Small Animal Clinical Pharmacology - CYF MEDICAL DISTRIBUTION

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Table 8.2 Suggested antibacterial drug selection for canine and feline infections Diagnosis Common organisms (less common) Suggested drugs Pyoderma, pustular dermatitis Dogs Staphylococcus (secondary Escherichia, Proteus, Amoxicillin-clavulanate, cephalosporin, cloxacillin/flucloxacillin Pseudomonas) Cats Streptococcus, Pasteurella, Staphylococcus Amoxicillin-clavulanate, lincosamide, doxycycline, cephalosporin Bite wounds, traumatic and contaminated wounds Dogs Staphylococcus, Streptococcus, Pasteurella, anaerobes Amoxicillin-clavulanate, cephalosporin Cats Anaerobes, Pasteurella, Actinomyces Penicillin G, clindamycin, doxycycline, amoxicillin, cephalosporin Anal sac inflammation, abscessation Escherichia, Enterococcus, (Clostridium, Proteus) Otitis externa Staphylococcus, Malasezzia, Pseudomonas, Proteus Otitis media, otitis interna Staphylococcus, Pseudomonas, Proteus Amoxicillin-clavulanate, chloramphenicol, sulfonamide-trimethoprim Topical: aminoglycoside, polymyxin, fluoroquinolone, chloramphenicol, ticarcillin Amoxicillin-clavulanate, fluoroquinolone, chloramphenicol, ticarcillin Conjunctivitis Dog Staphylococcus, Streptococcus, Escherichia, Proteus Topical: neomycin-polymyxin-bacitracin, chloramphenicol, gentamicin Cats Viruses, Chlamydophila, Mycoplasma, 2° bacteria Tetracycline, chloramphenicol Infectious tracheobronchitis Dogs Bordetella, viruses, secondary bacteria (Mycoplasma?) Sulfonamide-trimethoprim, doxycycline, chloramphenicol Bacterial pneumonia*, pyothorax* Dogs Single or mixed Gram-negative aerobes and/or anaerobes Amoxicillin-clavulanate, fluoroquinolone + metronidazole Cats Various anaerobes, Pasteurella, other Gram-negative aerobes, Actinomyces Amoxicillin-clavulanate, fluoroquinolone + metronidazole Periodontitis, gingivitis, ulcerative stomatitis Anaerobes and mixed aerobes Penicillin G, amoxicillin, metronidazole ± spiramycin, doxycycline, clindamycin <strong>Small</strong> intestine bacterial overgrowth/antibiotic-responsive diarrhea Escherichia, Enterococcus, Staphylococcus, Clostridium Tetracycline, tylosin, metronidazole Cholecystitis, cholangitis Dogs Escherichia, Salmonella, anaerobes Amoxicillin-clavulanate, chloramphenicol, fluoroquinolone + metronidazole Cats Coliforms Amoxicillin-clavulanate, chloramphenicol, fluoroquinolone Lower urinary tract infection, pyelonephritis* Dogs Escherichia, Proteus, Staphylococcus, Streptococcus, Klebsiella, Pseudomonas, Enterobacter Prostatitis Dogs Escherichia, Proteus, Staphylococcus, Streptococcus, Klebsiella, Pseudomonas, Enterobacter Mastitis* Escherichia, Staphylococcus, Streptococcus Osteomyelitis* Staphylococcus (possibly with Streptococcus, Escherichia, Proteus, Pseudomonas, anaerobes) Discospondylitis Staphylococcus (Streptococcus, Aspergillus) Amoxicillin-clavulanate, sulfonamide-trimethoprim, cephalosporin, fluoroquinolone Sulfonamide-trimethoprim, fluoroquinolone Chloramphenicol, amoxicillin-clavulanate, fluoroquinolone Amoxicillin-clavulanate, lincosamide, cloxacillin/ flucloxacillin, fluoroquinolone, cephalosporin Cloxacillin/flucloxacillin, lincosamide, cephalosporin, amoxicillin-clavulanate Septic arthritis* Staphylococcus, Streptococcus (anaerobes, coliforms) Cloxacillin/flucloxacillin, amoxicillin-clavulanate Septicemia*, bacterial endocarditis* Various aerobes or anaerobes Fluoroquinolone + penicillin G or metronidazole, gentamicin + cephalosporin or cloxacillin/flucloxacillin Toxoplasmosis Toxoplasma gondii Clindamycin, sulfonamide + pyrimethamine Feline infectious anemia Mycoplasma haemofelis (formerly Haemobartonella felis) Doxycycline, enrofloxacin ‘Anaerobes’ here signifies bacterial species that are obligate anaerobes, while ‘aerobes’ denotes aerobic and facultatively anaerobic bacteria. Culture and susceptibility testing should be performed, if possible, prior to initiating therapy for those conditions marked by * and in all other conditions if initial empirical antimicrobial therapy is unsuccessful.
CHAPTER 8 ANTIBACTERIAL DRUGS Table 8.3 Suggested administration of oral antibacterial drugs in dogs in relation to feeding a Category Better when fasting Drug absorption may be impaired by ingesta. Fasting means no food for at least 1–2 h before and 1–2 h after dosing Better with food Drug availability is improved, or gastrointestinal upsets are reduced by ingesta No restriction needed Drugs or drug groups Azithromycin Cefradine Most erythromycin preparations Most fluoroquinolones b Lincomycin Most penicillins# Rifampicin Most sulfonamides Most tetracyclines Cefadroxil Chloramphenicol palmitate (in cats) Doxycycline * Ibafloxacin Metronidazole * Nitrofurantoin * Cefalexin Chloramphenicol capsules and tablets Chloramphenicol palmitate (in dogs) Clarithromycin Clindamycin Hetacillin Spiramycin a Data from human studies except: cefadroxil, cefalexin, chloramphenicol, clarithromycin, enrofloxacin, ibafloxacin, penicillins. b Enrofloxacin availability is reduced by ingesta in dogs. Effects of ingesta on fluoroquinolones are generally mild but absorption may be delayed slightly; avoid dairy foods. # Effect on amoxicillin is mild. * Food may reduce gut irritation without hindering absorption importantly. or subcutaneous (SC) administration may be equally satisfactory in these instances. The intravenous (IV) route should be considered if maximum plasma drug concentrations are desired immediately after dosing, as with life-threatening infections, or in shocked or hypotensive patients where poor tissue perfusion may impede drug absorption after administration by other routes. Dosage and frequency of administration Dosing regimens for commonly used antibacterial drugs are suggested in Table 8.4 and are based on the mode of action of each drug (concentration or time dependent), the susceptibility of the target pathogen and the pharmacokinetics of the drug. The ideal regime may vary with the case, depending on the susceptibility of the pathogen, tissue penetration of the drug and degree of immunocompetence of the patient. <strong>Small</strong>er doses may suffice in lower urinary tract infections using drugs excreted in high concentration in urine but larger or more frequent doses may be required for relatively resistant pathogens or infections in areas where drug penetration is poor. Assessment and duration of therapy In acute infections, it is usually evident within 2–3 days whether treatment is having the desired effect. An inadequate response should prompt re-evaluation of the diagnosis and treatment. If underdosing or poor tissue penetration is suspected, an increased dose rate and/or frequency of administration of the same drug might be appropriate. Otherwise, selection of a different drug is warranted. For the majority of uncomplicated and acute infections in dogs and cats, treatment for 4–5 days up to a week seems adequate. With chronic infections, it may take longer to determine whether treatment is being effective and prolonged administration is usually required. This can be explained by existing tissue damage, impaired blood supply and compromised local immunity. Treatment for 4–6 weeks or more is generally required when bacterial infections are chronic. Similarly prolonged treatment is also advised for pyoderma, prostatitis, pyelonephritis, recurrent lower urinary tract infections, septic arthritis, osteomyelitis, septicemia, pneumonia, bacterial endocarditis and antibiotic-responsive diarrhea. Combination antibacterial therapy Combination antibacterial therapy is only indicated in certain specific circumstances (except sulfonamidetrimethoprim and β-lactam plus β-lactamase inhibitor). Bacteriostatic and bactericidal drugs should not generally be used in combination. The disadvantages of combination chemotherapy include increased cost and increased risk of toxicity. The primary indications for using combinations include: ● mixed bacterial infections ● to delay emergence of resistance in certain specific circumstances ● severe infections where the etiology is unknown (ensure selected drugs are compatible) ● life-threatening infections prior to availability of susceptibility data ● unusual pathogens, including Mycobacterium, Rhodococcus and fungi. Examples of antibacterial combinations sometimes used in small animal practice include: a fluoroquinolone with metronidazole (capable of penetrating difficult body barriers and efficacy against Gram-negative aerobes, obligate anaerobes, penicillinase-producing Staphylococcus, most Gram-positive aerobes except Streptococ- 154
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CONTRIBUTORS Matthias J Kleinz Depa
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Dedication To Tom, Rosalind and Jim
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CHAPTER 1 PRINCIPLES OF CLINICAL PH
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CHAPTER 2 CLINICAL PHARMACOKINETICS
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CHAPTER 3 ADVERSE DRUG REACTIONS Un
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CHAPTER 3 ADVERSE DRUG REACTIONS
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CHAPTER 4 THE PHARMACOLOGY OF THE A
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CHAPTER 5 ANESTHETIC AGENTS However
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CHAPTER 5 ANESTHETIC AGENTS Table 5
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CHAPTER 5 ANESTHETIC AGENTS doses.
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Page 131 and 132: 7 Behavior-modifying drugs Kersti S
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Page 153 and 154: 8 Antibacterial drugs Jill E Maddis
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Page 191 and 192: 9 Systemic antifungal therapy Josep
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CHAPTER 11 GLUCOCORTICOSTEROIDS AND
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12 Immunomodulatory therapy Michael
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CHAPTER 12 IMMUNOMODULATORY THERAPY
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CHAPTER 13 NONSTEROIDAL ANTI-INFLAM
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CHAPTER 14 OPIOID ANALGESICS inflam
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A Agonist opioid (morphine) B Parti
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CHAPTER 14 OPIOID ANALGESICS Small
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CHAPTER 14 OPIOID ANALGESICS Clinic
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15 Cancer chemotherapy Jane M Dobso
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CHAPTER 15 CANCER CHEMOTHERAPY to m
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CHAPTER 16 ANTICONVULSANT DRUGS sei
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17 Drugs used in the management of
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CHAPTER 17 DRUGS USED IN THE MANAGE
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CHAPTER 19 GASTROINTESTINAL DRUGS C
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CHAPTER 21 DRUGS USED IN THE TREATM
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23 Drugs and reproduction Philip G
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CHAPTER 23 DRUGS AND REPRODUCTION I
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CHAPTER 23 DRUGS AND REPRODUCTION F
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CHAPTER 23 DRUGS AND REPRODUCTION C
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CHAPTER 23 DRUGS AND REPRODUCTION M
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CHAPTER 23 DRUGS AND REPRODUCTION n
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CHAPTER 23 DRUGS AND REPRODUCTION E
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24 Topical dermatological therapy R
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CHAPTER 24 TOPICAL DERMATOLOGICAL T
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CHAPTER 25 OCULAR CLINICAL PHARMACO
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Index A α-adrenergic receptors 70,
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INDEX Antiplatelet drugs 456-457 pi
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INDEX Ceftazidime 168 Ceftiofur 166
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INDEX Drug receptors 4-8 Drug-drug
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INDEX Hepatic excretion 33 Hepatic
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INDEX Metabolism dogs vs cats 47 an
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INDEX Pentazocine 319, 327 Pentobar
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INDEX Semicarbazone 230 Septic arth
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