Do people use antibiotics for routine cat castrates?

Re: Do people use antibiotics for routine cat castrates?

Anthony Todd — Sun, 07 Aug 2011 16:11:46 GMT

[quote user="rhona kerr"]severely infected[/quote]

For sure, ABs for an active infection around an extraction site, but that's much different from a clean castration site,

Re: Do people use antibiotics for routine cat castrates?

Anthony Todd — Fri, 05 Aug 2011 08:40:09 GMT

Any actual evidence of human infection from dog/cat dental. you know, cultures an' all?

I'll even accept anecdotes!

Is the risk real or theoretically possible?

Re: Do people use antibiotics for routine cat castrates?

john wilcox — Fri, 05 Aug 2011 03:21:13 GMT

First principles is the surgery clean, clean contaminated, contaminated or dirty. I would assume a clean procedure in a routine neutering procedure. Thus by definition abs should not be needed.

In this study so long as you are not a student and not taking longer than 90 minutes to do the cat castration giving antibiotics does not change the risk of infection. Surgical wound infection rates in dogs and cats. Data from a teaching hospital Vet Surg. 1988 Mar-Apr;17(2):60-4.

Vasseur PB, Levy J, Dowd E, Eliot J.A study done on clean or clean/contaminated wounds in people (The timing of prophylactic administration of antibiotics and the risk of surgical -wound infection; David C. Classen, M.D., R. Scott Evans, Ph.D., Stanley L. Pestotnik, R.Ph., Susan D. Horn, Ph.D., Ronald L. Menlove, Ph.D., and John P. Burke, M.D. N Engl J Med 1992; 326:281-286).

This study shows the best time to give abs was preoperatively i.e. before the incision it gets a 0.6% chance of infection. This being iv antibiotics. Thus the aim is to get high levels during the time of surgery. Amoxyl injections given on recovery will not be doing this.

With all surgery think rationally is infection a risk if so how am I best to give antibiotics to have peak effect during the procedure. Be brave and don't give antibiotics when they are not indicated and especially in a cat castrate

Re: Do people use antibiotics for routine cat castrates?

Evelyn Barbour-Hill — Thu, 14 Jul 2011 20:40:04 GMT

[quote user="rhona kerr"]also thought it helps reduce aerosolised bacteria for personnel at time of op? [/quote]

I've no figures to hand but I'm not sure that it does; in fact it might merely ensure that the aerosol bacteria were clindamycin resistant ones?

Anyway, plenty of sluicing with chlorhexidine before commencing and while working should do the trick.

Re: Do people use antibiotics for routine cat castrates?

rhona kerr — Thu, 14 Jul 2011 08:47:40 GMT

Back to the "dental" antibioutics - given that I am a poor slob on the front line, I often give a course of antirobe to severely infected (you know, the green ones) dogs mouths so that the animal is established on the course prior to "dental", partly for animal comfort - the difference this can make to their demeanor, etc can be phenomenal, also thought it helps reduce aerosolised bacteria for personnel at time of op? Given that most practices use those completely rubbish bits of paper as "masks" anything is good!

Re: Do people use antibiotics for routine cat castrates?

Anthony Todd — Wed, 13 Jul 2011 20:08:43 GMT

[quote user="Clive Ansell"]but the only 1 of the 6 vets that used antibiotics had the most post op complications, usually wound reactions and breakdown,[/quote]

Yeah well, to go around again, it's obvious:

No gloves, using dreadful catgut, on a reel FFS, thiopentone via a strapped syringe, quick 5 minute op., no pre-op check [all his complications were immunocompromised], no post op check, using the same kit for every spay of the morning, gut skin sutures, and pulled iscaemicaly tight, plenty of finger groping for the uterus, no pulse-ox, no apalert, no endo tubation, no oxygen, no isoflurane, no time off for coffee, only three nurses available, phone not on answerphone.

Loads of reasons; all of them sorted with a big dose of broad-spectrum antibiotics, or perhaps they're all MRSA.....

Oh. forgot no tissue cement, and a buster collar, silly me.

Many is the time my colleague sent off the thio [as alkaline as caustic soda!! for culture after a wound breakdown.......

Re: Do people use antibiotics for routine cat castrates?

Rob Loxley — Wed, 13 Jul 2011 14:11:42 GMT

[quote user="Clive Ansell"]the only 1 of the 6 vets that used antibiotics had the most post op complications, usually wound reactions and breakdown, not necessarily infected wounds. not sure why?[/quote]

?poor technique leading to a previous history of wound problems, to which their response was to give periop antibiotics thereafter?

Re: Do people use antibiotics for routine cat castrates?

Clive Ansell — Wed, 13 Jul 2011 12:00:19 GMT

[quote user="Alan Tevendale"]

[quote user="Clive Ansell"]

numerous machines that go "ping"

[/quote]

I presume the hospital administrator was visiting.

[/quote]

All we need now is the patient

Re: Do people use antibiotics for routine cat castrates?

Clive Ansell — Wed, 13 Jul 2011 11:56:01 GMT

[quote user="Anthony Todd"]

[quote user="Anthony Todd"] necessary to use antibiotics in any routine surgery let alone cat castrates.[/quote]

So, to close the catspay/castration antibiotic thread, is there any evidence, from any source, that shows that antibiotics before during or after this routine surgery are necessary at all.

References, not anecdotes, for and against please.

[/quote]

A busy practice I locumed in last autumn with 6 vets did a clinical audit on post op complications following routine castrates and speys in cat and dogs. I can't remember figures off hand, but the only 1 of the 6 vets that used antibiotics had the most post op complications, usually wound reactions and breakdown, not necessarily infected wounds. not sure why?

I can't quote references of course, but in my opinion and with experience I feel routine uncomplicated ops don't need antibiosis.

Re: Do people use antibiotics for routine cat castrates?

Clive Ansell — Tue, 12 Jul 2011 19:46:54 GMT

[quote user="Julian Earl"]

[quote user="David Mills"]

[quote user="Julian Earl"]

... but if it is sub-therapeutic it should not select for resistance. As far as I was taught, the incidences of sub-therapeutic levels causing resistance are miniscule.

[/quote]

It's about scale i.e. how sub-therapeutic and for how long: any antibiotic used at sub-therapeutic levels will still select for resistance. But yes, in the grand scheme it is small compared to other horrors.

[/quote]

How? If we are talking about therapeutic being above the minimum inhibitory concentration, the either they are above that level and inhibiting all but those that are resistant, or not inhibiting and not selecting. Or is that too simplistic? My understanding is/was that below the MIC means no selection except in very rare instances as I alluded to before.

[/quote]

Presumably MIC's have to be different for each organism? , so at a given concentration some will be inhibited and some will not. Those that are not go on and survive/multiply. what is sub therapeutic for one for one organism may be effective against another. the more resilient (and possibly pathogenic) go on and survive and thrive.

Re: Do people use antibiotics for routine cat castrates?

David Mills — Tue, 12 Jul 2011 19:10:19 GMT

Studies aren't abundant in this, but a recent peer-reviewed one (free to view):

http://www.liebertonline.com/doi/abs/10.1089/mdr.2010.0101?journalCode=mdr

Re: Do people use antibiotics for routine cat castrates?

Mark Holmes — Tue, 12 Jul 2011 14:50:57 GMT

[quote user="Julian Earl"]How? If we are talking about therapeutic being above the minimum inhibitory concentration, the either they are above that level and inhibiting all but those that are resistant, or not inhibiting and not selecting. Or is that too simplistic? My understanding is/was that below the MIC means no selection except in very rare instances as I alluded to before[/quote]

Probably in the same way that a population (a dazzle apparantly..... you do learn something from kids TV) of Zebra get faster despite the fact that the Lions only take a few. The greater the predation the stronger the selection pressure but remember that the generation time is measured in a few hours not years. A weak selection pressure will select for resistance over sufficient generations.

Re: Do people use antibiotics for routine cat castrates?

Julian Earl — Tue, 12 Jul 2011 14:36:07 GMT

[quote user="David Mills"]

[quote user="Julian Earl"]

... but if it is sub-therapeutic it should not select for resistance. As far as I was taught, the incidences of sub-therapeutic levels causing resistance are miniscule.

[/quote]

Re: Do people use antibiotics for routine cat castrates?

Evelyn Barbour-Hill — Mon, 11 Jul 2011 23:57:42 GMT

[quote user="David Mills"]Grow up[/quote]

Very Bad Argument, that.

[quote user="David Mills"]Sorry, I thought you were trying to compare someone saying 'dental' to someone saying 'operation' and how saying dental, therefore, was as indistinct as saying operation. Argument? Comment? Do you know what you were trying to say?[/quote]

Yes, thank you. I was saying that the term "dental" was absurdly vague. As I suspect you know. However to you the term is not absurdly vague because you feel that 99.9% of the time "dental" means "scale/polish +/- extractions." At least we have now established that.

To paraphrase your own comment and adopt your own style of discussion: do you know what you are trying to do with your "dental"?

Re: Do people use antibiotics for routine cat castrates?

David Mills — Mon, 11 Jul 2011 23:28:34 GMT

[quote user="Julian Earl"]

... but if it is sub-therapeutic it should not select for resistance. As far as I was taught, the incidences of sub-therapeutic levels causing resistance are miniscule.

[/quote]

It's about scale i.e. how sub-therapeutic and for how long: any antibiotic used at sub-therapeutic levels will still select for resistance. But yes, in the grand scheme it is small compared to other horrors.

Convenia is a cephalosporin and therefore should not be used for any first line treatment at all, convenient or not.

[quote user="Evelyn Barbour-Hill"]

Why is it Bad Argument when there was no argument put forward?

[/quote]

Sorry, I thought you were trying to compare someone saying 'dental' to someone saying 'operation' and how saying dental, therefore, was as indistinct as saying operation. Argument? Comment? Do you know what you were trying to say?

It's a Bad Argument purely and simply because the ridiculous mismatch of scale makes the argument invalid. Operation overs a whole range of procedures far beyond the mouth.

[quote user="Evelyn Barbour-Hill"]

If 99.9% of your dental procedures are "scale/polish +/- extractions" then you are not helping your patients much.

[/quote]

Grow up.

Re: Do people use antibiotics for routine cat castrates?

Anthony Todd — Mon, 11 Jul 2011 22:43:44 GMT

[quote user="Anthony Todd"] necessary to use antibiotics in any routine surgery let alone cat castrates.[/quote]

So, to close the catspay/castration antibiotic thread, is there any evidence, from any source, that shows that antibiotics before during or after this routine surgery are necessary at all.

References, not anecdotes, for and against please.

Re: Do people use antibiotics for routine cat castrates?

Julian Earl — Mon, 11 Jul 2011 21:50:28 GMT

That's a good point you raise there. I think the injection would have more use if it was active for a shorter time, seven days maybe.

Re: Do people use antibiotics for routine cat castrates?

Alan Tevendale — Mon, 11 Jul 2011 20:51:09 GMT

I'm not sure what side of the fence I'm on with this point however Pfizers argument is that with conventional daily antibiosis you actually spend a significant amount of time between doses at sub-therapeutic levels on a daily basis between doses and also how confident are you that the owners are giving all of your prescribed course. So many times I've been told by a client that after telling them I'm prescribing their dog antibiotics "don't worry I've already got some of those tablets at home from when I was in with fluffy/fido". At least with a long lasting injection they can't do that. Having said that I think I'd rather see a slightly shorter acting course than 14 days with a shorter tail off period as well.

How many people here actually think every time they give an injection of convenia "this animal needs 2 weeks of antibiotics" and aren't just using it for it's convenience.

Re: Do people use antibiotics for routine cat castrates?

Julian Earl — Mon, 11 Jul 2011 20:00:28 GMT

... but if it is sub-therapeutic it should not select for resistance. As far as I was taught, the incidences of sub-therapeutic levels causing resistance are miniscule.

Re: Do people use antibiotics for routine cat castrates?

Rob Loxley — Mon, 11 Jul 2011 19:47:54 GMT

[quote user="David Mills"]amoxicillin is time dependent. Worry with LA is that there is obviously no sudden switch-off period - levels probably decline over hours/days meaning high resistance selection in that time[/quote]

and Pfizer are now pushing Convenia for use with periodontal disease; looking at the literature the blood level looks like it spends a long time (after the initial 14 days) at subtherapeutic levels...

Re: Do people use antibiotics for routine cat castrates?

Evelyn Barbour-Hill — Mon, 11 Jul 2011 19:25:04 GMT

[quote user="David Mills"]Dentals, of course, refer to 99.9% of dental procedures carried out in veterinary practice - scale/polish +/- extractions.[/quote]

Does it? Who says? Why is it Bad Argument when there was no argument put forward? If you are going to discuss "are antibiotics indicated in dentals" you would do best to define "dental" first.

If 99.9% of your dental procedures are "scale/polish +/- extractions" then you are not helping your patients much.

Re: Do people use antibiotics for routine cat castrates?

David Mills — Mon, 11 Jul 2011 18:08:18 GMT

[quote user="Rob Davis"]

or in certain other situations (eg valvular heart disease, orthopaedic implants, immunocompromised patients).

[/quote]

Not so in humans re heart disease as the chances of having allergic reaction to the antibiotic is higher than the chances of developing bacterial endocarditis. There is an almost continual bacteraemia with periodontal disease so it's a waste of time and money using antibiotics preventatively except in restricted cases, as Rob mentions.. Dentals, of course, refer to 99.9% of dental procedures carried out in veterinary practice - scale/polish +/- extractions. So actually nothing like saying 'operation'. Bad Argument.

Yes, my mistake, amoxicillin is time dependent. Worry with LA is that there is obviously no sudden switch-off period - levels probably decline over hours/days meaning high resistance selection in that time, especially as the course (3 days) is likely worthless.

Re: Do people use antibiotics for routine cat castrates?

Evelyn Barbour-Hill — Mon, 11 Jul 2011 17:51:30 GMT

Far too much antibiotic is wasted on dental treatments. (In my opinion, of course )

I wish people wouldn't talk about "dentals": it's even vaguer than "operations". (Ooh, will he need an operation?) However, leaving that aside:

Gingivitis and the sequel periodontitis are caused by accumulation of plaque undisturbed, so that it increases in depth and accumulates ever further under the gingival margin, so that its local ecology changes and anaerobic and "aggressive" species are encouraged and become dominant: a process usually summarised as maturation of plaque. Your dental treatment (assuming you have done it properly) removes all the plaque from the subgingival region. Your aftercare is aimed at constantly discouraging and disturbing plaque so that it never gets a chance to thicken. This is completely different to treating say an infected wound or a superficial pyoderma. It's ridiculous to suggest you can get rid of the bacteria from the gums: all the oral bacteria, all the species, are present all the time in the mouth anyway.

Sure, an antibiotic can have a place in the treatment of dental disease. But not as routine.

Re: Do people use antibiotics for routine cat castrates?

Martin Atkinson — Mon, 11 Jul 2011 14:20:21 GMT

[quote user="Rob Davis"]

[quote user="Martin Atkinson"]I virtually always give a post dental course of antirobe (usually clindamycin)[/quote]

Does antirobe come in other flavours then?

[/quote]

....erm not as far as I'm aware that was a typo and I probably meant to say antibiotic not antirobe but got my fingers tied up.

Interesting previous thoughts on gingivitis and antibiotics though, I find the gingivitis clears up much more quickly post dental with antibiotics or not at all if I don't use them, maybe that is just condemnation of my dental technique!

Re: Do people use antibiotics for routine cat castrates?

Rob Davis — Mon, 11 Jul 2011 14:05:44 GMT

[quote user="Martin Atkinson"]I virtually always give a post dental course of antirobe (usually clindamycin)[/quote]

Does antirobe come in other flavours then?