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PROTECT Write your practice policy on empirical antibacterial use in the boxes below
Periodontal disease
Skin infections
Bite and other traumatic wounds: Lance, debride and lavage. In cat bites amoxicillin first choice; otherwise
choice as for Pyoderma. Heavily infected/deeper injuries: metronidazole OR amoxicillin/clavulanate +
Surgical prophylaxis
Prophylactic antimicrobial use is not a substitute for good aseptic
P
amoxicillin OR amoxicillin/clavulanate OR ampicillin OR clindamycin OR metronidazole + spiramycin. With or fluoroquinolone are appropriate while awaiting culture results. technique.
ractice policy without chlorhexidine mouthwash. Practice Policy: Perioperative antibiosis is appropriate:
Practice Policy: for prolonged surgery (>1.5 hours)
Infected traumatic wound: amoxicillin/clavulanate OR 1st generation cephalosporin.
A practice policy for empirical prescribing for implant introduction
(whilst awaiting cultures) can optimize therapy, Practice Policy:
where infections would be catastrophic (e.g. in CNS)
and minimize inappropriate use of Respiratory infections Pyoderma: where there is an obvious break in asepsis
antibacterials Bacterial pneumonia (including aspiration): Empirical choice of antibacterials suitable for surface and superficial pyoderma (if no resistance or treatment
for bowel surgery with a risk of leakage
cats: amoxicillin/clavulanate OR doxycycline. failure) but culture required for deep pyodermas.
dogs: aminoglycoside* + metronidazole* OR amoxicillin + fluoroquinolone OR amoxicillin + metronidazole* Topical: chlorhexidine AND/OR fusidic acid OR silver sulfadiazine*. (Antifungals for concurrent Malassezia for dental procedures where there is periodontal disease
R educe prophylaxis OR doxycycline OR oxytetracycline. often useful.) for contaminated wounds or pre-existing infection.
Systemic: amoxicillin/clavulanate OR cefadroxil OR cefalexin OR cefovecin (if problems expected with
Practice Policy: administration/compliance) OR clindamycin OR fluoroquinolones (if others inappropriate). Continue 1 week In most cases:
beyond resolution of clinical signs. intravenous amoxicillin/clavulanate OR first-generation cephalosporin.
Antibacterials are not a substitute for Bacterial rhinitis, chronic rhinitis and sinusitis: amoxicillin/clavulanate
Practice Policy: Where anaerobic involvement is highly likely (e.g. periodontal disease):
surgical asepsis Practice Policy: add or substitute metronidazole.
Prophylactic antibacterials are only Pyoderma (idiopathic recurrent):
Kennel cough: no antimicrobials in mild cases; more severe: amoxicillin/clavulanate OR doxycycline Topical therapy important: antimicrobial shampoos/rinses, especially chlorhexidine. For significant bowel leakage in an otherwise metabolically stable
appropriate in a few medical cases OR oxytetracycline.
(e.g. immunocompromised patients) Systemic: Alternatives to antibacterials include immunostimulants (Staph Phage Lysate, autogenous vaccine). animal:
Practice Policy: Last resort is pulse therapy 23 consecutive days/wk. combination may be most appropriate, e.g. ampicillin +
agents; only use when other agents are Skin and ears
ineffective (ideally determined by culture and
Genitourinary infections
Malassezia dermatitis
Cystitis: amoxicillin/clavulanate OR trimethoprim/sulfadiazine. Many cats with cystitis do not have bacterial Miscellaneous
sensitivity testing) infections routine antibacterials not required. Non-specific pruritus, scaling, nodules, crusts, etc.
Endocarditis: amoxicillin/clavulanate + enrofloxacin OR amoxicillin/clavulanate + metronidazole*.
Practice Policy: Practice Policy:
T reat effectively
Practice Policy:
Pyelonephritis (acute): trimethoprim/sulfadiazine. Culture required in chronic cases.
Practice Policy:
Septic peritonitis: amoxicillin/clavulanate OR ampicillin + cefotaxime OR ampicillin + gentamicin* OR
Second and Third Choice Antibacterials
These include: amikacin, 3rd generation and 4th generation cephalosporins
Practice Policy: clindamycin + enrofloxacin OR fluoroquinolone + ampicillin. Add metronidazole* if anaerobe suspected. (except cefovecin) and fluoroquinolones. These antibacterials should be
Treat long enough and at a sufficient dose
used only when other agents are inappropriate (e.g. in penicillin-sensitive
and then stop Struvite urolithasis (dog): amoxicillin/clavulanate OR trimethoprim/sulfadiazine. Practice Policy:
individuals) and/or ineffective, and culture/sensitivity testing indicates that
Avoid underdosing Septicaemia: ampicillin + cefotaxime OR ampicillin + gentamicin* OR clindamycin + enrofloxacin OR
Practice Policy: they will be effective.
Repeat culture after enrofloxacin + ampicillin OR fluoroquinolone + amoxicillin/clavulanate.
long courses Practice Policy:
Orthopaedic infections Follow the Cascade
Discospondylitis/Osteomyelitis: amoxicillin/clavulanate OR 1st generation cephalosporin OR clindamycin.
Long courses (68 wk) may be needed. Suggested antibacterials are listed in alphabetical order. Order of selection
Practice Policy: *
should follow the Prescribing Cascade. The following agents ( ) are not
authorized as sole agents for systemic use in small animals: aminoglycosides,
Septic arthritis: amoxicillin/clavulanate OR 1st generation cephalosporin.
For further information on individual drugs and dosages, azithromycin, erythromycin, gentamicin, metronidazole. Metronidazole is
BSAVA 2011. The publishers, editors and contributors cannot take responsibility for information provided on dosages and
methods of application of drugs mentioned or referred to in this publication. Details of this kind must be verified in each case by
see BSAVA Small Animal Formulary, 7th edition. authorized for oral use in combination with spiramycin. Oxytetracycline is not
individual users from up to date literature published by the manufacturers or suppliers of those drugs. Veterinary surgeons are
reminded that in each case they must follow all appropriate national legislation and regulations (for example, in the United
Practice Policy: authorized for use in the cat.
Kingdom, the prescribing cascade) from time to time in force. Other than adding practice policy, the poster may not be altered
in any way or used for any other purpose without prior written permission of the copyright holder, and may not be sold.