Session 813-20 Polysystemic Infections
72 hours
After initial antibiotic therapy is started, how long should you treat before switching to another antibiotic if you are not seeing a response?
Oropharynx, CNS, MSK, liver, GI, female repro
Anaerobic infections and their associated aerobic infections can be seen in what areas of the body?
No, shedding is only 7-14 days
Are antibiotics always needed for a Toxoplasma gondii infection? Y/N why?
Support: blood, HCO3 for acidosis, fluids Vogeli: Imidocarb diproprionate Gibsoni & conradae: azithromycin and atovaquone combo Resistant Gibsoni: combo clindamycin, diminazene, & imidocarb. If not available use combo doxycycline, enrofloxacin, & metronidazole
Babesiosis (anemia & fever): name support care and treatments used for specific varieties
Pradofloxacin
Based on new research what medication might be better to treat Feline Bartonellis with?
diet change and probiotic
Besides antibiotics, how else can we support a patient with a Giardia infection?
Osteomyelitis, open wounds, abscesses, bacteremia and endocarditis
Besides being associated with aerobic infections what other conditions are anaerobic infections associated with?
Treatment: most common is combo doxycycline + fluoroquinolone, azithromycin has been successful in some dogs. Rifampin for resistant cases. Aminoglycoside for endocarditis. Duration: 4-6 weeks & CS are gone Support: flea & tick cntrol Zoonotic: Yes
Canine Bartonellis, name the treatment, duration, additional support, zoonotic importance.
Treatment: Atovaquone and azithromycin combo Support: blood & fluid
Cytauxzoonosis (cats with fever and anorexia): name treatments and support care
Yes
Do most dogs with neosporosis die? Y/N
pneumonia w/ sepsis and pyothorax, enrofloxacin w/ penicillin or clindamycin
Empirical treatment for most Respiratory infections in dogs and cats is doxycycline, but with what conditions would this not be your best first line choice and what could you choose?
No, self-limiting, so only treat with systemic signs because can become resistant
Even though Campylobacter and salmonella potential infections should have a fecal culture to determine antimicrobial sensitivity for other pets and people in the household do they always need antibiotic treaty? Y/N, why?
Treatment: only in clinically ill cats use doxycycline first, fluoroquinolone second. Duration: 7 days Support: Flea control Zoonotic: Yes, cat scratch fever
Feline Bartonellis: name the treatment, duration, additional support, zoonotic importance
Treatment: drain lymph node abscess, gentamicin, enrofloxacin, chloramphenicol (for CNS), doxycycline (beware of esophageal stricture) Duration: 21 days Support: none Zoonotic: Yes
Feline Plague: Yesina pestis: name treatment, duration, additional support, zoonotic importance.
Fluoroquinolones
For Gram- or resistant pyoderma what are first line treatments?
bismuth subsalicylate-anti-inflammatory, antimicrobial, blocks enterotoxin effects metronidazole-effective in anaerobic environment amoxicillin-high concentration in urine
For Helicobacter spp infections, what his the triad treatment and what is each drug used for?
Fluoroquinolones: cirprofloxacin, enrofloxacin, marbofloxacin?
For a tritrichomonas foetus infection, if ronidazole doesn't work what other class of antibiotics can be used, and give an example?
Doxycycline
For acute bacterial URI and bacterial CIRDS what is your best recommendation for treatment in cats & dogs?
life threatening
For any of the polysystemic mycotic infections, when would amphotericin B be warranted?
fluoroquinolones w/ penicillin or clindamycin
For bacterial bronchitis and uncomplicated pneumonia doxycycline is the treatment of choice, but if there are signs of sepsis what antibiotic would be warranted?
no, empirical therapy
For infectious agents such as Borrelia burdorferi, Ehrlichia, Hemoplasmas, Rickettsia, Giardia, toxoplasma gondii, can future be used? Y/N, how do you start treatment?
Parenteral, beta lactams, clindamycin, chloramphenicol, penicillin G, and metronidazole
For patients with Pyothorax, pneumonia, peritonitis, or bacteremia how should antibiotics be administered? What are appropriate antibiotics?
Actinomyces
From this list of anaerobic bacteria, which one is a facultative anaerobe? Actinomyces, Bacteroides, Clostridium, Eubacterium, Fusobacterium, Peptostreptococcus, and Porphyromonas
No
Has any treatment been shown to eliminate H. Canis or americanum infection for the tissues of dogs? Y/N
Treatment: Acute-trimethoprim-sulfadiazine, pyrimethamine, and clindamycin combo for H. americanum Decoquinate to prolong survival *Imidocarb choice for H. canis and may help americanum Doxycycline or oxytetracycline in cats Support: NSAID for discomfort
Hepatozoonosis (dogs: fever, weight loss, anemia): name treatments and support care
transplacentally or neonatally or immunocompromised, clindamycin or azithromycin
How can Toxoplasma cause pneumonia? How is it treated?
1 week
How long beyond resolution of clinical signs do you treat chronic infections?
60-90 days or when CS are gone for 1 month
How long should animals with coccidiomycosis be treated?
2 weeks past resolution of radiographic changes
How long should antibiotic therapy for osteomyelitis and discospondylitis be?
2x for 5days, 1x for 5 days and then 60-90 days or 4 weeks beyond the resolution of measurable disease
How long should treatment of Blastomycosis be?
Clindamycin, sulfadimethoxine or ponazuril. Shorten oocyst shedding period
If antibiotics are warranted for a Toxoplasma gondii infection what 3 would be your best options, and what do they help with?
reinstitute complete course of therapy
If reoccurrence occurs with blastomycosis how should treatment be administrated?
don't start a new antibiotic until you do a complete work-up
If you have a patient that is being treated for acute bacterial URI with doxycycline and there has been no response to therapy, what antibiotic should you start?
rifampin
If you need good intracellular penetration for Staph or Strep what drug can be considered?
oxygenation & blood supply
In addition to antibiotics what other support do we need to provide for anaerobic infections?
Gram+, Gram -, aerobic, and anaerobic
In life-threatening infections, while you await susceptibility testing, what bacteria should you aim treatment against?
Secondary
In the case of a URI with a bacterial component, is the bacterial infection typically a primary infection of a secondary infection?
Treatment: Acute phase-start IV ampicillin +/- fluoroquinolone, carrier phase needs doxycycline Duration: 2 weeks Support: fluids for renal Zoonotic: Yes
Leptospirosis: name treatment, duration, additional support, zoonotic importance.
Treatment: tylosin, erythromycin, clindamycin, lincomycin, tetracyclines (doxy), chloramphenicol, aminoglycosides, and fluoroquinolones Support: none Zoonotic: Yes but minimal
Mycoplasma and ureaplasma: name treatment, additional support, zoonotic importance.
Treatment: Trim-sulfa w/ pyrimethamine or clindamycin, ponazuril Support: none, but grave prognosis with neuro involvement
Neosporosis: name treatments and support care
fluoroquinolone or azithromycin
Of the treatments available for mycoplasma and ureaplasma, what choice would be best for an animal w/ a mixed infection or a life threatening infection?
Doxycycline
Of the treatments available for mycoplasma and ureaplasma, what choice would be best for an animal with a competent immune system or without a life threatening disease?
Anaerobic
On the radiographs of the lungs, if consolidated lung lobes are seen what type of infection should be suspected?
2-3 days
Once treatment with clindamycin has ben started for a patient with Toxoplasmosis, how quickly will clinical signs (not involving eyes or CNS) resolve?
Campylobacter, azithromycin or erythromycin or quinolone
Popular empirical treatments for dogs and cats with hepatic and GI infections are amoxicillin, metronidazole, penicillin, or ampicillin, but for what condition would this not be the right choice and which drug would?
3 days
Recent studies of uncomplicated urinary tract infections suggest what duration of treatment?
5-7 days, no more than 2 days
Typically, in a first-time bacterial infection of an immune-competent animal how long is the treatment? Do you treat beyond the resolution of clinical signs if so how long?
Ponazuril
What antibiotic is effective for Cystoisospora spp. infections?
Ronidazole
What antibiotic is used to treat Tritrichomonas foetus?
Doxycycline
What antibiotic is used to treat upper respiratory tract infections caused by B. vonsonii, E. canis, and R. Rickettsia?
1st gen cephalosporins, amoxicillin-clavulanate, and clindamycin
What antibiotics are good empirical therapy choices for osteomyelitis and discospondylitis?
Metronidazole +/- fenbendazole
What antibiotics are used to treat GI infections with Giardia?
Chloramphenicol, quinolones, or tetracyclines
What antibiotics should be avoided in pregnant animals due to concern for neonate?
reduce dose with renal patients, beware of CNS signs, tachycardia, hypotension, and blindness in cats
What are cautions and adverse effects to be aware of if you need to use a fluoroquinolone for a Tritrichomonas infection?
Canine & feline bartonellis, Yersina pestis, leptospirosis, mycoplasma, and ureaplasma
What are common polysystemic bacterial diseases?
penicillins, clindamycin, chloramphenicol, or minocycline
What are first line treatments for actinomyces?
amoxicillin, clindamycin, metronidazole, or 1st/2nd cephalosporin
What are first line treatments for anaerobe abscesses?
penicillin, clindamycin, tri-sulfa, amikacin, or imipenem
What are first line treatments for nocardia?
Doxycycline
What are most Rickettsial diseases treated with?
aerobic infections
What are most anaerobic infections associated with?
Actinomyces, Bacteroides, Clostridium, Eubacterium, Fusobacterium, Peptostreptococcus, and Porphyromonas
What are the common anaerobic bacteria in dogs and cats?
B. vonsonii, E. canis, and R. Rickettsia
What are the common upper respiratory tract infection pathogens?
Anterior uveitis, endophthalmitis, optic neuritis
What are the ocular manifestation that are recognized in 30% of dogs with blastomycosis?
Amphotericin B-life threatening, make sure they are hydrated Fluconazole-CNS, ocular, urinary Ketoconazole *Itraconazole-fewer side effects, treatment of choice
What are treatments for Blastomycosis?
Amphotericin B-life threatening or keto response is poor Fluconazole-meningoencephalitis Ketoconazole-no well tolerated, GI issues, increase liver enzymes, suppress testosterone and cortisol itraconazole-when toxicity from keto Posaconazole-refractory disease, humans Voriconazole-CNS Penetration
What are treatments for Coccidiomycosis?
Amphotericin B-life threatening *Fluconazole-common, CNS penetration, ocular Ketoconazole-not well tolerated *Itraconazole-common Posaconazole Voriconazole-CNS Penetration, no use in cats 5-flucytosine-CNS penetration but adverse effects
What are treatments for Cryptococcus?
Amphotericin B-life threatening Fluconazole Ketoconazole-not well tolerated *Itraconazole-drug of choice because effective and low toxicity
What are treatments for histoplasmosis?
Staph, Strep, Proteus, Pseudomonas, E. coli, and anaerobes
What bacteria is commonly associated with osteomyelitis and discospondylitis?
CNS toxicity
What caution is there to be aware of with overdoses of ronidazole?
azithromycin, chloramphenicol, trimethoprim-sulfonamide, metronidazole, and fluoroquinolones
What common antibiotics will penetrate the CNS?
Vasculitis with epistaxis
What conditions do the pathogens B. vonsonii, E. canis, and R. Rickettsia cause with upper respiratory infections?
Ketoconazole, cheap
What has ben the treatment of choice for Coccidiomycosis, why?
Doxycycline
What is a good empirical antibiotic for dogs with non septic suppurative polyarthritis?
uveitis, glucocorticoids
What is an additional concern with toxoplasmosis, how is it treated?
Tri-sulfa
What is an alternative protocol treatment for dogs with toxoplasmosis?
Chloramphenicol
What is an empirical first choice for a CNS infection that you suspect an anaerobic or rickettsial infection?
Zoonotic be careful with pregnant women can enter fetus
What is an important health concern with feline toxoplasmosis?
Staphylococcus pseudointermedius, amoxicillin, cephalexin, or clindamycin or tri-sulfa 3-4 weeks
What is the most common cause of pyoderma in the dog & cat? What would be a good empirical therapy antibiotic choice?
Clindamycin
What is the most common treatment for both canine and feline toxoplasmosis?
Metronidazole, amoxicillin, and bismuth subsalicylate
What is used to treat Helicobacter spp infections?
Azithromycin because resistance is possible
What medication is not recommended for the treatment of Feline Bartonellis and why?
Glucocorticoids
What other drug has been shown to lessen the clinical signs of histoplasmosis more quickly than antifungals?
E. coli, enrofloxacin
What pathogen is associated with Boxer colitis and what antibiotic is it treated with?
Toxoplasma gondii, cat
What pathogen is shown in the image? What animal is the definitive host?
Ehrlichia, Rickettsia, Anaplasma
What rickettsial disease are of the most importance in the US?
Coccidia (protozoa)
What type of bacteria are Cystoisospora spp.
Bacteriostatic, normal immune response are required for max drug effect
What type of drugs are less effective in immunosuppressed animals, why?
bacterial component
When a patient presents with a URI that involves mucopurulent discharge what additional component is likely present?
Cryptosporidium, tylosin, azithromycin, nitazoxanide
When a patient presents with persistent diarrhea after trying to treat other causes, what bacteria can you try targeting and what antibiotics would be beneficial?
Bacterial encephalitis
When choosing empirical treatment for dogs or cats with CNS or muscle infections, clindamycin can treat just about any infection, with what condition would it NOT be the appropriate choice?
fluoroquinolones
When choosing treatment for osteomyelitis and discospondylitis, if a Gram- bacteria is suspected such as Bartonella, what class of antibiotics would be a good first choice?
Trim-sulfa and fluoroquinolones, but after barrier established need chloramphenicol
When inflammation is present with prostatic what medications can be used acutely?
penicillins, tetracyclines, and clindamycin
When inflammation is present, what other medications can cross the BBB?
Clindamycin
When inflammation is to present, what antibiotic will still effective cross the BBB in cats to treat toxoplasmosis?
Azithromycin and trimethoprim-sulfonamide
When muscle disease is from Toxoplasmosis, besides clindamycin what other antibiotics can be used?
fluoroquinolone, penicillina, and clindamycin
When prothorax is due to hematogenous spread bacteria what combo of medication can be started why you await culture?
mouth & vagina
Where are the following anaerobes found? Actinomyces, Bacteroides, Clostridium, Eubacterium, Fusobacterium, Peptostreptococcus, and Porphyromonas
Good activity for Gram+ and anaerobes and they penetrate the bone well
Why are 1st gen cephalosporins, amoxicillin-clavulanate, and clindamycin all good empirical choices for the treatment of osteomyelitis and discospondylitis?