Ciprofloxacin dose.

Re: Ciprofloxacin dose.

Stephen Courtney — Thu, 21 Jul 2011 00:01:23 GMT

[quote user="Clive Ansell"]

The patient is aggressive and topical treatments are not possible, so it is the occasional ga and clean/flush along with systemic meds. Plus it is the all to familiar costs are an issue too.

[/quote]

Chronically infected ears can be very painful, and I now give these animals the benefit of the doubt and dish out tramadol...cheap as chips (until someone licenses it...) and often surprising how much easier they get to handle...!

As far as the deliberate typo goes...assume that has the same implications for VNs as for vets, these days...a friendly warning might be in order...

Re: Ciprofloxacin dose.

Mark Holmes — Wed, 20 Jul 2011 19:59:58 GMT

I say take a good sturdy volume of the cascade and use it to beat the person responsible for doctoring your results until one or both are in tatters. Two birds one stone.

Re: Ciprofloxacin dose.

Clive Ansell — Wed, 20 Jul 2011 17:24:10 GMT

So what would be the position under the cascade rules?

Swab comes back as sensitive to Ciprofloxacin, but resistant to Enrofloxacin in vitro.

Lets assume for the sake of discussion that Enrofloxacin is metabolised into Ciprofloxacin and concentrations are high enough to be clinically effective.

Assuming there are no other therapeutic options, is one compelled to prescribe Enrofloxacin in the knowledge that in vitro testing shows it to be ineffective, but it will be converted into the active metabolite Ciprofloxacin which has been shown to be effective? . Discuss.

Re: Ciprofloxacin dose.

Clive Ansell — Wed, 20 Jul 2011 17:15:11 GMT

[quote user="Mark Hedberg"]

Weird case; why fudge a lab result? If a client wants a cheaper drug, they can always ask, can't they?

[/quote]

Not 100% sure they did, but suspicious. I guess they knew I would say no unless there was laboratory evidence to support it. Client and at least one nurse are good friends or possibly related.

Re: Ciprofloxacin dose.

Mark Holmes — Wed, 20 Jul 2011 17:00:48 GMT

Try ear wicks from dermapet great for cases when you needs to apply extended topicals and cannot do it directly

Re: Ciprofloxacin dose.

Mark Hedberg — Wed, 20 Jul 2011 16:52:25 GMT

http://www.google.co.uk/m/url?client=safari&ei=KPkmToiyJpHv8QP6xZIE&hl=en&oe=UTF-8&q=http://www.ncbi.nlm.nih.gov/pubmed/9344173&ved=0CBYQFjAA&usg=AFQjCNEwLi2a6OXWjULymNUxz0JRBA9vGg

30-40% is converted, but many studies abound. Weird case; why fudge a lab result? If a client wants a cheaper drug, they can always ask, can't they?

Re: Ciprofloxacin dose.

Clive Ansell — Wed, 20 Jul 2011 16:46:23 GMT

Many thanks for all you replies, however the plot thickens. It seems that when the lab results were entered into the computerised notes the "s" after Marbofloxacin got converted to an "r". Although not 1005 sure, I have a feeling it was deliberate, as one of the nurses is a friend of the client and since discovering the "error" I have been asked to write a script for Ciprofloxacin as it is considerably cheaper. It's a No I'm afraid.

I didn't know Enrofloxacin was metabolised into Ciprofloxacin, and I cannot find an reference to it anywhere??

The patient is aggressive and topical treatments are not possible, so it is the occasional ga and clean/flush along with systemic meds. Plus it is the all to familiar costs are an issue too.

Re: Ciprofloxacin dose.

Mark Hedberg — Wed, 20 Jul 2011 14:42:50 GMT

The dose i use is 10mg/kg bid; one drug i have used in resistant cases is azithromycin at 10mg/kg sid for 2-3 wks. Do not lower the dose to q48h, it just comes back.

Re: Ciprofloxacin dose.

bob lehner — Wed, 20 Jul 2011 14:34:38 GMT

[quote user="Mark Holmes"]Is it fully resistant to enrofloxacin or partically resistant, as often those bugs with partial resistance will be susecptible to massive doses topical[/quote]

Agree - in vitro testing uses low levels of abs - in vivo by direct application in the ear give a hugely higher concentration. Last ear talk I went to said that Enroflox resistance in the lab may not reflect what happens if you instill it directly into the infected ear.

Re: Ciprofloxacin dose.

Eamon McAllister — Wed, 20 Jul 2011 13:57:04 GMT

My book says 10 - 20 mg/kg q24h. Avoid use in dogs 4weeks to 7 months of age. Use cautiously in animals with renal problems and in epileptic patients.

Re: Ciprofloxacin dose.

Mark Holmes — Wed, 20 Jul 2011 13:43:13 GMT

Is it fully resistant to enrofloxacin or partically resistant, as often those bugs with partial resistance will be susecptible to massive doses topically, I have had success with these using a combination of flushes and tris/edta and topical enroflaxacin.

Re: Ciprofloxacin dose.

Bob Russell — Wed, 20 Jul 2011 13:36:56 GMT

I tend to fall back on non-antibiotic treatment such as flushing, Surosolve etc, usually in conjunction with (deep breath!) steroids to improve comfort. I work on the assumption that a bug that is already very antibiotic resistant may well not be treated effectively with the more specific antibiotics and may well 'learn' to be resistant to the new antibiotics.

This may well have already been done. Sorry no idea of dose!

Re: Ciprofloxacin dose.

Rob Loxley — Wed, 20 Jul 2011 13:35:57 GMT

My American formularly says 20mg/kg SID.

Something however is niggling me that enrofloxacin is largely metabolised to ciprofloxacin by the liver anyhow, but my pharmacology knowledge is rusty...