Resistant psuedomonas

Re: Resistant psuedomonas

Alan Tevendale — Sun, 03 Apr 2011 11:25:41 GMT

I know what you mean. Gutting really as such a nice dog and really nice genuine owners.

Re: Resistant psuedomonas

Simon Baker — Sun, 03 Apr 2011 08:55:06 GMT

OK, I can certainly sympathise with the decision to go for PTS. If a client can't go with you for the bumpy ride of well-supervised maintenance treatment it does make life very difficult for the vet and the animal.

Re: Resistant psuedomonas

Alan Tevendale — Sun, 03 Apr 2011 08:03:27 GMT

The ears are pretty much normal now and interesting the infection on the face seems to be improving. However my colleague has had a very lengthly discussion with the owner regarding underlying causes and it looks like the owner is going to go for PTS.

Re: Resistant psuedomonas

Simon Baker — Sat, 02 Apr 2011 19:04:43 GMT

Alan, are the ears now normal but you just have the problem on the skin surface of the face?

Re: Resistant psuedomonas

Vikki Halliday LLB — Sat, 02 Apr 2011 14:06:30 GMT

[quote user="Julian Earl"]I do recall some evidence relating to cattle mastitis indicating that teat dips with chlorhexidine encourage the growth of either pseudomonas or proteus spp[/quote]

I think anything antibacterial used at low enough a dose not to kill the pathogen will encourage development of growth of resistant strains.

But I don't think you can say that Chlorhexidine solely encourages growth of an organism, if that were the case we wouldn't be using it as a surgical scrub!

Re: Resistant psuedomonas

Jillian Hall — Sat, 02 Apr 2011 09:46:10 GMT

It seems that almost every topical product (including saline) has at some point been reported to have adverse effects down the ear. And to my knowlege nothing is licenced in the absence of an intact TM. But surely a hefty dose of Pseudomonas (or any other pathogen) can't be doing the declicate structures of the ear much good either. My feeling is that you need to carefully consider the benefits versus risks of these treatments, and obviously inform the owner of these potential risks, but also the benefits i.e. trying to eradicate the infection.

Re: Resistant psuedomonas

Julian Earl — Sat, 02 Apr 2011 00:00:36 GMT

[quote user="Vikki Halliday"]

[quote user="Julian Earl"]

Isn't chlorhexidine contra-indicated in cases of Pseudomonas as it can encourage proliferation?

[/quote]

I don't think it encourages proliferation, but too dilute a solution could cause a resistant strain to become the major pathogen.

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2672.2004.02402.x/pdf

This appears to suggest that at a high enough level, this is not a major problem[/quote]

Indeed but I do recall some evidence relating to cattle mastitis indicating that teat dips with chlorhexidine encourage the growth of either pseudomonas or proteus spp. I thought it was the former but perhaps after all it was the latter and it is okay for pseudomonas. I'll have to try and dig out the notes, but they were from years ago.

Re: Resistant psuedomonas

Evelyn Barbour-Hill — Fri, 01 Apr 2011 22:08:49 GMT

Well, I'm no dermatologist either.

If you want to risk the phone call the next day from a puzzled client to say the dog seems to have gone deaf, then try chlorhexidine down the ear.

Re: Resistant psuedomonas

Richard Fox — Fri, 01 Apr 2011 22:05:18 GMT

Fair enough Bob :) Perhaps it was just cats that I was thinking of and thus off topic as we are taking about a dog :)

Re: Resistant psuedomonas

bob lehner — Fri, 01 Apr 2011 21:45:14 GMT

[quote user="Evelyn Barbour-Hill"]

What? Who said that? Have they evidence?

[/quote]

The talk was given by Filippo De Bellis DVM CertVD DipECVD MRCVS.

I have gone back and listened again and he definitely says 0.2% Chlorhexidine is considered safe in the canine middle ear (some reservations in cats) - and at this strength, if used with Tris EDTA it does have effective antibacterial action.

In the general discussion at the end of the talk he and two other experienced clinicians with a particular interest in ears expressed the view that ototoxicity associated with treating middle ears is generally surprisingly rare - but always best to avoid proprietary products with an oily base if the eardrum is ruptured - aqueous products in many cases appear to be safe - e.g. gentamycin/baytril and Tris EDTA . Although they did say anything, including saline, if flushed into the middle ear via the external ear canal can cause trouble by transfer of debris or pathogens.

I'm no dermatologist - just quoting what I heard !

Re: Resistant psuedomonas

Richard Fox — Fri, 01 Apr 2011 17:57:55 GMT

[quote]

I had you lot down as more sensible than soime of my clients and therefore didn't feel it necessary to elaborate.

[/quote]

Re: Resistant psuedomonas

Vikki Halliday LLB — Fri, 01 Apr 2011 17:21:19 GMT

[quote user="Richard Fox"]

However it is contraindicated in cases that have tympanic rupture - maybe check first?

[/quote]

I was really meaning that the chlorhexidine could be used on the lip fold pyoderma, AND the vinegar wash in the ear.

I had you lot down as more sensible than soime of my clients and therefore didn't feel it necessary to elaborate.

Hmm, perhaps I should review my dispensing labels.....

Re: Resistant psuedomonas

Richard Fox — Fri, 01 Apr 2011 17:03:59 GMT

[quote user="bob lehner"]

There was a good WebinarVet programme on treating ear infections last week, where 0.2% Chlorhexidine was said to be quite safe in the middle ear.

I vaguely remember hearing once that Pseudomonas could live happily in the sort of solutions of Hibiscrub that people were using to store their otoscope heads in.

[/quote]

Not what I have heard. I thought it was said that you should check the ear drum first?

[quote]

Arch Otorhinolaryngol. 1985;242(2):167-76.

Cochlear ototoxicity of chlorhexidine gluconate in cats.

Igarashi Y, Suzuki J.

Abstract

Chlorhexidine gluconate is a derivative of chlorhexidine and is a popular disinfectant with a strong bactericidal action that is widely used for preoperative sterilization in ear surgery. The purpose of this investigation is to ascertain the potential ototoxicity of this agent. After topically applying chlorhexidine gluconate solutions to the middle ear cavities of 12 cats, we observed the excised cochleas using both scanning and transmission electron microscope studies. Either 0.05% or 2% chlorhexidine gluconate solutions were infused into the right ear of the test animal through one of two tubes chronically installed in the tympanic bullae. The left ears were utilized as controls and were infused with sterilized physiological saline. The solutions were administered once every other day for three separate infusions. Nine animals were decapitated 7 days after the third application, while the other three animals were sacrificed at 4 weeks. In the 2% chlorhexidine group, we found that hair cells in the organ of Corti had degenerated and had lost their hair bundles over a wide range. This pathology was more marked in the lower cochlear turns. In the animals sacrificed at 4 weeks, the injuries present seemed to have progressed. Even at a clinical concentration of 0.05%, chlorhexidine caused intracellular degeneration but with little surface damage. Our findings would suggest a cause of hearing loss when chlorhexidine is used clinically in the ear.

[/quote]

Re: Resistant psuedomonas

Evelyn Barbour-Hill — Fri, 01 Apr 2011 16:31:59 GMT

[quote user="bob lehner"]

where 0.2% Chlorhexidine was said to be quite safe in the middle ear.

[/quote]

What? Who said that? Have they evidence?

Still, I suppose unilateral deafness might well go un-noticed.

Re: Resistant psuedomonas

bob lehner — Fri, 01 Apr 2011 16:26:24 GMT

There was a good WebinarVet programme on treating ear infections last week, where 0.2% Chlorhexidine was said to be quite safe in the middle ear.

I vaguely remember hearing once that Pseudomonas could live happily in the sort of solutions of Hibiscrub that people were using to store their otoscope heads in.

Re: Resistant psuedomonas

Richard Fox — Fri, 01 Apr 2011 15:15:08 GMT

However it is contraindicated in cases that have tympanic rupture - maybe check first?

Re: Resistant psuedomonas

Vikki Halliday LLB — Fri, 01 Apr 2011 00:12:41 GMT

[quote user="Julian Earl"]

Isn't chlorhexidine contra-indicated in cases of Pseudomonas as it can encourage proliferation?

[/quote]

I don't think it encourages proliferation, but too dilute a solution could cause a resistant strain to become the major pathogen.

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2672.2004.02402.x/pdf

This appears to suggest that at a high enough level, this is not a major problem

Re: Resistant psuedomonas

Gerry Henry — Thu, 31 Mar 2011 10:53:13 GMT

Totally off license but the intra mammary product PATHOCEF is brillaint at clearing up pseudomonas, usually within 10 days too.

Re: Resistant psuedomonas

HMC — Tue, 29 Mar 2011 15:21:45 GMT

Tris-EDTA for the Pseudomonas? It may come as an ear preparation but you might be able to use it on the skin too (I don't see why not). Some useful information on the Dechra website.

Have you taken a photo? Could you post that online?

Re: Resistant psuedomonas

Julian Earl — Tue, 29 Mar 2011 12:48:38 GMT

[quote user="Vikki Halliday"]

Vinegar washes and hibiscrub also can work well in cases where finance is an issue.

[/quote]

Isn't chlorhexidine contra-indicated in cases of Pseudomonas as it can encourage proliferation?

Re: Resistant psuedomonas

Rob Davis — Tue, 29 Mar 2011 12:46:48 GMT

Definitely pred before PTS!

Re: Resistant psuedomonas

Alan Tevendale — Mon, 28 Mar 2011 23:01:24 GMT

I have a feeling that this case may end up on pred especially as the owners are now considering PTS.

Re: Resistant psuedomonas

Vikki Halliday LLB — Mon, 28 Mar 2011 22:44:03 GMT

Hmm, have also seen a similar immune mediated case that started out as a peripheral pinnal furunculosis, and spread from there via muzzle to whole body.....yup ended up on pred.

Re: Resistant psuedomonas

Michael Woodhouse — Mon, 28 Mar 2011 22:23:43 GMT

Add a bit of pred?

Re: Resistant psuedomonas

Vikki Halliday LLB — Mon, 28 Mar 2011 22:17:22 GMT

Vinegar washes and hibiscrub also can work well in cases where finance is an issue.

But I agree, allergy may be an underlying factor, try it on an antihistamine and EFA supplement, as if you can relieve some of the itch, you might reduce self trauma and therefore further infection.