, 15 Aug 2017 22:40:39 GMT

I copped for a serious dog bite, ending up with overnight stay and i/v augmentin. NICE guidance is clear - prophylactic high dose amoxy-clav. The problem was exacerbated by the original A&E not flushing the wound. I'll be more insistent - should there be a next time.

In this case, I too would have given antibiotics to the dog.

RE: Antibiotics and cat bites

Derek Lyon — Tue, 15 Aug 2017 11:27:34 GMT

Yes where did this thread start! On a similar topic years ago I was trimming a Zebra's foot with a double edged hoof knife! You guessed it...the knife slipped and opened a huge gaping wound in my hand......had to quickly reverse the immobilisation with Revivon and rush off to A&E. There the Dr said it needed stitching. He was about to start when I asked him if he was going to clean out the wound as it might have Zebra faeces in it! Oh OK he said and then put LA in and sutured the wound. I had to enquire about giving me anti tetanus and antibiotics!! After he did that all I had to do was work with a very painful hand and go in 10 days to my GP for suture removal. He could not/was unable do it so I went home and removed them myself!! Happy days

RE: Antibiotics and cat bites

Mike Dale — Mon, 14 Aug 2017 19:55:25 GMT

[quote user="Michael Woodhouse"]Right, we are in agreement, give antibiotics. This rarely happens on here. Now tell us the story that prompted the thread![/quote]

A relative's dog seen within an hour of a cat attack. Did not apparently receive antibiotics and became seriously ill. I do not know the full facts of the case, have not examined the dog and have absolutely refused to comment on that basis. The subsequent illness might have been unrelated. However, it had me thinking, "What would I have done about the cat bite injuries? What would most people have done?

I would have given antibiotics; how much and what type would depend on the severity and site of injury and the former health status of the patient. And in response to earlier comment about thorough cleaning - well, you clean what you can and that must be better than doing nothing. Whether or not you perform radical surgical exploration will depend again on the situation and one's personal experience of treating such wounds. When I was hospitalised by a retriever bite to my hand ripping a tendon sheath the consultant sent me back to theatre next day because his registrar had not opened and explored the wounds on the other side of my hand. I made a full recovery.

RE: Antibiotics and cat bites

Michael Woodhouse — Mon, 14 Aug 2017 00:04:22 GMT

[quote user="Mike Dale"]If you were presented with a dog that an hour or two earlier had been bitten by a cat several times and had clear puncture wounds, would you prescribe a course of antibiotics immediately after due cleaning of the wounds?[/quote]

Right, we are in agreement, give antibiotics. This rarely happens on here. Now tell us the story that prompted the thread!

RE: Antibiotics and cat bites

Rob Loxley — Sun, 13 Aug 2017 20:29:44 GMT

[quote user="Nicola M"]

[quote user="robloxley"]

Out of interest, NHS policy is to prescribe prophylactic antibiotics (usually 5 days co-amox) to people with cat bites if the wound is less than 48 hours old.

[/quote]

Is that a new thing?

[/quote]

https://cks.nice.org.uk/bites-human-and-animal#!changes
"May 2008 — minor update to the text for animal bites, making it clearer that all cat bites require antibiotic prophylaxis. Issued May 2008."

RE: Antibiotics and cat bites

Beats — Sun, 13 Aug 2017 20:24:07 GMT

[quote user="Nicola M"]

[quote user="robloxley"]

Out of interest, NHS policy is to prescribe prophylactic antibiotics (usually 5 days co-amox) to people with cat bites if the wound is less than 48 hours old.

[/quote]

Is that a new thing? I had to virtually beg for them a few years ago when had deep bite over tendon sheaths...

[/quote]

https://cks.nice.org.uk/bites-human-and-animal#!scenariorecommendation:14

or http://tinyurl.com/yd282o9l if you want a quick URL to jot down to be handed to medical professional.

If I recommend someone attends casualty / their GP, I dispatch them with a printed copy of the relevant NICE guidelines, where applicable, to streamline care - same goes for any potential zoonosis. I have only ever seen problems with reasonable care (suturing series of deep penetrating wounds to hand from bite injury and no antibacterials... student whose hand was seriously swollen when came back 2 days later...) when treated by nurse at casualty and not actually attended to by doctor. My GP prescribes amox/clav over the phone for cat bite injuries on request in my limited experience after ensuring adequate local treatment has been undertaken.

RE: Antibiotics and cat bites

Anthony Todd — Sun, 13 Aug 2017 18:01:48 GMT

[quote user="Martin Atkinson"]an injection of pot. amox.[/quote]

There were many CBAs that came back to me after broad spectrum A/Bs and were dramatically improved with good old narrow spectrum pen LA.

Makes me laugh, with all this high and mighty talk of restricting the use of broad spectrum A/Bs!

RE: Antibiotics and cat bites

Anthony Todd — Sun, 13 Aug 2017 17:55:56 GMT

Sorry, I can't delete my mysterious duplicates, sorry again.

RE: Antibiotics and cat bites

Anthony Todd — Sun, 13 Aug 2017 17:55:09 GMT

[quote user="Derek Lyon"]with cat bites an injection with Duplocillin LA was given with check up and repeat (if needed) 3 days later. Mind you this was over 20 years ago and perhaps times have changed? [/quote]

And it worked every time!!

RE: Antibiotics and cat bites

Derek Lyon — Sun, 13 Aug 2017 17:25:55 GMT

Over 20 years ago we told owners/Vets who had had a cat bite to go to NHS and receive treatment and supplied a client information sheet. Owners and medics thought your needed anti tetanus injections rather than antibiotics.!! As for animals with cat bites an injection with Duplocillin LA was given with check up and repeat (if needed) 3 days later. Mind you this was over 20 years ago and perhaps times have changed?

RE: Antibiotics and cat bites

Dermod Malley — Sat, 12 Aug 2017 21:58:17 GMT

[quote user="robloxley"]Out of interest, NHS policy is to prescribe prophylactic antibiotics (usually 5 days co-amox) to people with cat bites if the wound is less than 48 hours old.[/quote]

I thought it was flucloxacillin, but that was probably 15 years ago and apparently the agent of choice to treat HUMAN bites n- ie man bites man. Does the VDS still supply a client information sheet about bites that recommends GP's/A&E to give metronidazole?

RE: Antibiotics and cat bites

Evelyn Barbour-Hill — Sat, 12 Aug 2017 17:18:26 GMT

[quote user="Bob Russell"]I will also give a cat with an abscess at least a three day injection. [/quote]

Ah now, a cat bite abscess is a completely different kettle of fish. Most do not need any antibiotic (nor any sulphonamide nor any metronidazole) at all.

RE: Antibiotics and cat bites

patrick murphy — Sat, 12 Aug 2017 16:11:25 GMT

what is a 3 day injection please? is that once daily for 3 days? and back to an old chestnut of mine is there any evidence to support the efficacy of LA antibiotics (beside Convenia). the very last time it was in horses and in order to achieve a therapeutic level one had to give (if memory serves) 450 ml?and if they worked would it not save the NHS large amounts of wasted dispensed antibiotics? just wondering

RE: Antibiotics and cat bites

Anthony Todd — Sat, 12 Aug 2017 14:41:09 GMT

[quote user="Nicola M"]s that a new thing? I had to virtually beg for them a few years ago when had deep bite over tendon sheaths...[/quote]

I remember a judge at a cat show losing a finger joint after a cat bite!

RE: Antibiotics and cat bites

Nicola Cole — Sat, 12 Aug 2017 14:28:50 GMT

[quote user="robloxley"]

Out of interest, NHS policy is to prescribe prophylactic antibiotics (usually 5 days co-amox) to people with cat bites if the wound is less than 48 hours old.

[/quote]

Is that a new thing? I had to virtually beg for them a few years ago when had deep bite over tendon sheaths...

RE: Antibiotics and cat bites

Anthony Todd — Sat, 12 Aug 2017 14:27:15 GMT

[quote user="Mike Dale"]due cleaning of the wounds?[/quote]

How does anyone "clean" a puncture wound from a cat canine, that's if you can even find them sometimes??

PS One shot of pen used to fix CBAs that had already had a course of amox......

And I thought it was modern to restrict broad-spectrum ABs to the indicated usage viaculture and sens.?

RE: Antibiotics and cat bites

Emily Rainbow — Sat, 12 Aug 2017 13:55:14 GMT

If just skin puncture wounds then a Amox LA inj only. If a bit more then a 5d course.

If it's burst/I lance an abscess in consult then just the inj.

RE: Antibiotics and cat bites

Bob Russell — Sat, 12 Aug 2017 10:48:34 GMT

Absolutely!

I will also give a cat with an abscess at least a three day injection. Have not given long courses for years because cats recover rapidly and owners don't complete courses anyway. I did feel a bit irresponsible doing this but my belief has been that our job is to tip the balance in the favour of the immune system.

Some suggestions being made recently indicate this may not have been such an evil thing to do after all!

I have limited antibiotic use generally massively in the last ten years though!

RE: Antibiotics and cat bites

Martin Atkinson — Sat, 12 Aug 2017 10:45:28 GMT

Yes not least because even if you've adequately cleaned the wounds you cannot be certain that there are not others you've missed. I would typically give an injection of pot. amox. and a 5 day course of tablets.

RE: Antibiotics and cat bites

Rob Davis — Sat, 12 Aug 2017 10:23:58 GMT

Yes

RE: Antibiotics and cat bites

Rob Loxley — Sat, 12 Aug 2017 09:24:13 GMT

[quote user="Mike Dale"]would you prescribe a course of antibiotics[/quote]

Yes

Out of interest, NHS policy is to prescribe prophylactic antibiotics (usually 5 days co-amox) to people with cat bites if the wound is less than 48 hours old.

RE: Antibiotics and cat bites

Virginia Campbell — Fri, 11 Aug 2017 21:56:22 GMT

Yes. That is what antibiotics are for. But agree one shot would do; I'd probably give Synulox. Might give a couple of days' worth of tablets if it had really been hammered or I was unsure of the timing of the bites.

RE: Antibiotics and cat bites

vetbl.locum — Fri, 11 Aug 2017 21:29:09 GMT

Yes but one shot not course

Taking cover now

Rgds