Topic of the Month Brainstorm: Use of Antibiotics In Common Cases

RE: Topic of the Month Brainstorm: Use of Antibiotics In Common Cases

Andrew Kent — Tue, 19 Sep 2017 21:22:20 GMT

[quote user="Nicola M"]

I looked into this last night (out of curiosity). I'll say at the start I DON'T AGREE with it being available without prescription.

The theory is that a pharmacist will only dispense them if they see evidence of bacterial conjunctivitis-which can be difficult to distinguish from viral. Presumably if you went to the doctor with the same signs they would also dispense it (as long as the pharmacist has been trained appropriately). Just like a lot of vets would reach for an eye prep which included an antibiotic with ocular discharge of a few days duration.

So in theory it frees up doctors time if they're not dealing with those cases (estimated to previously have been 2% of all visits to the GP) and if the treatment would be the same...

[/quote]

Thanks for the info Nicola - I suppose we are lucky to not have the political aspect to this that human medics do as its a whole additional complexity!

RE: Topic of the Month Brainstorm: Use of Antibiotics In Common Cases

Anthony Todd — Tue, 19 Sep 2017 09:24:46 GMT

[quote user="Anthony Todd"]You know I ignore opinions, even from you....[/quote]

[sigh] Andrew gets hoisted by his own petard yetI get my usual one star; there is no justice.......

RE: Topic of the Month Brainstorm: Use of Antibiotics In Common Cases

Nicola Cole — Tue, 19 Sep 2017 09:23:23 GMT

[quote user="Anthony Todd"]

Fair enough. I'd accept your view more easily if the humans would stop chloro in simple eye drops.

[/quote]

I looked into this last night (out of curiosity). I'll say at the start I DON'T AGREE with it being available without prescription.

So in theory it frees up doctors time if they're not dealing with those cases (estimated to previously have been 2% of all visits to the GP) and if the treatment would be the same...

Unfortunately you can also buy them over the internet so that degree of control has in some situations been lost.

When it was first introduced it would appear there was resistance from at least some of the medical profession.

Chloramphenicol is not a third line antibiotic from a reserving it for human use point of view. There are very few things it would be chosen to treat-the main exception being the eye where it works very well if in the right formulation. Used orally/I.v. it has a number of side effects, some of which are dose dependent and reversible, one specific one which isn't reversible-aplastic anaemia.

It's use in food producing animals is controlled/banned (depending on the country) because of concerns over meat residues for human consumption and they couldn't set a 'safe limit' so due to the risk of aplastic anaemia it was stopped.

That being said, there is also environmental contamination with chloramphenicol (it is also a naturally occurring product and from previous use before its use was stopped in food animals-it and metabolites can be passed in faeces so it's thought was spread as manure to fertilise land etc).

Anyway, I'm not arguing the case for the use of it without prescription-I'm just giving some background as to why it may have been deemed acceptable by the licensing authorities: it's a drug which is mostly only used for the eyes, being dispensed (mostly-grr Internet) by people who have been trained to dispense it.

RE: Topic of the Month Brainstorm: Use of Antibiotics In Common Cases

Anthony Todd — Tue, 19 Sep 2017 00:35:24 GMT

[quote user="Andrew Kent"]I agree that the possible underlying viral disease makes me a little cautious but yes I use this for rhinitis and have had some good results.[/quote]

I'm sure you are preparing a paper as I type [slowly].

You know I ignore opinions, even from you....

RE: Topic of the Month Brainstorm: Use of Antibiotics In Common Cases

Kate Richardson — Mon, 18 Sep 2017 22:04:04 GMT

LOL, thought you were telling me off!!!

RE: Topic of the Month Brainstorm: Use of Antibiotics In Common Cases

Andrew Kent — Mon, 18 Sep 2017 21:59:57 GMT

[quote user="Kate Richardson"]Why the [/quote]

Just because i've barely got my head around antibiotic resistance yet so can't even think about antivirals :-)

RE: Topic of the Month Brainstorm: Use of Antibiotics In Common Cases

Kate Richardson — Mon, 18 Sep 2017 21:57:10 GMT

[quote user="Andrew Kent"]

[quote user="Kate Richardson"] I use famcyclovir a lot as well, maybe we should be reaching for that more, but does that potentially lead to viral resistance then?[/quote]

[/quote]

Why the

RE: Topic of the Month Brainstorm: Use of Antibiotics In Common Cases

Andrew Kent — Mon, 18 Sep 2017 21:55:46 GMT

[quote user="Kate Richardson"]Andrew Kent problem with corticosteroids in these cases is vast majority are herpes virus related so risk of worsening clinical signs, however at an anti inflammatory dose you might be ok. Do you use inhaled steroids for rhinitis cases? Is it effective for rhinitis? [/quote]

I agree that the possible underlying viral disease makes me a little cautious but yes I use this for rhinitis and have had some good results.

[quote user="Kate Richardson"] I use famcyclovir a lot as well, maybe we should be reaching for that more, but does that potentially lead to viral resistance then?[/quote]

RE: Topic of the Month Brainstorm: Use of Antibiotics In Common Cases

Kate Richardson — Mon, 18 Sep 2017 21:44:05 GMT

Andrew Kent problem with corticosteroids in these cases is vast majority are herpes virus related so risk of worsening clinical signs, however at an anti inflammatory dose you might be ok. Do you use inhaled steroids for rhinitis cases? Is it effective for rhinitis? I use famcyclovir a lot as well, maybe we should be reaching for that more, but does that potentially lead to viral resistance then?

RE: Topic of the Month Brainstorm: Use of Antibiotics In Common Cases

Andrew Kent — Mon, 18 Sep 2017 21:25:32 GMT

[quote user="Kate Richardson"]I'm not comfortable with it either Andrew Kent but whats the alternative for cats with chronic rhinitis? [/quote]

The most common alternative for me would be inhaled steroids which I do find effective in some cases. Historically we favoured antibiotics over steroids due to side effects to the individual but in my mind this is now reversed.

[quote user="Anthony Todd"]Fair enough. I'd accept your view more easily if the humans would stop chloro in simple eye drops[/quote]

But we can control our own behaviour much more easily than other peoples and it is all steps in the right direction.

[quote user="Nicola M"]

But it's only 'a single cat' if only one vet in the country does it for one animal!

Every single vet (or doctor) that uses antibiotics when they're not needed, bearing in mind this is likely to be multiple animals a day unless the mindset changes, adds up to so much more than 'a single cat' when you look at the animal population as a whole.

[/quote]

[quote user="Kate Richardson"]I usually use antibiotic A, (short courses as needed) until it stops being effective, then go to B, and C, and often end up going back to A, which then works again, which I hope means no permanent resistance has developed. [/quote]

The problem with some of these diseases is we are using antibiotics for the possible immunomodulating activity rather than antibiotic activity, with doxycycline being the most common in the airway.

Andy

RE: Topic of the Month Brainstorm: Use of Antibiotics In Common Cases

Kate Richardson — Mon, 18 Sep 2017 19:44:57 GMT

[quote user="Anthony Todd"]

[quote user="Kate Richardson"] what's the alternative for cats with chronic rhinitis? [/quote]

I assume the A/Bs are giving a satisfactory response??

If not then what's the point?

If they are then repeat when signs recur??

Or try a different one??

[/quote]

I can only speak for myself, but assume others would do the same, yes only conti ue giving if a satisfactory response. Absolutely no point if not. Short courses as needed and repeated as necessary.

[quote user="Anthony Todd"]

[quote user="Clive Ansell"]Before "trying a different one" why not take a swab for culture and sensitivity? try and indentify the pathogens involved and which ab might be the most effective, for a more specifically targeted approach. Inexpensive, and non invasive. [/quote]

I would assume, in this day of testing, that a swab or more had already be done, moreover the bacteria would probably be sensitive to one or more A/B on culture.

Not sure that a culture and sens. is cheaper than a generic A/B but, a point that seems to be glossed over, not always do culture and sens. match the clinical response.

Ignoring the fact that, after antibiotics of any nature the flora has been changed.

Er, and the delay in waiting for lab. results.

Give me 5 days of the next likely A/B any day.

[/quote]

I have to agree with you Anthony! Occasionally will swab for C&S but costs become prohibitive when the clinical signs recur so frequently as is often the case with chronic rhinitis. The other side of it is you are dealing with secondary infection, likely commensals, which is a worry if one ends up selecting for a resistant one which then becomes a pathogen.

I usually use antibiotic A, (short courses as needed) until it stops being effective, then go to B, and C, and often end up going back to A, which then works again, which I hope means no permanent resistance has developed.

RE: Topic of the Month Brainstorm: Use of Antibiotics In Common Cases

Nicola Cole — Mon, 18 Sep 2017 18:17:37 GMT

[quote user="Anthony Todd"]

PS Not sure that a 5 day course of an A/B, in a single cat, is going to change the resistance landscape in feline medicine as much as the purists believe.

[/quote]

But it's only 'a single cat' if only one vet in the country does it for one animal!

RE: Topic of the Month Brainstorm: Use of Antibiotics In Common Cases

Anthony Todd — Mon, 18 Sep 2017 13:38:26 GMT

I would assume, in this day of testing, that a swab or more had already be done, moreover the bacteria would probably be sensitive to one or more A/B on culture.

Not sure that a culture and sens. is cheaper than a generic A/B but, a point that seems to be glossed over, not always do culture and sens. match the clinical response.

Ignoring the fact that, after antibiotics of any nature the flora has been changed.

Er, and the delay in waiting for lab. results.

Give me 5 days of the next likely A/B any day.

PS Not sure that a 5 day course of an A/B, in a single cat, is going to change the resistance landscape in feline medicine as much as the purists believe.

RE: Topic of the Month Brainstorm: Use of Antibiotics In Common Cases

Clive Ansell — Mon, 18 Sep 2017 12:45:35 GMT

[quote user="Anthony Todd"]

[quote user="Kate Richardson"] what's the alternative for cats with chronic rhinitis? [/quote]

I assume the A/Bs are giving a satisfactory response??

If not then what's the point?

If they are then repeat when signs recur??

Or try a different one??

[/quote][quote user="Anthony Todd"]

[quote user="Kate Richardson"] what's the alternative for cats with chronic rhinitis? [/quote]

I assume the A/Bs are giving a satisfactory response??

If not then what's the point?

If they are then repeat when signs recur??

Or try a different one??

[/quote]

Before "trying a different one" why not take a swab for culture and sensitivity? try and indentify the pathogens involved and which ab might be the most effective, for a more specifically targeted approach. Inexpensive, and non invasive.

RE: Topic of the Month Brainstorm: Use of Antibiotics In Common Cases

Anthony Todd — Mon, 18 Sep 2017 12:42:02 GMT

[quote user="Robin Grimmer"]Spot on Sarah.[/quote]

Fair enough. I'd accept your view more easily if the humans would stop chloro in simple eye drops.

RE: Topic of the Month Brainstorm: Use of Antibiotics In Common Cases

Robin Grimmer — Mon, 18 Sep 2017 12:19:01 GMT

Spot on Sarah. Anthony, you are no spring chicken. God forbid, but supposing you were in hospital and picked up an infection that was multi-drug resistant? Might make you think that perhaps we shouldn't be dishing out antibiotics like sweeties when there is no clinical justification just to placate owners. Medics have got their house in order, we need to do the same. There hasn't been a 'new' antibiotic for 30 years now.

RE: Topic of the Month Brainstorm: Use of Antibiotics In Common Cases

Sarah Keir — Mon, 18 Sep 2017 11:51:23 GMT

[quote user="Anthony Todd"]

[Same embarrassment with the side-effects of childrens' measles vaccination. No good saying to an affected child's parents "But, it's very rare"....]

[/quote]

Which is why so many children did not get the correct vaccinations and we had measles outbreaks! And by avoiding these 'a bit difficult' conversations with clients we end up giving antibiotics where they are not making a difference and run the risk of running out of antibiotics that work within our lifetimes!

RE: Topic of the Month Brainstorm: Use of Antibiotics In Common Cases

Anthony Todd — Mon, 18 Sep 2017 11:04:30 GMT

[quote user="Kate Richardson"] what's the alternative for cats with chronic rhinitis? [/quote]

I assume the A/Bs are giving a satisfactory response??

If not then what's the point?

If they are then repeat when signs recur??

Or try a different one??

RE: Topic of the Month Brainstorm: Use of Antibiotics In Common Cases

Anthony Dennison — Mon, 18 Sep 2017 09:19:45 GMT

[quote user="Anthony Todd"]

[quote user="David Mills"]never, ever, ever, seen dry eye, sterile folliculitis or arrhropathy[/quote]

Nor me. Someone must have??

Wasn't it only in dobermans??

[/quote]

I had a cross-breed dog get acute hepatitis after giving it TMPS for a skin infection. Came back a couple of days after starting the course a little lethargic and so incredibly yellow.

RE: Topic of the Month Brainstorm: Use of Antibiotics In Common Cases

Kate Richardson — Sun, 17 Sep 2017 20:45:49 GMT

[quote user="Andrew Kent"]

Another topic that I find challenging with antibiotic use is those conditions that end up on chronic, often continuous, antibiotics. The most common of those that I see are the chronic gut disease dogs that only respond to antibiotics (usually metronidazole in the UK), the chronic rhinitis dogs/cats that only respond to doxycycline and the recurrent urinary tract infections that end up with frequent antibiotic treatment.

A few years ago I never really worried about this but now I do and I really really try to avoid it but its not always possible.

How do others feel about continuous antibiotics?

Andy

[/quote]

I'm not comfortable with it either Andrew Kent but whats the alternative for cats with chronic rhinitis?

RE: Topic of the Month Brainstorm: Use of Antibiotics In Common Cases

Andrew Kent — Sun, 17 Sep 2017 14:35:25 GMT

A few years ago I never really worried about this but now I do and I really really try to avoid it but its not always possible.

How do others feel about continuous antibiotics?

Andy

RE: Topic of the Month Brainstorm: Use of Antibiotics In Common Cases

Anthony Todd — Sun, 17 Sep 2017 12:08:32 GMT

[quote user="Andrew Kent"]I have never had a problem with that approach or had anything die that I think would have survived had I started antibiotics earlier.[/quote]

Sorry for chopping your quote.

I suppose it comes back to the "Aren't you going to give it something?" and the manure that would follow, when it came back, to say nothing of more serious complications, if I didn't.

I'll live with the possibility of antibiotic sensitivity when the modvet gives a broad sperctrum A/B when ordinary penicillin is more effective.....

RE: Topic of the Month Brainstorm: Use of Antibiotics In Common Cases

Andrew Kent — Sun, 17 Sep 2017 11:50:23 GMT

[quote user="Anthony Todd"]

[quote user="Andrew Kent"]I have never had a problem with that approach or had anything die [/quote]

Nor me, with my approach.

[/quote]

but at what cost? How many unnecessary antibiotic treatments?

and can we really say now that unnecessary antibiotics don't do any harm both for the individual and the population?! Because the evidence suggests just the opposite.

PS thanks for where you terminated my quote - definitely not the life of a medic :-)

RE: Topic of the Month Brainstorm: Use of Antibiotics In Common Cases

Anthony Todd — Sun, 17 Sep 2017 11:08:45 GMT

[quote user="Andrew Kent"]I have never had a problem with that approach or had anything die [/quote]

Nor me, with my approach.

RE: Topic of the Month Brainstorm: Use of Antibiotics In Common Cases

Andrew Kent — Sun, 17 Sep 2017 10:34:58 GMT

[quote user="Anthony Todd"]

How do you justify not giving an A/B??

"Not necessary, except in the rare case when the dog may develop a pneumonia", not that A/Bs would do any harm....]????

[/quote]

It's honestly not that difficult to justify not giving antibiotics if you talk to, and explain your thought process, to the clients - I accept this takes time and is not straightforward in a 5 minute consult.

If an infectious complication were to develop then I would discuss and add an antibiotic.

I have never had a problem with that approach or had anything die that I think would have survived had I started antibiotics earlier.

Andy