Antibiotics and cat bite abscesses

RE: Antibiotics and cat bite abscesses

Sarah Keir — Mon, 13 Jan 2020 09:06:47 GMT

[quote userid="10320" url="~/001/veterinary-clinical/small-animal/medicine/f/discussions/28775/antibiotics-and-cat-bite-abscesses/218727"]kin appears to be so compromised that it sloughing is almost inevitable (i've always hypothesised that the blood supply is compromised by the pressure/ stretching of the original abscess)[/quote]

Some bacteria (Staphs?) produce epithelotoxic compounds which causes the necrosis - also why you get epidermal collarettes in pyoderma.

RE: Antibiotics and cat bite abscesses

Richard Carter — Mon, 13 Jan 2020 09:02:32 GMT

how have you decided it is sterile? - most cat abscesses I deal with smell like e.coli when opened and most will grow something if you culture. I agree that an abscess is a sign the patient has an immune system that is responding but doesn't mean it is winning. Head off the enemy at the pass - give some proper antibiotics

This discussion is sounding a bit like doctors and tonsillitis - from the doctors point of view doesn't matter the child is on and off sick from school for the next few months while the immune system tries to cope - for the parents and the child - they going through hell

RE: Antibiotics and cat bite abscesses

Alistair Graham-Evans — Sun, 12 Jan 2020 22:09:20 GMT

[quote userid=""] our primary job is to look after the welfare of the animal[/quote]

In my opinion if the animal has to come back for repeated treatment and the condition is prolonged due to lack of antibiosis then this has not been the best welfare outcome. I am careful with antibiotic use generally.

I respect other people's opinion however in my experience an injection of LA antibiotic, or short course of broad spectrum antibiotic in most bite abscesses would seem appropriate. In the case posted by Janine I think it was a bit harsh criticising the young vet for giving antibiotic to the pyrexic cat with an abscess - if I were that young individual I would be feeling a little bewildered and alienated from the "team"!

RE: Antibiotics and cat bite abscesses

vs0u — Sun, 12 Jan 2020 21:11:21 GMT

[quote userid=""]Flushing is the best way to deal with this. Does anyone disagree[/quote]

I rarely flush them, unless they are bad enough to need debridement. The vast majority I would just lance, squeeze as much as feasible without upsetting cat too much, and give some amox. I'm not aware of any problems occurring with this approach. I give anti inflammatories only if the cat is unwell - generally they seem so much better once it's lanced it doesn't seem worth it really just for pain relief - maybe I should rethink this?

RE: Antibiotics and cat bite abscesses

Julian Earl — Sat, 11 Jan 2020 21:59:10 GMT

client has brought the animal to us to get the quickest and best outcome.

I don't quite agree with this inasmuch as our primary job is to look after the welfare of the animal. therefore, the first aim has to be to reduce/eliminate any pain. with an abscess tis has to mean drainage and if draining then the best next step is flushing the cavity. There is now an open wound that could easily scab-/seal-over and recur. Flushing is the best way to deal with this. Does anyone disagree? I believe that abscesses generally consist of largely sterile necrotic tissue debris once they reaching the point of being large/distended and tense. Hence antibiotics might help reduce the risk of recrudescence but are not necessary for the original infection and abscess. But as has been pointed out, cellulitis does require antibiosis and it is for that aspect that I would advise the use of antibiotics. Either tablets that can be reliably given I food, or using the reliable technique described in the Vet. Record approximately in May or June 2017. For reasons of welfare I think that NSAIDs are more justified than antibiotics in most cases.

Online Julian Earl

RE: Antibiotics and cat bite abscesses

Alistair Graham-Evans — Sat, 11 Jan 2020 05:43:36 GMT

[quote userid="9440" url="~/001/veterinary-clinical/small-animal/medicine/f/discussions/28775/antibiotics-and-cat-bite-abscesses"] needs to be weighed against the consideration of inappropriate use of antibiotics in practi[/quote]

If there is an infection with abscessation and/or cellulitis ( ie every cat bite ) then surely broad spectrum antibiotic eg Amoxicillin is an APPROPRIATE treatment. I think we may be trying to be too politically over-correct and over-thinking this a bit! Obviously an anti-inflammatory medication and pain relief as well. An abscess on the temporal region is never going to drain well anyway.

I'm sure there may be some infected bites that resolve on their own but the client has brought the animal to us to get the quickest and best outcome.

RE: Antibiotics and cat bite abscesses

Lucy Fleming — Fri, 10 Jan 2020 22:15:56 GMT

[quote userid="9440" url="~/001/veterinary-clinical/small-animal/medicine/f/discussions/28775/antibiotics-and-cat-bite-abscesses"]there is an area around the tail base which is another ruptured abscess with necrotic tissue and sloughing off.[/quote]

This is an interesting one, as I come across the odd abscess where the skin appears to be so compromised that it sloughing is almost inevitable (i've always hypothesised that the blood supply is compromised by the pressure/ stretching of the original abscess). Often you can pick them in advance, but not always...

RE: Antibiotics and cat bite abscesses

Richard Carter — Fri, 10 Jan 2020 10:03:00 GMT

think this is a baby and bath water discussion - by definition of an abscess you have living bacteria inside an animal having avoided the animals protection/ immune system. The immune system has responded hence the abscess but septicaemia, toxaemia from bacteria and necrosis still very real risks to the ongoing recovery and the animal has been presented to you as a vet for action to prevent further deterioration. Yes - main treatment - lance , flush, debride, leave drainage but also cover the bacteria taken into the blood stream by WBC. This is a valid reason to use a proper antibiotic.

RE: Antibiotics and cat bite abscesses

Julian Earl — Thu, 09 Jan 2020 14:46:21 GMT

Aquick return to this thread. If a discrete ababscess and therefore with pressure involved. Lance,drain and flush.

If cellulitis? then antibiotics. Is there an alternative for a cellulitis?

RE: Antibiotics and cat bite abscesses

Anthony Dennison — Tue, 07 Jan 2020 13:04:10 GMT

In agreement with most of the replies here already. Recent wound, just local cellulitis - NSAIDs and normally a 5 day course of antirobe (I've had better responses with this than amoxyclav).

If it's burst open, healthy granulation tissue, no swelling and normal temp, just NSAIDs and get the owners to keep clean at home. Don't often give antibiotics unless it's looking sticky, or there are multiple wounds.

RE: Antibiotics and cat bite abscesses

Bob Russell — Tue, 07 Jan 2020 10:54:57 GMT

I don't give antibiotics to a cat with a formed abscess until it has pointed.

A cat with a new wound but no abscess will get amoxicillin injection as will those with discharging or lanced abscesses.

My impression is they do much better than the ones that have not had antibiotics (usually those cats have not been taken to the vet so seen later.

I am,not anti antibiotic treatment. I do provide much more analgesia than I have done in the past.

Our antibiotic 'purchases have halved in the last five years or so despite a higher workload (not this week though!!!(.

RE: Antibiotics and cat bite abscesses

Thomas Johnson — Mon, 06 Jan 2020 10:21:39 GMT

If I saw a cat with a fresh wound that looked to have been caused by another cat I would normally give antibiotics to prevent an abscess forming, often a single shot of Betamox LA. If I see a cat with an abscess I will make a judgement as to whether to give antibiotics or not, if the cat is well, not pyrexic, and the abscess has either burst and is likely to drain well, or I can lance it to allow it to drain well, I won't usually give antibiotics but will give Metacam, and the majority do very well. I will often lance an abscess with the cat conscious, and as others have said the release of pressure seems to really help, I have often had cats brought in and the owners report that the day before the cat seemed unwell and they had felt a lump, but the next day the abscess had burst and the cat seemed back to its normal self.

In my first job my boss rarely treated cat abscesses, he would tell the owner to wait until it burst then keep it clean, and we very rarely saw any of them back with problems.

RE: Antibiotics and cat bite abscesses

Julie Innes — Mon, 06 Jan 2020 09:03:43 GMT

I was taught that cat bites always required antibiotics, as they were generally due to pasteurella! We even used to have letters to give owners to give their doctors if they got bitten, so that they would be given antibiotics and not just a tetanus. So I have always given antibiotics to CBAs. One d=time I didn't give antibiotics to a dog bite (tiny wound visible, cleaned up and flushed) it turned into a huge abscess and half it's skin sloughed off! I think it one of those cases where antibiotic use is definitely justifiable.

RE: Antibiotics and cat bite abscesses

Chris Milligan — Sun, 05 Jan 2020 14:35:59 GMT

[quote userid="9440" url="~/001/veterinary-clinical/small-animal/medicine/f/discussions/28775/antibiotics-and-cat-bite-abscesses"]One of our newer vets has been criticised by the team for dispensing antibiotics for pyrexic cat with an abscess and has asked my opinion.[/quote]

there's the school of thought that gives antibiotics to everything, and a school of thought that gives them to nothing. the truth probably lies somewhere in between I suspect but for infected tissue like an abscess, especially with pyrexia (which, under at least one of the recent attempts to redefine what sepsis means, constitutes septicaemia), I think not using them is probably asking for that case to come back if not in the same condition then worse off.

RE: Antibiotics and cat bite abscesses

Beats — Sun, 05 Jan 2020 09:04:07 GMT

[quote userid="9440" url="~/001/veterinary-clinical/small-animal/medicine/f/discussions/28775/antibiotics-and-cat-bite-abscesses"]One had an abscess lanced on the temporal region which has recurred twice now over 4 weeks[/quote]

I take abscesses in the temporal region seriously - it is hard to achieve good drainage. i'll often take a 4mm punch biopsy and make a decent hole as low laterally as can to try to effect continued drainage and see back regular enough to pick any crust off of my hole. On occasions I make 2 holes and stick a penrose through to keep drainage going. The failure here may not be due to antibiotics not given [though I would defeintely give them and for that location BetLA every 2 days for at least 3 visits most likely], as recurrence in this region is quite likely due to inadequate drainage.

[Lumbar spine / dorsal tail-base would be lesser, but still significant, culprit for poor drainage in my experience]

[quote userid="9440" url="~/001/veterinary-clinical/small-animal/medicine/f/discussions/28775/antibiotics-and-cat-bite-abscesses"]the third case had a wound only so had metacam and has now presented with an abscess on its forearm .[/quote]

So the initial presentation was for a wound, rather than an abscess. If it is a significant puncture wound that may lead to an abscess i will give BetLA. If it is a minor excoriation with little risk, I won't. Picking off the crust from the teeth marks and checking for other crusts/punctures is equally improtant in my opinion.

I think it does matter a bit what antibiotics are being used - more cats treated with Betamox LA / amoxicillin oral suspension, versus a smaller number treated with amox/clav / convenia and I would think the former less of issue re responsible antibiotic use. equally shorter courses (BetLA injection and see back in 2 to 3 days and make fresh decision then) probably better from point of view of inducing antibiotic resistance (and allows picking crust off inadequate drainage holes preventing recurrence)?

[quote userid="9440" url="~/001/veterinary-clinical/small-animal/medicine/f/discussions/28775/antibiotics-and-cat-bite-abscesses"]one was sedated , abscess lanced and flushed , no antibiotics and the original wound is now a large abscess again filled with thick green purulent material . In addition there is an area around the tail base which is another ruptured abscess with necrotic tissue and sloughing off.[/quote]

I would undoubtedly have given the betLA, but this may not be the cause of poor outcome here. If inexperienced new graduate (and meaning absolutely no disrespect, just comparing what I now know versus what I knew then) technical management of abscesses re identification of other puncture sites, achieving adequate drainage, identifying potentially more problematic cases and following-up those cases adequately to prevent recurrence are learned skills. FIV cases get longer amoxicillin courses also with me - sometimes 2 weeks (rightly or wrongly).

RE: Antibiotics and cat bite abscesses

Julian Earl — Sun, 05 Jan 2020 06:19:54 GMT

Whether or not they need antibiotics for any associated cellulitis etc, I always administer NSAIDs for these. They are painful so analgesia is always a required! I tend to use carprofen in most instances of whatever brand is available in our fridge at the time. As far as I have been able to tell, they do not delay the healing process. Any thughts on this aspect of NSAIDs?

RE: Antibiotics and cat bite abscesses

Neil Wheadon — Sat, 04 Jan 2020 20:55:33 GMT

We've been here before and I recall Evelyn saying 'don't' which was the first time I'd considered it, but never brave enough to do it.

Our ginger cat had a nasty abscess on his neck 2 years ago. I put him on antirobe and he failed to get better, it was only after synulox that he improved and quite quickly.

The problem seems to be that some need antibiotics whilst others don't, and in the case of Custard the cat he was quite poorly without one that worked. Looking at it from an owners point of view it's tricky isn't it. Give them and you cover nearly all the cases, don't and you need good follow up or a client that trusts you.

Neil

RE: Antibiotics and cat bite abscesses

Freya . — Sat, 04 Jan 2020 19:36:34 GMT

As others have said probably depends a lot on the abscess, I don't now give antibiotics to cat bite abscesses where the cat is bright eating etc Often Lance concious with little to no restraint think the cats seem so relieved at the release of pressure they hardly notice the scalpal. If there horrible then sedated/Ga for proper debride and flush I think they need antibiotics I give them ampicillin with tabs to follow on or they can come back in 2 days for a 2nd betamox. Or my alternate if liquid zodon not very keen on giving 3rd gen cephalosporin for this so generally pretend to myself convenia doesn't exist.

I do think its a bit of a balance but cats seem much better equipped for dealing with cat bites than people are so not sure that comparison is completely fair. If cats succombed easily they'd probably not be many ferals about.

RE: Antibiotics and cat bite abscesses

Julian Earl — Sat, 04 Jan 2020 16:50:38 GMT

I tended to always use them but I think that they are only justified if there is peripheral cellulitis around the wound. Otherwise for an encapsulated abscess I think lancing, though flushing is adequate. I was led to believe that most pus in abscesses is sterile nd consists of necrotic tissue rather than active infection. Certainly lancing and flushing seems to immediately relieve the discomfort which is the primary objective in my opinion! For adequate flushing I think sedation or a GA I best. Re-inflating the cavity is likely to be painful for the cat? Stretching inflamed tissue etc. Also of course the cat is stationary so one can do a better and safer job, safer = for oneself!

RE: Antibiotics and cat bite abscesses

Michael Woodhouse — Sat, 04 Jan 2020 16:21:09 GMT

I would always treat with antibiotics. Generally a single shot of Betamox LA and see back 2-3 days and only repeat if needed.

In the grand scheme of antibiotic resistance 150mg of amoxycillin is going to make stuff all difference to anything. I don't see any need for amoxyclav etc

RE: Antibiotics and cat bite abscesses

janine redman — Sat, 04 Jan 2020 15:09:00 GMT

I was hoping to find that people had either tried it and found it worked , or tried and found it didn’t . We see far fewer cat bite abscesses these days so would have only a limited number to audit. Though 3of 3 failures might be significant, I don’t know how many have been successfully treated

RE: Antibiotics and cat bite abscesses

Sarah Keir — Sat, 04 Jan 2020 12:50:14 GMT

You may find this interesting - https://bestbetsforvets.org/bet/479

http://veterinarymedicine.dvm360.com/research-updates-single-injection-antibiotic-treatment-cats-with-abscesses-and-infected-wounds

Perhaps you would like to do an internal audit or research to answer the question as it looks like we have no evidence?

RE: Antibiotics and cat bite abscesses

janine redman — Sat, 04 Jan 2020 12:09:33 GMT

The criticism was not public and definitely well intentioned, we have vets doing certification in surgery and medicine and they seem to have been advised that antibiotics are not required following flushing of an abscess and are enthusiastically trying to get their point across. I am trying to decide which way is most effective and appropriate for the patient

RE: Antibiotics and cat bite abscesses

Francisco Gomez — Sat, 04 Jan 2020 11:25:46 GMT

I completely agree that newly qualified vets should be treated with a lot more care than that. I have seen, however, clients knocking them down instead.

The struggle of antibiotics use is something that I sometimes find difficult to balance. I have seen others avoiding them in cases like this for the client to have to come back and pay extra for the antibiotic to be given.

I have committed this mistake too. I have been in the situation where I have not given an antibiotic and later found that I should have.

RE: Antibiotics and cat bite abscesses

Iain Richards — Sat, 04 Jan 2020 11:17:06 GMT

If it is a true abscess, walled off and with drainage, it won't need antibiotic treatment. However, most of our patients are cellulitis as well, and it's reasonable to use them. Co-amoxyclav is first line, although many are fine in my experience with a singel shot of clam LA