Swollen jaw/swelling next to jaw-cat

RE: Swollen jaw/swelling next to jaw-cat

Kate Richardson — Sat, 16 May 2020 15:55:05 GMT

[quote userid="3094" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/29092/swollen-jaw-swelling-next-to-jaw-cat/222664"] The drainage of the pus and debris is possibly less critical after that maybe. The size of the hole is probably less critical after that. [/quote]

No the size of the hole is critical. The inside HAS to heal before the skin does. Otherwise you leave some dead space.

RE: Swollen jaw/swelling next to jaw-cat

Gillian Mostyn — Sat, 16 May 2020 15:32:35 GMT

[quote userid="3094" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/29092/swollen-jaw-swelling-next-to-jaw-cat/222664"] a very good case for thorough flushing of the necrotic material until it flushes clear is it not?[/quote]

As long as it is under GA! Or the next vet will suffer!

RE: Swollen jaw/swelling next to jaw-cat

Julian Earl — Sat, 16 May 2020 13:29:34 GMT

PS someone will have the C&S results from CBAs?? Historical information nowadays but I recall reading in a Vet Record paper many, many years ago that the most common bacteriology showed Pasteurella, plus inevitably ,Staphs and Streps as well. I cannot recall the sensitivities after all this time [ 30 years or more!!] but if still accurate, penicillin or variant thereof would be appropriate. ?

Regarding those abscesses mentioned earlier on top of the head that are lanced and need drainage, a very good case for thorough flushing of the necrotic material until it flushes clear is it not? The drainage of the pus and debris is possibly less critical after that maybe. The size of the hole is probably less critical after that.

RE: Swollen jaw/swelling next to jaw-cat

bob lehner — Sat, 16 May 2020 10:19:43 GMT

[quote userid="8991" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/29092/swollen-jaw-swelling-next-to-jaw-cat/222644"]There have been several assumptions (shown to be false) on this thread, both related to the OP's case and subsequently, along with mis-categorisations and some post-rationalisation.[/quote]

and then:

[quote userid="8991" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/29092/swollen-jaw-swelling-next-to-jaw-cat/222644"]If you don't treat 100 with antibiotics, and 1 subsequently requires them (I believe the figure is lower than this by at least a half), then you have a strong justification in that singular case. [/quote]

Ermm - do you have any real data to support your second statement? Otherwise you are as guilty as the next person of allowing your own presumptions to colour your clinical judgement.

(For what it's worth - and I'm afraid I don't have any data to support my view - I think your second statemnt is tosh).

RE: Swollen jaw/swelling next to jaw-cat

Anthony Todd — Sat, 16 May 2020 09:45:15 GMT

[quote userid="8991" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/29092/swollen-jaw-swelling-next-to-jaw-cat/222644"]On these threads, there are always horror stories. It is the wrong way round. Think about the vast majority that are cured without antibiotics rather than those that aren't. If you treat 100 CBAs with antibiotics and they all get better, it tells you nothing. [/quote]

What I saw was CBAs returning to check progress [which is reasonable] that had been lanced and given the favourite broad-spectrum A/B.

Clever marketing as "broad" inplies "better"....

These still had discharge and peri-abscess pain, which always seemed to resolve quicker after plain pen. Response to pen seemed to be quicker on first visit too.

Could have written a paper, I suppose, which tries to validate any sort of vague opinion by adding extraneous data. but he result, if obvious, is surely the important point.

Not to mention antibiotic conservation and targeting!

PS someone will have the C&S results from CBAs??

RE: Swollen jaw/swelling next to jaw-cat

Anthony Todd — Fri, 15 May 2020 21:13:33 GMT

[quote userid="6297" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/29092/swollen-jaw-swelling-next-to-jaw-cat/222645"]young male cat cystitis[/quote]

Now that is a new one for me??

RE: Swollen jaw/swelling next to jaw-cat

Thomas Johnson — Fri, 15 May 2020 17:06:28 GMT

[quote userid="8991" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/29092/swollen-jaw-swelling-next-to-jaw-cat/222644"]Regarding justifying their use, a minimal reduction in duration of signs is not a strong enough justification. Where an animal would not have got better without them is the arbiter of their use. All indiscriminate use is doing is saving up resistance for the future. [/quote]

A very well written post and very similar to how I would judge how to treat, but I think that to only use antibiotics where the animal wouldn't get better without them is too strict, I think it is also justifiable to use antibiotics where they will significantly reduce morbidity.

[quote userid="8991" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/29092/swollen-jaw-swelling-next-to-jaw-cat/222644"]And, anyone using convenia for CBAs and young male cat cystitis needs shooting.[/quote]

Now this I entirely I agree with!

RE: Swollen jaw/swelling next to jaw-cat

David Mills — Fri, 15 May 2020 16:49:28 GMT

There have been several assumptions (shown to be false) on this thread, both related to the OP's case and subsequently, along with mis-categorisations and some post-rationalisation.

Cat bite abscesses aren't a uniform group of afflictions, probably related to the nature, depth and severity of the initial insult.

Some are superficial, well-walled off abscesses with little or no associated periabscess cellulitis and little if any appreciable pain. Antibiotics have no place in the management of these (a non-exact comparison to human medicine would be expecting or taking antibiotics for a boil post-lancing). Drainage, cleaning and NSAIDs will suffice. Antibiotics can often prolong the resolution of these

Some are deeper, with appreciable pain and morbidity. With these, proper drainage UGA or sedation and flushing is required. Still, I would question the use of antibiotics in these cases as again they can prolong resolution.

Some infections are more generalised cellultis-type presentations, such as multiple wounds and a diffusely swollen distal limb. Antibiotics in these are justified.

On these threads, there are always horror stories. It is the wrong way round. Think about the vast majority that are cured without antibiotics rather than those that aren't. If you treat 100 CBAs with antibiotics and they all get better, it tells you nothing. Correlation is not causation. If you don't treat 100 with antibiotics, and 1 subsequently requires them (I believe the figure is lower than this by at least a half), then you have a strong justification in that singular case.

Antibiotic stewardship is about critically appraising the use of antibiotics and avoiding the temptation to give them "just in case" and because people always have in the past. It is about finding presentations that need them not where you think they might be useful, and that comes from an honest inquiry into where they have been used in the past when they didn't need to be. AmoxLA for cat castrates comes to mind.

Regarding justifying their use, a minimal reduction in duration of signs is not a strong enough justification. Where an animal would not have got better without them is the arbiter of their use. All indiscriminate use is doing is saving up resistance for the future.

Dog fights offer limited extrapolatable value as the nature of a dog's bite (crushing, tearing traumatic, deeper tissues affected) is different to a cats (piercing, superficial, little tearing) so the comparison is pretty weak.

And, anyone using convenia for CBAs and young male cat cystitis needs shooting.

RE: Swollen jaw/swelling next to jaw-cat

Anthony Todd — Fri, 15 May 2020 13:52:36 GMT

There is currently no peer-reviewed evidence to support or refute the use of antibiotics in cats with draining cat bite abscesses to reduce the time taken to resolve clinical signs.

That's what I hope is the purpose of this site! Not me of course, but the posters on here are vets who have seen more clinical cases than most writers of Journal papers and I trust what they say!

I don't think any poster makes rash statements, nor ones that are incorrect. Ironically the statements and conclusions that are often challenged are those in these peer-reviewed journals.

[quote userid="2131" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/29092/swollen-jaw-swelling-next-to-jaw-cat/222637"]Antimicrobial resistance is a real worry and much more immediate than climate change and what have you.[/quote]

So why use a broad-spectrum antibiotic when a narrow spectrum works and arguably better?

RE: Swollen jaw/swelling next to jaw-cat

Evelyn Barbour-Hill — Fri, 15 May 2020 13:30:39 GMT

[quote userid="6386" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/29092/swollen-jaw-swelling-next-to-jaw-cat/222633"]Evelyn will probably answer better than I can [/quote]

I doubt that!

but

[quote userid="6386" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/29092/swollen-jaw-swelling-next-to-jaw-cat/222633"] I feel that once you’ve reduced the bacteria you need to then anything beyond that is pointless and only starts knocking out good bacteria or provides an opportunity for resistance? [/quote]

Spot on.

To which I would add: the golden age of antibiotic drugs when you used them whenever they might be handy, even though the body's mechanisms could deal quite efficiently with the invasion, is gone, it's the past.

Antimicrobial resistance is a real worry and much more immediate than climate change and what have you.

RE: Swollen jaw/swelling next to jaw-cat

Kate Richardson — Fri, 15 May 2020 13:19:36 GMT

So annoying, edit doesn’t work on my phone. I might be wrong. Hopefully someone more educated in such matters will provide the right info! Also always happy to learn.

RE: Swollen jaw/swelling next to jaw-cat

Evelyn Barbour-Hill — Fri, 15 May 2020 13:17:18 GMT

[quote userid="6386" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/29092/swollen-jaw-swelling-next-to-jaw-cat/222614"]

Evelyn Barbour-Hill said:
If "the abscess comes back" it's because you didn't ensure good drainage from all parts of the cavity . And, with respect to Kate, I don't think gravity has much to do with it. Sure, if there's a big cavity and the bite hole is at the top, make another incision at the bottom, but what really matters is making the incision big enough and making sure it communicates with all parts of the cavity.

Also with respect Evelyn, do you not think it’s a combination of both gravity and a big enough incision? I learnt a lot about dead space in my early years with horse wounds (mostly by getting it wrong a lot initially!) no point in just making a hole , it has to be as ventral as possible so any discharge itself keeps the drainage port open while it heals from within and from top to bottom- however this is very difficult on top of the head- I find the drainage wounds just clog up and seal too quickly unless they are really big or you can clean them regularly which isn’t always possible for many reasons

So Evelyn Barbour-Hill how do you manage the ones right on top of the head between the ears? Do you just make a really large incision? If so, do your clients accept that ok? (I’m presuming you explain why!)

[/quote]

Well, yes, make another incision at the lowest point if that's the obvious thing to do. Though I'd add that horses tend to stand upright most of the time while cats roll around and are quite happy to sleep upside down.....

I make the incision quite big... but it's all relative. It's not really very big but it's clearly pretty big in relation to the holes that some surgeons make. And remember I probe vigorously – verging on the curetting. Break down those fibrin pockets. Waggle the skin around. I don't want to see anything but maybe blood coming out by the time I've finished.

If you don't GA its more likely that you won't incise or probe enough, either because it hurts the cat or because you are worried either consciously or subconsciously that it will hurt the cat.

As for cost being "unacceptable" – how much cost does the quick dollop of propofol, or the slightly less quick dollop of dom/torb, add? And if you want to be charitable to your client – well, be charitable. I've never understood the idea that charitable treatment has to be inferior treatment.

[quote userid="5012" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/29092/swollen-jaw-swelling-next-to-jaw-cat/222613"]normothermic, normal appetite and thirst. I suspected a soft tissue injury and prescibed Metacam. Several days later, massive abscess that burst with sloughing skin needing surgery. Client complained and was refunded to the tune of several hundred pounds. I had a snotty email from one of the senior partners informing me I was negligent in not giving antibiotics, and inviting me to pay all or some of the bill. [/quote]

Suppose that you had given some antibiotic at first presentation. There might well still have been a massive abscess several days later.

RE: Swollen jaw/swelling next to jaw-cat

Kate Richardson — Fri, 15 May 2020 13:12:55 GMT

But I guess it depends on what and why you are using them

RE: Swollen jaw/swelling next to jaw-cat

Kate Richardson — Fri, 15 May 2020 13:11:57 GMT

Evelyn will probably answer better than I can but I feel that once you’ve reduced the bacteria you need to then anything beyond that is pointless and only starts knocking out good bacteria or provides an opportunity for resistance?

RE: Swollen jaw/swelling next to jaw-cat

Gillian Mostyn — Fri, 15 May 2020 12:05:11 GMT

I was taught (many moons ago) to always give a course of abx rather than a one or two day course. I thought it was best practice? Is that no longer the case? As I never give antibiotics for aseptic ops etc then I rarely have any cause for giving one-off shots anyway. Happy to learn.

RE: Swollen jaw/swelling next to jaw-cat

Kate Richardson — Fri, 15 May 2020 11:25:51 GMT

[quote userid="2457" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/29092/swollen-jaw-swelling-next-to-jaw-cat/222624"]Different question. Dog fight wounds that don't require surgery. Who gives antibiosis on presentation, as prophylaxis? [/quote]

if there is a known bite wound, then yes, if it has gone full thickness. But I don’t think they need 5 days. 1-2 max if given in first few hours of injury. Same for cats

RE: Swollen jaw/swelling next to jaw-cat

Kate Richardson — Fri, 15 May 2020 11:19:03 GMT

just to be clear I don’t ga or sedate all cats either, just the ones that warrant it. I dont give antibiotics to all cat abscesses I’m presented with, just the ones that warrant it.

RE: Swollen jaw/swelling next to jaw-cat

bob lehner — Fri, 15 May 2020 10:53:11 GMT

[quote userid="4181" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/29092/swollen-jaw-swelling-next-to-jaw-cat/222619"]Luckily someone has done some research https://bestbetsforvets.org/bet/479[/quote]

Very interesting - conclusion: ''There were no published articles found directly comparing the antibiotic treatment to no antibiotic treatment in cats with abscesses. A small number of trials have compared one type of antibiotic usage with another in cat bite abscesses, but there is no consensus as to which antibiotic is more efficacious, with all studies reporting over 95% success rates. This does not address the issue as to whether we should use them at all.''

Says it all really - I'm always truly amazed when reading VetSurgeon.org as to how many varied opinions there are on the most basic and everyday things we all deal with. The much vaunted and trendy 'Evidence Based Medicine' has some way to go yet in our noble profession.

RE: Swollen jaw/swelling next to jaw-cat

Gillian Mostyn — Fri, 15 May 2020 10:37:55 GMT

[quote userid="9440" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/29092/swollen-jaw-swelling-next-to-jaw-cat/222607"]Whilst I appreciate the reasoning, many of my clients would not agree or be able to afford the cost of admitting for sedation and general anaesthetic to treat a cat bite abscess with thorough flushing and debridement.[/quote]

I was starting to think it was just me! I can't remember the last time I sedated or GA'd a cat just for an abscess.

When my cat has been fighting, has a few small small wounds and is off his food, he gets 5 days of amoxyclav. He is aok by the following day. A couple of times I've just cleaned the wounds, gave an NSAID, and waited to see if he would be ok. He got cheesy abscesses which needed popping and took longer to settle. I wouldn't be happy if I went to a vets to be told to wait and see, and if he gets an abscess bring him back for me to GA and treat him at that point. I realise I'm 'personalising' it, but, as I said, I always think 'what would I do if it were my pet'.

I've also seen a few cases where other vets chose not to give antibiotics and things got bad very quickly. I realise that these may be the unusual cases, and most got better and were never seen again. But it would be interesting to to know 'fail rate' with the different approaches.

Different question. Dog fight wounds that don't require surgery. Who gives antibiosis on presentation, as prophylaxis? I do. Should I wait and see if infection develops?

RE: Swollen jaw/swelling next to jaw-cat

Kate Richardson — Fri, 15 May 2020 10:34:35 GMT

Julian- antibiotics are used (in most cases) to reduce the numbers of bacteria to a level the body's own immune system can deal with so how long you need them for will depend on how quickly the levels drop to a manageable level? In my mind they assist the body to do its normal job, they aren't there to do the entire job for you

RE: Swollen jaw/swelling next to jaw-cat

Mark Hedberg — Fri, 15 May 2020 10:02:29 GMT

[quote userid="6550" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/29092/swollen-jaw-swelling-next-to-jaw-cat/222579"]In humans the antibiotic of choice is amox/clav so is a quick shot of betamox LA a suitable choice?[/quote]

Isn't Betamox just Amoxicillin in trihydrate form? I don't think there's a way to make the clavulanic acid last longer. (interesting yet completely irrelevant philosophical/pharmacological thought - what would it take to make the clavulanic part LA?)

RE: Swollen jaw/swelling next to jaw-cat

Julian Earl — Fri, 15 May 2020 09:18:19 GMT

My real question was aimed at the duration of treatment. Surely under-treatment with a short-duration is the worst crime here?

Everyone seems to have carefully avoided answering this question? Is 48 hours of amoxycillin really adequate. Or even 72 -96 hours of procaine penicillin, either being by the single injection of the antibiotic concerned. So how many times do you usually ask them to return for repeat doses? What are your criteria for making this decision? Associated cellulitis? Pyrexia, inappetence or something else?

Thanks in anticipation.

I like to think that this thread could be extremely useful to new graduates and this is a key question!

RE: Swollen jaw/swelling next to jaw-cat

Rob Loxley — Fri, 15 May 2020 09:04:45 GMT

Luckily someone has done some research https://bestbetsforvets.org/bet/479

RE: Swollen jaw/swelling next to jaw-cat

Kate Richardson — Fri, 15 May 2020 08:43:25 GMT

cant edit above message but should add you might consider abs if the cat had a temperature but even if it did, not giving antibiotics would have been far from negligent.

RE: Swollen jaw/swelling next to jaw-cat

Kate Richardson — Fri, 15 May 2020 08:38:47 GMT

[quote userid="5012" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/29092/swollen-jaw-swelling-next-to-jaw-cat/222613"]Client complained and was refunded to the tune of several hundred pounds. I had a snotty email from one of the senior partners informing me I was negligent in not giving antibiotics, and inviting me to pay all or some of the bill. [/quote]

I hope you told them to get stuffed. That’s just ridiculous. Sure if the cat had a temperature but negligent to not give antibiotics- I think not.