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In short, there are only three times when antibiotic use is necessary:

1. When definite bacterial infection is present
(e.g. as part of treatment for a cat bite abscess where pus is visible);

2. Where infection may not be present but is highly likely to develop
(e.g. right after a cat fight; or a critically ill patient with a weakened immune system);

3. Where an infection could lead to total catastrophe
(THIS IS RARE: e.g. a patient undergoing total hip replacement – infection can cause surgical disaster).
So, before choosing to use an antibiotic, your vet must be convinced that one of the above circumstances is definitely the case. If so, they should then be thinking “what are the most likely bacteria to be involved?” They will then choose an antibiotic likely to kill those bacteria. We can make guesses on which bacteria are likely to involve each body system – for example, bacteria called Staphylococci are common in infections of dogs’ skins and are normally killed by a predictable list of antibiotics. It is important to note that antibiotics should NOT be used to prevent infection (i.e. before an infection takes place) except in high-risk situations.
A large number of complaints that pet owners present to vets do NOT need antibiotic treatment in the first instance!

Examples include…

Simple diarrhoea
This is most frequently down to dietary indiscretion in dogs (eating something ridiculous!), and is often best managed by changes to feeding and basic husbandry

Mild viral diseases
Antibiotics are not useful against viruses; for example, many coughs do not require antibiosis. The exception is where a viral infection is likely to lead to bacterial infection later (“secondary infection”), for example in puppies with parvovirus whose immune systems are weaker than normal.

Allergic itches
Unless the skin is showing specific signs of bacterial infection, antibiotics are usually unnecessary.

In addition, there are certain bacterial infections that can be controlled using methods other than antibiotics (e.g. very mild skin infections), or that can be controlled by giving antibiotics only to the infected area of the body (such as drops for eye or ear infections). Again, this allows us to minimise the use of the antibiotic, and therefore the chances of either side effects or bacterial resistance.

Client Expectations and Veterinary Communication

Article written by Tony Sarma 

In my first job, as a junior vet, one case springs to mind. An Old English Sheepdog turned up with a mild diarrhoea which had started the day before. The owners were themselves a doctor and a nurse, and demanded antibiotics. I stuck to my guns and told them that at this stage antibiotics were not indicated. However, they complained and complained until I asked my boss to intervene. He gave them some antibiotics immediately.

The next day, they called to say that the dog was worse and demanded “stronger” antibiotics. The boss duly complied.

When I asked him about this, he told me “clients don’t understand that they are paying for your experience or your diagnostic skills; they want their animal to be treated – so if that’s what they want, they’ll feel short-changed by a consultation charge if all you do is give them basic advice. Even if that advice is entirely correct. That’s why I give them antibiotics.”

As it happens, the Sheepdog didn’t get better until it was eventually wormed – the antibiotics were no use, and this case perfectly illustrates the pressure that vets may feel from clients; and in this example, the clients themselves had medical training and should have known better.

I personally have found that if I spend time with the client and their pet, explain precisely why antibiotics are not necessary at this point, and give the clients a chance to ask any questions they may have, they virtually never complain. My concluding statement is often along the lines of “firstly there is no point giving Fido/Tiddles chemicals unless he really needs them; secondly, there’s no point in you paying more for drugs unless he really needs them”.

This to me demonstrates that controlling use of antibiotics requires co-operation between the vet and the client; the client needs to know that not all conditions need antibiotics, and the vet needs to be prepared to address all of a client’s questions in the consultation – that, not the automatic use of antibiotics, should be what the client is paying for.

 

Did you know...

Surgical sites, cuts or grazes can become infected by bacteria falling from the skin into the wound, from contaminated hands or instruments, or by droplets from an uncovered mouth or nose.

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