ANTIMICROBIAL RECOMMENDED ROUTE INTER-DOSING …...omphalophlebitis. If no enlargement of the...
Transcript of ANTIMICROBIAL RECOMMENDED ROUTE INTER-DOSING …...omphalophlebitis. If no enlargement of the...
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HORSES
*Manyoftherecommendationinthisguiderepresentoff-labeluseofantimicrobials.Compliancewiththelegalrequirementsofyourjurisdictionisyourresponsibility.
FORMOREINFORMATION:www.fvas.unimelb.edu.au/vetantibiotics
AUSTRALIANVETERINARY
PRESCRIBING GUIDELINES
DOSERATESANTIMICROBIAL
AGENTRECOMMENDED
DOSEROUTE INTER-DOSING
INTERVAL
Procainepenicillin* 22,000IU/kg IM 12hours
Gentamicin* 7.7-9.7 mg/kg IVorIM 24hours
Trimethoprim/sulphonamide
30mg/kg POorIV 12hours
Doxycycline* 10mg/kg PO 12hours
Oxytetracycline* 6.6mg/kg Slow IV 12hours
Metronidazole* 20mg/kg PO 12hours
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SURGICAL PROPHYLAXIS
FORMOREINFORMATION:www.fvas.unimelb.edu.au/vetantibiotics
SURGICALCONTAMINATION
LEVEL
ANTIMICROBIALRECOMMENDATION
DURATIONOFTHERAPY
CLEAN, NOMITIGATINGFACTORS
NONE N/A
CLEAN,MITIGATINGFACTORS
Penicillin &Gentamicin Stopwithin24hours
CLEANCONTAMINATED
Penicillin &Gentamicin 24-48hours
CONTAMINATED Chooseantimicrobialappropriateforinfection
Treatuntil cured
MITIGATINGFACTORS• Surgicalduration>90mins• Surgeryinvolvinganimplant• Surgicalsiteinfectionwouldbeamajorthreattothepatient(i.e.centralnervoussystemsurgery)
TIMING:Tissuelevelsarerequiredatthetimeofincisiontoconferprotectionfromsurgicalsiteinfection.IVantimicrobials:
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AVPG SKIN/FEET
WOUNDSNOSYNOVIALSTRUCTURESINVOLVED:noantimicrobialstherapyindicated,evenifcontaminationofthewoundispresent.Systemicantimicrobialsonlywhen:• Systemicallyunwell• Potentialsynovialinvolvement(seebelow)• Immunosuppressedpatient
SYNOVIALSTRUCTUREINVOLVED:Lavageisalmostalwaysrequiredforsuccessfuloutcome.Systemicantimicrobialsalwaysindicated.Therapyshouldbebasedofcultureandsusceptibilitytesting.Empiricaltherapywithpenicillinandgentamicinshouldbeinitiatedpendingcultureresults.
FOOTABSCESS CELLULITISPRIMARY noobviousunderlyingcause.Oftenmoreseverethansecondarycases.SECONDARY:anunderlyingcausecanbeidentified(surgery,jointinjection,wound,blunttrauma).
DIAGNOSTICSFine-needleaspirateshouldbecollectedforcultureandsusceptibilitytesting.Careifneededforcellulitisoccurringoversynovialstructures.
TREATMENTIVRP:gentamicin1/3systemicdoseSystemicantimicrobials:Penicillin&gentamicin(adjustdoseifIVRPperformed)oroxytetracycline.Topicaltherapy:Coldwaterhosingandpressurebandage.Analgesiaespeciallyifnon-weightbearingasrisklaminitisincontralaterallimb.
FORMOREINFORMATION:www.fvas.unimelb.edu.au/vetantibiotics
Noantimicrobialtherapyindicated.
Curettetoestablishdrainage.Ifrecurrentconsiderunderlyingdisease.Radiographsshouldbetakentoinvestigateforpedalosteitis&ACTHmeasuredtoinvestigateforequineCushing’sdisease(PPID).Systemicantimicrobialsonlywhen:• Immunosuppressedpatient• Ifseverecellulitisispresent
Ensurehorsesarevaccinatedfortetanus.
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STRANGLES SINUSITISDIAGNOSTICSNotifiabledisease,samplesshouldbesubmittedforserology,cultureorPCRtoconfirmdiagnosis.
TREATMENTNoantimicrobialrecommended.Mostcasesresolvequicklyoncedrainagehasbeenestablished.Asmallpercentagecontinuetoshed(carriers).Systemicantimicrobialsonlywhen:• Respiratorycompromise• Metastaticdisease(Bastardstrangles)
Inthesecases,penicillinisfirstlinetherapy.
RESPIRATORY
PNEUMONIA
FORMOREINFORMATION:www.fvas.unimelb.edu.au/vetantibiotics
AVPG
DIAGNOSTICSAsampleoffluidfromthesinusshouldbeobtainedtoconfirmthediagnosis.Cultureisnotusuallyrequired.Considerunderlyingdisease(dentalorequineCushing’s)especiallyifrecurs.
TREATMENTSinuslavagealonemaybesufficientandisalmostalwaysrequiredforsuccessfuloutcome(minimallyinvasivetechniqueinthefieldcanbeused).Systemicantimicrobialswhen:• Recurrentdisease• SystemicallyunwellInthesecases,penicillinortrimethoprim/sulphonamideisfirstlinetherapy.
DIAGNOSTICSTranstracheal wash,orendoscopictrachealwashwithatripleguardedcatheter,shouldbeperformedforcytologicalevaluation.Cultureandsusceptibilitytestingshouldbeperformedinallcases.Cultureofbronchoalveolar lavagespecimensisneverappropriateasthesesamplesarecontaminatedbytheupperairway.
TREATMENTShouldbebasedoncultureandsusceptibilityresults.Empiricaltherapywithpenicillin&gentamicinshouldbeinitiatedpendingresults.Metronidazoleshouldbeaddedifanaerobesaresuspected(foulsmelltotrachealfluid).
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PNEUMONIA SEPTICARTHRITISDIAGNOSTICSStreptococcuszooepidemicus andRhodococcus equi areequallycommon.Transtracheal washisrequiredforcytologicalexaminationandcultureandsusceptibilitytestinginallcases.
TREATMENTBasedoncultureandsusceptibilityresults.Empirictherapycanbeinitiatedwhileresultspending.IfS.zooepidemicus issuspectedpenicillinisappropriate.IfR.equi issuspectedclarithromycinandrifampinisrecommended.
DURATIONOFTHERAPYVariesbypathogen;1weekgenerallyadequateforS.zooepidemicus,4-6weekgenerallyrecommendedforR.equi.
FOALSSEPSIS
FORMOREINFORMATION:www.fvas.unimelb.edu.au/vetantibiotics
AVPG
DIAGNOSTICSSepsisscorecanbeusedtoassessrisk(seewebsite).Bloodforcultureandsusceptibilityshouldbecollectedbutfalsenegativesarecommon.
TREATMENTBasedoncultureandsusceptibilityresultsifpossible.Empirictherapycanbeinitiatedwhileresultspending.Penicillin&gentamicinisrecommended.Carewithgentamicinifrenalfunctioniscompromised.Intravenoustrimethoprim/sulphonamideisalternate.
DURATIONOFTHERAPY2weeksisgenerallyconsideredtobeadequate,unlessfocalinfectiondevelops(i.e.septicarthritis).
DIAGNOSTICSArthrocentesisshouldbeperformedtoobtainfluidforcytologicalevaluationandforcultureandsusceptibilitytestinginallcases.Radiographsshouldbetakentoinvestigateboneinvolvement.
TREATMENTBasedoncultureandsusceptibilityresults.Empirictherapycanbeinitiatedwhileresultspending.Penicillin&gentamicinisrecommended.Oxytetracyclineisanalternative,especiallyifosteomyelitisisdiagnosed.
DURATIONOFTHERAPYTreatfor1weekpastresolutionofclinicalsigns,longerifosteomyelitisispresent.
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DIAGNOSTICSUltrasoundevaluationshouldbeperformedtoruleoutomphalophlebitis.Ifnoenlargementoftheumbilicalremnantsisidentifiedantimicrobialtherapyisnotindicated.
TREATMENTNoantimicrobialtherapyindicated.Frequenttopicalantibacterialtherapywithchlorhexidineisrecommendeduntilpatencyresolves.
FOALSPATENTURACHUS OMPHALOPHLEBITIS(NAVELILL) HIGH-RISKFOALS
FORMOREINFORMATION:www.fvas.unimelb.edu.au/vetantibiotics
AVPG
DIAGNOSTICSUltrasoundevaluationshouldbeperformedtodefinetheinfectedstructureandtoallowformonitoringwithtreatment.
TREATMENTPenicillin&gentamicinismosteffectivebutoftennottoleratedwell.Trimethoprim/sulphonamideordoxycyclinearesuitablealternativesthatcanbegivenorally.
DURATIONOFTHERAPYSerialultrasonographic examinationshouldbeperformedandtherapycontinueduntil1weekafterresolutionofdisease.
Prematurefoalandthosewithneonatalencephalopathy(’DummyFoalSyndrome’)areatincreasedriskofsepsis.Failureofpassivetransfershouldbeaddressedwithplasmatransfusion.Thereisnoevidenceforanybenefitfromprophylacticantimicrobialsinplaceofplasmatransfusion.
DIAGNOSTICSSerialhaematologic evaluationandsepsisscoremayguidenecessityforantimicrobialtherapy.
TREATMENTProphylactictherapyiswarrantedwhenleukopaenia ispresentorsepsisscoreishigh.Penicillin&gentamicinismostappropriatebutcareshouldbetakeninfoalswithimpairedrenalfunction.Trimethoprim/sulphonamideIVisanalternative.
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DIARRHOEA PERITONITISACUTEDIARRHOEADIAGNOSTICSCultureshouldbeperformedforSalmonella.Diagnosisofclostridialdiseaserequirestoxintest.
TREATMENTAntimicrobialtherapyrarelyindicated.Onlyif:• Confirmedclostridial cause• Severeleukopaenia andneutropaeniaIfclostridial:metronidazoleIfleukopaenic:penicillin&gentamicin
DURATIONOFTHERAPYClostridial:untildiarrhoearesolvesLeukopaenic:untilleukopaenia resolves
CHRONICDIARRHOEAAntimicrobialtherapyrarelyindicated.
GASTROINTESTINAL
FORMOREINFORMATION:www.fvas.unimelb.edu.au/vetantibiotics
AVPG
LAWSONIAINFECTION(PROLIFERATIVEENTEROPATHY)
DIAGNOSTICSAbdominocentesis shouldbeperformedtocollectfluidforcytologicalevaluationandcultureandsusceptibilitytesting.Differentiationbetweenprimaryandsecondaryoriginsiscriticalassecondaryperitonitisistypicallyduetoleakagefromthegastrointestinalorreproductivetractsandsurgeryshouldbeconsidered.
TREATMENTSystemicantimicrobialtherapyshouldbeinstitutedimmediatelyfollowingsamplecollection.Penicillin&gentamicin&metronidazoleareappropriate.
DURATIONOFTHERAPYSerialabdominocentesis shouldguidetherapy.Treatfor1-2weekspastresolutionofdisease
DIAGNOSTICSDiagnosiscanbemadeviaserology(ELISA)orbyfaecal PCR.
TREATMENTMildtomoderatedisease:doxycyclinePOSeveredisease:oxytetracyclineIV
DURATIONOFTHERAPYMildtomoderatedisease:generally3weeksisrecommendedSeveredisease:3-4weeks
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RETAINEDPLACENTA PLACENTITIS
REPRODUCTION
FORMOREINFORMATION:www.fvas.unimelb.edu.au/vetantibiotics
AVPG
DIAGNOSTICSDiagnosiscanbemadeonclinicalsignsalone.
TREATMENTLargevolumeuterinelavageiscriticalforstimulatingplacentaldetachmentandremovingendotoxinstherebypreventingabsorption.Systemicantimicrobialsarealwaysrequired.Penicillin,gentamicinandmetronidazoleshouldbeadministered.NSAIDsarealsocritical.
DURATIONOFTHERAPY1weekpastresolutionofclinicaldisease.
DIAGNOSTICSUltrasonographic examinationoftheplacentaisnecessary.Samplesshouldbecollectedforcultureandsusceptibilitytestingifthecervixisopen.Thereisnoevidenceforprophylacticorpulsetherapyforplacentitis.
TREATMENTTrimethoprim/sulphonamideispreferableandgentamicinmaynotcrosstheplacenta.
DURATIONOFTHERAPY1weekpastresolutionofultrasonographic andclinicaldiseaseoruntilfoaling.Generallyrequirestherapyuntilfoaling.
ENDOMETRITISDIAGNOSTICSCytologicalevaluationandcultureandsusceptibilitytestingisrequiredfordiagnosis.Considerunderlyingdisease.
TREATMENTThereisnoevidenceforroutinetreatmentofmarespost-service.Therapyshouldbeguidedbycultureandsusceptibilityresults.Intrauterinepenicillinandaminoglycosideappearseffectiveinmostcases.