Review Article on antibiotics

RE: Review Article on antibiotics

Camilla Edwards — Thu, 02 Aug 2018 10:53:08 GMT

https://onlinelibrary.wiley.com/doi/abs/10.1111/jsap.12862

RE: Review Article on antibiotics

vetbl.locum — Thu, 02 Aug 2018 10:36:12 GMT

[quote user="bob lehner"]See article in this month's JSAP suggesting that the addition of metronidazole has no benefit over amoxyclav alone for HGE cases.[/quote]

Any chance of link to that article ?

Rgds

RE: Review Article on antibiotics

Martin Atkinson — Mon, 30 Jul 2018 11:55:20 GMT

[quote user="Anthony Todd"]My next door neighbour has an aged CKCS which has been diagnosed with pancreatic disease and is on a special tinned diet from the vet. [low fat!] Gets recurrent D&V and is always given metronidazole and is always better in 24hours.[/quote]As said: it is more than likely acting as an immunomodulatory agent, probably has IBD as well as pancreatic disease albeit what is meant by 'pancreatic disease' needs to be defined.

RE: Review Article on antibiotics

Bob Russell — Mon, 30 Jul 2018 11:34:45 GMT

My patients have managed to get better without metronidazole over a period of 30 odd years.

Fever, significant dysentery or signs of systemic disease will occasionally be given antibiotics. After a full work up the situation may be different but I would probably go for salazopyrine rather than metronidazole. Never seen a dry eye case following a short course but clearly it is something to discuss with owners.

RE: Review Article on antibiotics

Rob Loxley — Sun, 29 Jul 2018 17:32:31 GMT

[quote user="Evelyn Barbour-Hill"]metronidazole is cheaper than any other placebo............. [/quote]

maybe not, since Metrobactin!

RE: Review Article on antibiotics

Evelyn Barbour-Hill — Sun, 29 Jul 2018 16:35:34 GMT

[quote user="Anthony Todd"]Gets recurrent D&V and is always given metronidazole and is always better in 24hours.......[/quote]

The thing is, metronidazole is cheaper than any other placebo.............

RE: Review Article on antibiotics

Laurence Webb — Sat, 28 Jul 2018 23:49:19 GMT

[quote user="Anthony Todd"]

[quote user="robloxley"]a more realistic scenario in a first opinion practice,[/quote]

My next door neighbour has an aged CKCS which has been diagnosed with pancreatic disease and is on a special tinned diet from the vet. [low fat!]

Gets recurrent D&V and is always given metronidazole and is always better in 24hours.......

[/quote]Regression to the mean?

RE: Review Article on antibiotics

Anthony Todd — Sat, 28 Jul 2018 23:29:28 GMT

[quote user="robloxley"]a more realistic scenario in a first opinion practice,[/quote]

My next door neighbour has an aged CKCS which has been diagnosed with pancreatic disease and is on a special tinned diet from the vet. [low fat!]

Gets recurrent D&V and is always given metronidazole and is always better in 24hours.......

RE: Review Article on antibiotics

Rob Loxley — Sat, 28 Jul 2018 18:31:20 GMT

[quote user="Beats"]Re the original post query, try: https://www.fecava.org/sites/default/files/files/DSAVA_AntibioticGuidelines%20-%20v1-1_3(1).pdf[/quote]

Looks like interesting reading for a quiet time

[quote user="Camilla Edwards"]I was one of the authors on the above mentioned JSAP article - we were hoping to create a more realistic scenario in a first opinion practice, rather than a purified, referral level population, so although it was not perfect - it probably reflects real life more than other trials do.[/quote]

It's great to see research coming out of practice, and answering the question posed so congratulations, but in these days of antibiotic stewardship would be nice to see a group without antibiotic treatment for comparison. I guess with lots of research it poses as many questions as it answers!

RE: Review Article on antibiotics

Camilla Edwards — Sat, 28 Jul 2018 18:14:26 GMT

I was one of the authors on the above mentioned JSAP article - we were hoping to create a more realistic scenario in a first opinion practice, rather than a purified, referral level population, so although it was not perfect - it probably reflects real life more than other trials do.

RE: Review Article on antibiotics

Beats — Sat, 28 Jul 2018 18:08:07 GMT

[quote user="bob lehner"]See article in this month's JSAP suggesting that the addition of metronidazole has no benefit over amoxyclav alone for HGE cases.[/quote]

I skim-read the article and I was unsure what, if any, conclusion to draw from it. One for the journal club?

Re the original post query, try: https://www.fecava.org/sites/default/files/files/DSAVA_AntibioticGuidelines%20-%20v1-1_3(1).pdf

Re metronidazole query, I didn't know it was the must use anti-diarrhoea drug in dogs? It features highly in the) pyramid of irresponsibility by some sources (like link above which places it alongside fluoroquinolones etc owing to its importance for C.difficile in human healthcare in hospital settings. [fig 1.1 in section 1.7]. Using such an important antibacterial for claimed "anti-inflammatory" effects sounds slightly odd? Steroids are excellent anti-inflammatories.

If you read Jill Maddison's (RVC) approach in her book (https://www.wiley.com/en-us/Clinical+Reasoning+in+Small+Animal+Practice-p-9781118741757)

aimed at the general practitioner, antibiotics seem to form a surprisingly important part of her suggested approach to diarrhoea.

RE: Review Article on antibiotics

bob lehner — Sat, 28 Jul 2018 17:38:30 GMT

[quote user="vetbl.locum"]

Can some one point me in direction of article reviewing antibiotic usage and discussion of time versus concentration types. Either in large or small animals

Also, one on why metronidazole is the must use anti diarrhoea drug for dogs!!

Rgds

[/quote]

See article in this month's JSAP suggesting that the addition of metronidazole has no benefit over amoxyclav alone for HGE cases.

RE: Review Article on antibiotics

Niall Taylor — Wed, 18 Jul 2018 20:22:46 GMT

[quote user="vetbl.locum"]... why not just use steroids which probability are less toxic![/quote]

Not convinced about the relative 'toxicity'. If you have a chronic condition requiring long-term medical and dietary management then low dose metronidazole might be preferable to prednisolone. Although I'm happy to admit I don't have any firm evidence to that effect .

[quote user="vetbl.locum"]Surely that trio needs Vit B12 for completeness! [/quote]

True!!!

Niall

RE: Review Article on antibiotics

Rob Loxley — Wed, 18 Jul 2018 19:27:42 GMT

[quote user="vetbl.locum"]If we are using it for anti inflammatory effect ...[/quote]

... then I wouldn't use the Metrobactin labelled dose

RE: Review Article on antibiotics

vetbl.locum — Wed, 18 Jul 2018 17:48:50 GMT

If we are using it for anti inflammatory effect ...why not just use steroids which probability are less toxic!

Surely that trio needs Vit B12 for completeness!

Rgds

RE: Review Article on antibiotics

Anthony Todd — Wed, 18 Jul 2018 17:46:54 GMT

[quote user="vetbl.locum"]so you did use antibiotic ..............neomycin[/quote]

[groan] I told you that, but has anyone any evidence that neomycin ever made any difference to any diarrhoea in any dog?

[it used to fix cows with alleged salmonella when the oral powder was mixed with dextrose and given I/V; those were the days....]

RE: Review Article on antibiotics

Niall Taylor — Wed, 18 Jul 2018 17:37:54 GMT

[quote user="vetbl.locum"]so you did use antibiotic ..............neomycin [/quote]

Probably the kaolin adsorbed it so it didn't have any effect anyway!

FWIW I agree with Martin, metronidazole is used more for it's anti-inflammatory effect in cases of infiltrative bowel disorder. Anti-biotics used in the sense of killing bugs are pretty useless, if not counterproductive in most GI cases unless you've got something specific like, say giardia, when you need to use... oh, yes, metronidazole!

A certain eminent gut specialist once confided to me he wished someone would produce a tablet containing metronidazole, fenbendazole and prednisolone, all in one handy dose. Can't see that happening these days though

Niall

RE: Review Article on antibiotics

vetbl.locum — Wed, 18 Jul 2018 17:26:38 GMT

[quote user="Anthony Todd"]I never gave these patients steroids or antibiotics ever per se although the "curative" Kaobiotic had neomycin in it.[/quote]

so you did use antibiotic ..............neomycin

RE: Review Article on antibiotics

Anthony Todd — Wed, 18 Jul 2018 11:56:26 GMT

[quote user="Martin Atkinson"]On the second QED.[/quote]

IMHO it's the diet advice that's given [and if followed!] that's the critical factor independent of any drugs.

Mine were "normal" animals with diarrhoea and, in the days of tinned wet food, with fat being the main energy source.

Diarrhoea was about 5.5% of attendances which, I guess, is much higher than today.

I never gave these patients steroids or antibiotics ever per se although the "curative" Kaobiotic had neomycin in it.

RE: Review Article on antibiotics

Martin Atkinson — Wed, 18 Jul 2018 09:56:29 GMT

Sorry no on the first sentence. On the second QED. It is as likely in cases where no specific diagnosis has been made that metronidazole works by an immunomodulatory mechanism rather than its anti-microbial properties and judicious dose of corticosteroids would work as well.