Antimicrobial stewardship pt 2 Flashcards
we should always culture rods in pyoderma cases due to what bacteria?
pseudomonas - always culture when rods are seen on cytology
pseudomonas and fluoroquinolones
- do all fluoroquinolones work? which are most used?
- susceptibility to one quinolone does not mean another will work
- marbofloxacin, enrofloxacin
deep pyoderma leaves what sort of lesions
- nodules
- ulcers
- draining tract
what antibiotics are reccomended for deep pyoderma?
- based on C/S
> quinolone + clindamycin (or in some cases, cephalexin)
chronic otitis - purpose of a culture of the ear
Culture of the ears is primarily intended to address possible systemic treatment as it does not tell us how an organism would react if it was “bombed” with the antibiotic. Nevertheless, one can certainly use a culture as an aid in the identification of the offending organism.
Culture does not replace cytology in the treatment of otitis.
What two products are on the market to help deal with compliance issues when treating the dog with otitis externa?
how do they achieve this?
dangers to vet staff and owners?
Osurnia (Elanco) and Claro (Bayer) are designed for long term effect .
- These treatments are administered into the clean ear on 2 occasions, one week apart (Osurnia) or once (Claro) and treatment effect lasts 30+ days.
- It is reportedly formulated in such a way as to allow for distribution throughout the ear canal and diffusion of active metabolites for weeks.
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- vet professionals and pet owners should be careful about eye injury and irritation in both people and dogs
> may occur due to dog head shaking
> Osurnia has been reported in connection with corneal ulcers
> Other clinical signs reported include eye irritation, conjunctivitis, squinting and eye pain after application of the medications to dogs’ ears
treatment of choice for otitis for Dr. Weisglass
hydrocortisone compounded product containing Burows solution, 1% hydrocortisone and Propylene glycol
the integrity of what structure in the ear is important to consider for ototoxicity?
tympanic membrane
- many cleaners are potentially ototoxic in the presence of a ruptured tympanum
Factors relating to ototoxicity of tpoical products include:
- length and shape of external ear canal
- size of the defect in the tympanum
- volume and viscosity of the applied product
> ointments are cleared slower and increase risk of ototoxicity - patency of the Eustachian tube
- presence of physical barriers obstructing passage to the round window
- permeability of the round window membrane
osurnia ingredients, dosing schedule, when is max clinical response? when to clean ear?
- florfenicol (antibiotic)
- terbinafine (antifungal)
- betamethasone
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pre-measured single use tubes > 1 tube per ear, one week apart
<><> - The maximal clinical response may be seen from 30-45 days after the first administration
- do not clean the ear canal for 45 days after initiation of treatment (cleaning the ear may affect product effectiveness)
> if other otic therapies are required, it is recommended to clean the ears before administration
warning for osurnia
The FDA has issues a warning to avoid contact with eyes during osurnia administration. Corneal ulceration and other eye injuries have been reported with accidental ocular exposure to Osurnia.
claro ingredients, dosing schedule
- florfenicol
- terbafine
- mometasone furoate
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Pre-measured single use tubes – 1 tube per ear should last 30 days
successful treatment of otitis externa depends on what
- ignoring the predisposing causes and primary causes while chasing the various perpetuating causes (bacteria, yeast) often results in lack of control and / or treatment failure
most commercial ear medications combine what ingredients
combine an antibiotic, antifungal and steroid.
Potentially Ototoxic Systemic Agents
- all aminoglycoside antibiotics
- some non-aminoglycoside antibiotics
- some diuretics
- antineoplastic agents
- etc…
