Applied Antimicrobials for Small Animals 4: GI disease

T/F dental scaling and oral surgeries can cause bacteremia?

True

Describe bacteremia caused by dental scaling and oral surgeries?

Healthy immune systems can take care of it

Most dental work are all clean-contaminated

When should you need antimicrobials to prevent post-op infections whith oral surgery?

Severe periodontal dz

Osteomyelitis

Orla inflammatory dz

Oronasal fistulas

When do you need to use antimicrobials to combat bacteremia after oral surgery?

Immunosuppressed or splenectomized

Some cardiac conditions

Severe liver or renal dz

Recent prosthetic placement

What drugs are good choices for dental dz?

Clindamycin

What is the MOA of clindamycin

Bacteriostatic concentrating in wbcs to reach the site of infeciton

What is the spectrum of clindamycin?

Gram positive bacteria and anaerobes

What are the adverse effects of clinamycin?

vomiting, diarrhea, esophageal lesions, alter GI flora

What drugs are a good choice for dental disease?

Amoxicillin-clavulanate

What is the spectrum of amoxicillin-clavulanate?

Gram+

Some gram -

Anaerobes

Aerobes

Why is bacterial gastritis rare?

Acid in the stomach can kill most bacteria

What are the main food born pathogens?

Salmonella, E. coli, Shigella

T/F food pathogens are rare to see in dogs and cats?

True

What should you do for most gastritis cases?

Nothing, it usually resolves in a few days without therapy

What is helicobacter?

Gram negative genus that can survive in the stomach

Produces urease to raise stomach pH

How do you diagnose helicobacter?

Gastroscopy and cytology/histopath

What is the protocol for helicobacter?

Triple antimicrobial

• Amoxicillin

• Metronidazole

• Clarithromycin

Describe campylobacter

Gram-negative microaerophilic bacteria

What does campylobacter cause?

Bloody diarrhea in puppies (confirm with PCR)

What is the #1 cause of bacterial diarrhea in people?

Campylobacter (ZOONOTIC FROM DOGS)

How can you increase the zoonotic risk of campylobacter?

Taking PPIs

T/F antimicrobials help diarrhea from campylobacter?

False (unknown)

What should you do if a pet has campylobacter?

Probably nothing as it should resolve in about a week with or without antimicrobial therapy. If the puppy is very sick or immunosuppressed then treat

What are the main choices for campylobacter treatment?

Macrolides: Erythromycin, Azithromycin, Tylosin

Why do we use antimicrobials for parvovirus?

Prophylactic bacterial treatment for parvo puppies to prevent concurrent infections with parvovirus because parvovirus targets bone marrow

How should we administer antimicrobials with parvo?

IV

What is the empirical choice of antibiotic for parvovirus?

Unasyn

What causes AHDS acute hemorrhagic diarrhea syndrome?

Microbiome dysbiosis, bacterial toxin production, dietary indiscretion

What are the C/S of AHDS?

Severe, acute, bloody diarrhea in dogs

Very hypovolemic

How do you diagnose AHDS (acute hemorrhagic diarrhea syndrome)?

C/S and a high PCV

Fecal cytology with a mixed population of bacteria

How do we treat AHDS?

IV fluids with recovery in 24-72 hours

When should we treat AHDS with antimicrobials?

Signs of SIRS/sepsis

Concern for bacterial translocation

What antimicrobial do we use for AHDS?

Ampicillin-sulbactam (Unasyn) IV

Metronidazole

Should you prescribe antibiotics if a client comes in with a dog that had acute diarrhea the last 24 hours?

False

What are your differentials for acute nonhemorrhagic diarrhea?

Dietary indiscretion, stress colitis, change in food

Addisons

What should you do if you have a patient with acute nonhemorrhagic diarrhea?

Check hydration

Maybe metro but wait a few days and decide

Should resolve in 3-5 days

Consider a probiotic

Spectrum of metronidazole?

Good anaerobic coverage with some anti-inflammatory properties

What is the taste of metronidazole?

Tablets taste horrible so dose at 20mg/kg PO q 24 hours instead of 10mg/kg 2x a day

What are the adverse effects of metronidazole?

Salivation, anorexia, weight loss, vomiting, diarrhea

CNS effects (vertical nystagmus, ataxia, encephalopathy)

How do you treat metronidazole toxicity?

Diazepam

Describe tylosin

Macrolide with anti-inflammatory properties

Tylosin spectrum

Gram positives and some aerobes

How do you give tylosin?

Comes in powder and tastes bad so put in capsule

What animals are most susceptible to granulomatous colitis?

Young boxers and french bulldogs

What does granulomatous colitis cause?

Painful, ulcerative large bowel bloody diarrhea and dramatic weight loss

Associated with E. coli

What do you treat granulomatous colitis with?

Enrofloxacin

What is a good protocol for dental disease?

Preoperative use Unasyn, ampicillin, or clindamycin

Postoperative: home with oral for 7-10 days

During a case of AHDS (acute hemorrhagic diarrhea) what do clostridial spores mean?

May or may not be a cause, must a fecal toxin test to see if that is the cause

T/F metronidazole can worsen acute nonhemorrhagic diarrhea?

True

What antimicrobials are most often used for an antibiotic trial in chronic diarrhea?

Metronidazole

Tylosin

T/F antibiotics are indicated for parvovirus with neutropenia?

True

T/F antibiotics are indicated for enteropathogenic bacteria with signs of systemic illness?

True

T/F antibiotics are indicated for an uncomplicated acute diarrhea?

False

T/F antibiotics are indicated with a chronic large bowel diarrhea in leu of workup?

False

T/F antibiotics are indicated during enteropathogenic bacteria in nonclinical cases or mild, self-limiting disease?

False