Guidelines for the clinical use of antimicrobial

agents in the treatment of

dogs and cats
Published in September 2018 by
The New Zealand Veterinary Association
PO Box 11212
Wellington 6142, New Zealand
E [email protected]
P +64 4 471 0484
F +64 4 471 0494
For more information please visit:
amr.nzva.org.nz

2 AMU guidelines | Dogs and cats | Version 4.0 | September 2018

Introduction
These guidelines are based on:

1. Guidelines for antimicrobial use in the treatment of dogs and cats compiled on
commission from the Board of the Swedish Veterinary Society. The General Assembly
of the Swedish Veterinary Association adopted these as their policy in October 2002.
2. The FECAVA (Federation of European Companion Animal Veterinary Associations)
guidelines, October 2014.
3. Consultation with New Zealand veterinary specialists to combine the data from
the above documents and adapt them for New Zealand conditions and diseases.

The intention is that this policy should be used as a general Antimicrobial – a drug, chemical, or other substance that either
guide when choosing treatment for dogs and cats. This can kills or slows the growth of microbes. Substances that are
sometimes mean either to refrain from treatment altogether considered antimicrobials include surface disinfectants, antibiotics,
or alternatively to choose a treatment that does not include parasiticides, anti-fungal and anti-viral agents (MPI definition).
antibiotics. The main aim is that the chosen treatments are as
effective as possible and that any undesirable side effects are
Acknowledgments
kept to a minimum. These guidelines have been formulated by the Antimicrobial Working Group
appointed by NZVA:
The policy can be used both for clinical practice, as well as for Professor Paul Chambers BVSc Bristol, DVA, PhD
educational purposes. Dr Isobel Gibson DVM Guelph, DVSc, DiplACVP
The document is divided into four main parts: Dr Kristen Manson BVSc Massey MANZCVS (Veterinary Pharmacology)
Dr Andrew Millar BVSc Massey MANZCVS (Veterinary Pharmacology)
1. Antimicrobial policy.
Dr Dennis Scott BVSc Massey MANZCVS (Veterinary Pharmacology)
2. The perioperative use of antibiotics. The guidelines have been approved by the Companion Animal Veterinarians
3. Guidelines for treatment based on disease-oriented Branch of the NZVA.
treatment. Peer review was carried out by:

4. General information concerning antimicrobial alternatives. Dr Nick Cave BVSc Massey, MACVSc, MVSc, DiplACVN, PhD, Senior
Lecturer in Small Animal Medicine, Massey University
The main document is designed as a reference document Professor Paul Chambers BVSc Bristol, DVA, PhD Senior Lecturer
with a summary in wall chart form to be utilised in in Veterinary Pharmacology, Massey University
consultation rooms and surgeries. Dr Allan Bell BVSc Massey, MACVSc, FACVSc, Registered specialist
in Veterinary Dermatology
Note: The tables shown provide examples and should not be
Dr Craig Irving BVSc Massey 1970, MACVSc, CertVet Ophthal, Registered
considered to be comprehensive. Regional data on resistance
specialist in Veterinary Ophthalmology
have to be taken into consideration. Use an antibiotic with
The project was carried out at the behest of, and under the supervision of the
known bioavailability at target site, and use as narrow Antimicrobial Strategic Group of NZVA comprised of:
spectrum a drug as possible.
Dr Mark Bryan BVMS Glasgow, MACVSc (Epidemiology), MVS (Hons)
Professor Nigel French BVSc Bristol, MSc, PhD, DLSHTM
Definitions Dr Eric Hillerton BSc PhD Adjunct Professor in Dairy Systems at Massey
University, Member Royal Entomological Society
Antibiotic – a medicine that kills bacteria or inhibits their
growth in the body. It includes natural substances (e.g. Dr Callum Irvine BVSc Melbourne (Hons)
penicillin), semisynthetic substances (e.g. ampicillin) and Dr Steve Merchant BVSc Massey (Dist)
totally synthetic substances (e.g. enrofloxacin). Dr Dennis Scott BVSc Massey MANZCVS (Veterinary Pharmacology)

Antiseptic – a chemical that has a non-selective effect on

microbes and is safe enough to apply topically to animals.

For the New Zealand veterinary profession 3

1. Antimicrobial policy
One of the largest threats to public and animal health is the increase in antibiotic resistance.
Bacterial resistance genes can be transferred between animals and humans and thus, the
benefits of their use in animals must be weighed against the risk to public health.

Resistance development can be reduced by the responsible antibiotics). Local treatment should be used where possible.
use of antimicrobials, good hygiene, and active infection Any effect on the normal flora can also be minimised if the
control. Active advice to animal owners on, for example, course of treatment is kept as short as possible.
hygiene and vaccination also plays an important part.
Drugs of last resort for serious infections in people should not
The objective of this document has been to produce a guide be used in animals. Third or fourth generation cephalosporins
that can be used when deciding upon a course of treatment should only be used in situations where their use is considered of
and it is written for current New Zealand conditions and the utmost importance to the animal’s welfare, and where there
practices. Sometimes the right choice can be to refrain from is a sound basis to suspect that other treatments will not work.
antimicrobial therapy altogether and instead to simply wait
and see, or alternatively choose another treatment.
Antibiotic treatment is normally only indicated if: Core principles
1. Consider the impact of antibiotic use on the animal, its
• there is bacterial infection
owner and other people, and the environment.
OR
2. Animals should receive antibiotics only when there is a
• there is sufficient reason to suspect that a bacterial susceptible bacterial infection, antibiotics are required
infection is present to maintain their health and welfare, and when no other
and treatment will work.

• the infection is not likely to resolve without antibiotic 3. When antibiotics are used, dose rates and regimes should
therapy. be designed for maximal efficacy and to limit re-treatment.
4. There are antibiotics considered so important in human
Measures to prevent infection should be used where possible
and if there is a non-antibiotic treatment which is likely to be medicine that they should not be used as first line
effective, this should be used in preference to antibiotics. treatment, and only used where no other treatment will
work.
Antibiotics prescribed “just in case” there is a bacterial infection
is never acceptable. Prophylactic antibiotic treatment can be 5. There will be a reduction in selection pressure for
justified in a few specific surgical procedures, where the risk for antimicrobial resistance if a smaller total amount of
bacterial infection is high or where an infection can drastically antibiotics are used in veterinary and human medicine.
worsen the prognosis. Prophylactic use of antibiotics should
never be used to cover for poor hygiene.
Antibiotic classification
Lifelong antibiotic treatment of chronic or continually recurring
General guidelines classifying antimicrobials according to
conditions is not compatible with good veterinary practice.
a three tier (traffic light) system is an example of a type of
This also applies to prolonged treatments with a low dose (less
system that might be employed.
than the therapeutic dose) or so-called pulse dosing.
Culture and sensitivity testing should be used to guide the
When possible, the infectious agent should be cultured
choice of drugs whenever possible.
and identified. This is especially important in cases of therapeutic
failure, relapse, and when antimicrobial resistance is suspected. Note: First line therapy represents the first choice for empirical
Samples should always be taken from postoperative infections. therapy.
The risk of antibiotic resistance should always be considered Narrow-spectrum antibiotics should be used in preference to
when choosing an antibiotic. This means that the drug and the broad-spectrum drugs when possible.
route of administration should be chosen so that the animal’s
Topical therapy should be used in preference to systemic
normal flora is affected as little as possible (narrow-spectrum
therapy whenever appropriate.

4 AMU guidelines | Dogs and cats | Version 4.0 | September 2018

 Antimicrobials for first line therapy under
therapeutic conditions.
1. Procaine penicillin
2. Penethamate hydriodide
3. Tetracyclines

Antimicrobials restricted to specific indications

or used as second line therapy under therapeutic
conditions.
1. Aminoglycosides
2. Semi-synthetic penicillins (ampicillin/clavulanic acid, cloxacillin)
3. 1st and 2nd generation cephalosporins
4. Lincosamides
5. Potentiated sulphonamides

Antimicrobials considered important in treating

refractory conditions in human and veterinary
medicine. These will only be used following veterinary
diagnosis on a case by case basis with sufficient
evidence to indicate need.
1. 3rd and 4th generation cephalosporins
2. Fluoroquinolones
3. Macrolides

The 5 R’s Responsibility

Veterinary practices should have an antibiotic stewardship The success of a stewardship plan requires engagement,
plan that covers: understanding, and personal responsibility of people
at all levels involved in the prescription, treatment, and
management of animals.
Reduction
Reduction in antibiotic use is achieved by:
Engagement will be achieved through:
1. Preventative measures such as vaccination. 1. Positioning of the program and a clear description of the
2. Avoiding use where there is no bacterial infection, for justification to all involved.
example, in uncomplicated viral infection. 2. Ensuring understanding of the core principles not just the
3. Use of topical/local antimicrobials in preference to systemic operational procedures.
delivery. 3. Encouragement of ‘upward leadership’ – empowerment of
4. Avoidance of prophylactic antibiotic usage unless justified team members to contribute to success of the plan, to bring
(see below). new ideas and innovation, and to refine the processes.

Refinement Review
Continuously evaluate prescribing practices and therapeutic A stewardship plan is a ‘living document’ and will be subject
plans, based on: to periodic (at least annual) review to ensure objectives
1. Response to treatment are met.

2. Previous similar cases 1. Animal health and welfare outcomes remain top priority
3. Published clinical studies and monitored to ensure they are achieved.

4. Local and published resistance data 2. Audit of compliance should be undertaken internally
and by independent bodies.
3. Reduction and replacement strategies should be monitored
Replacement
through measurement of animal daily doses (ADD) used.
Selection pressure can be reduced by using non-antimicrobial
alternatives where there is evidence of efficacy. 4. Susceptibility surveillance should be undertaken as appropriate
to ensure appropriate selection of antimicrobials, maximise
efficacy and monitor resistance in target pathogens.
5. Investigation of strategies that can be employed to
improve stewardship of antimicrobials within the practice
should occur on an on-going basis.

For the New Zealand veterinary profession 5

2. The perioperative use of antibiotics
Antibiotics should never be used as a substitute for asepsis. A whole series of measures
to maintain sterility must be taken pre-, intra- and postoperatively with regards to the
handling of the patient, hygiene routines for both the premises and equipment, as well
as surgical asepsis and technique in order to reduce the risk of postoperative wound
infections.

• Prophylactic antibiotics are not indicated Indications for antimicrobial prophylaxis

for clean wounds. The indications for antimicrobial prophylaxis in small animal
surgery are few. Antibiotics should only be prescribed where
• In clean-contaminated wounds, the use there is a high risk of surgical complications or where the
consequences of an infection are likely to be catastrophic,
of prophylactic antibiotics can be justified such as in the case of hip joint prosthetic surgery. Operations
if the operation is estimated to last more that are expected to be lengthy or surgical procedures
performed on high-risk patients are also situations where
than two hours. antibiotics can be justified.
• Contaminated wounds should be flushed The use of surgical implants, such as plates, screws or pins
in the case of fractures, corrective surgery, TPLO or TTA, are
with sterile saline: this may be all that not in themselves indications for prophylactic antibiotics.
is required to prevent infection in fresh Antibiotics should also not be prescribed in connection with
arthroscopy, laparoscopy or thoracoscopy. Dental treatments,
wounds. In older wounds, antibiotics may such as tartar removal, oral sanitation or tooth resection,
be justified. should not be performed at the same time as other surgical
procedures due to the risk of haematogenous dissemination
• Dirty wounds presuppose that the of bacteria from the mouth to the surgical area.
surgical area is already infected at the Some examples of operations and/or conditions where
antibiotic prophylaxis can be justified:
time of operation and antibiotics should
• Extensive operations in the gastrointestinal tract such as
be given. resections.
• Bile duct surgery with a pre-existing infection in the biliary
tracts.
• Extirpation of a lung lobe with a pre-existing infection in
the airways.
• Cemented hip joint and other joint replacements.
• A complicated fracture operation with extensive soft tissue
trauma.
• An operation on a high-risk and immunocompromised
patient or on a patient with a generalised skin infection.

6 AMU guidelines | Dogs and cats | Version 4.0 | September 2018

Antibiotics should be administered at least 30 but not more Clipping in pyoderma
than 60 minutes prior to incision, i.e. with the induction of
Clipping is trauma and exacerbates the cellulitis associated
anaesthesia. Intravenous administration is the preferred route
with deep pyoderma. Clipping is best performed after one
as intramuscular or subcutaneous administration results
week of antibiotic therapy because it is less traumatic and
in more uncertain serum concentrations, and they should
can often be achieved with scissors rather than clippers and
not be given by mouth. Numerous human studies have
without general anaesthesia.
shown that the risk of infection is not reduced if antibiotic
prophylaxis is started after the operation has been completed.
Human studies also show that there is no further prophylactic Pulse antibiotics in idiopathic recurrent
effect if treatment is continued following the operation’s pyoderma.
conclusion, but that extended treatment increases the risk of
Pulse therapy is indicated when all of the following criteria are met:
side effects and the development of bacterial resistance.
1. Where no underlying disease can be found and addressed
Recommended drugs: benzylpenicillin sodium 10mg/
kg iv every one to two hours throughout the operation or (with repeat investigations at least annually).
cephazolin 20mg/kg iv every one to two hours throughout 2. Where topical biocides are ineffective in terms
the operation. of prevention.
If a post-operative infection occurs, it must be sampled for 3. Where the use of antibiotics in this manner is effective i.e.
culture and sensitivity testing and treated accordingly. no clinical signs arise during such treatment.
4. Where pulse antibiotic therapy results in fewer antibiotic
treatment days in a year than would be otherwise be

3. Guidelines
required – treating new episodes of pyoderma as clinical
signs arose.
However this technique is better suited to referral centres and

for treatment should not be used in primary practice.

Cat bite abscesses require drainage, copious irrigation, and
debridement of necrotic tissue. If the cat has been recently
Skin bitten but an abscess has not yet formed, a single injection
of procaine penicillin is likely to be sufficient. Culture and
Skin is always colonised by bacteria, but infection is usually sensitivity is recommended for non-resolving cases. Third
an indication of underlying disease. Successful treatment generation cephalosporins e.g. cefovecin, should NOT be
of skin infections usually requires ancillary treatment for the used for cat bite abscesses.
underlying disease, e.g. ectoparasites or hypersensitivity.
Many, if not most, cases of skin infection in dogs and cats In uncomplicated otitis externa, topical treatment should
are the result of hypersensitivity (e.g. atopic dermatitis) and be based on a cytological evaluation of the discharge. The
antimicrobial drugs alone rarely work, particularly in the long ear should be cleaned and dried, and possibly acidified
term. This is especially true for suppurative otitis externa caused (with a proprietary acidic cleaning solution or dilute vinegar)
by bacteria such as Pseudomonas spp, which rapidly develop to discourage Pseudomonas. Broad spectrum (including
resistance over the course of treatment. As the condition is antifungal and antiparasitic) ear drops can be used: Many
likely to recur, this makes subsequent treatment difficult. The drugs are potentially toxic in the middle ear and in a
hypersensitivity should be appropriately managed. significant number of cases the tympanic membrane cannot
be visualised so care needs to be taken if rupture of the
The most common skin pathogen in dogs is Staphylococcus tympanic membrane is suspected. Recurring otitis must be
pseudintermedius, usually coagulase positive, and frequently properly investigated.
penicillinase producing. Narrow spectrum drugs are best.
Superficial infections are better treated with antiseptic
washes (chlorhexidine or povidone iodine).
Culture samples with the determination of bacterial
resistance should be taken from:
1. Pyodermas that do not respond to treatment (when there
is a poor response to antibiotic therapy at the 10–14 day
follow-up examination).
2. Recurring pyodermas.
3. Deep pyodermas.

For the New Zealand veterinary profession 7

Ready reference table for skin antibiotic therapy
Body system Skin Ears

Common Surface pyoderma Superficial pyoderma Deep pyoderma Wound/soft tissue Cat bite abscesses Otitis externa
conditions (microbial (bacterial folliculitis, (furunculosis, infection
overgrowth, fold impetigo) cellulitis)
pyoderma, acute
moist dermatitis)
Cytology and
culture

impression smears
from impression + + + of ear swabs
smears, tape strips + obtained after
preliminary cleaning
+
from pustule following biopsy
(if possible or by aspiration for surveillance
(not from surface of surgical site
exudate) infections or if not relevant due to
complications/ topical therapy
suspicion of multi-
resistant bacteria (e.g.
MRSP, MRSA, ESBL)
Likely pathogen Staphylococcus Staphylococcus Staphylococcus Variable Variable Cocci (mainly
pseudintermedius pseudintermedius pseudintermedius Staphylococcus
(Malassezia pseudintermedius),
sometimes involved) rods (mainly
Pseudomonas), and/
or yeasts, (Malassezia)
Empirical anti- Clindamycin or Cephalexin while Cleansing and Antiseptics often
microbial choice Cephalexin or TMPS debridement sufficient
coupled with
modern wound Topical treatment
dressings are often e.g. cocci use fusidic
Pending acid, rods use
sufficient
Amoxicillin when polymyxin B, yeasts
Systemic therapy indicated use miconazole
based on

may be indicated in
severe tissue damage
and/or fever
Remarks on therapy Topical therapy Therapy alone Always combine Topical antimicrobials Prior cleansing is
with antimicrobial (e.g. chlorhexidine) with topical therapy are usually not essential
shampoos, lotions, if infection is mild. (e.g. chlorhexidine recommended with
spray gels, creams etc shampoo). granulating wounds Use gluco-corticoid
Treat for seven days to reduce swelling
beyond clinical Treat for two weeks If as above always Drainage, copious and inflammation
resolution beyond clinical take sample after irrigation, and
resolution wound cleaning Underlying causes
debridement of
must be investigated
necrotic tissue
and resolved
R if persistent Third generation
Systemic therapy is
cephalosporins e.g.
not relevant
cefovecin, should
NOT be used for cat
bite abscesses

Reference key R

Cytology Culture and Hospitalisation Antimicrobial therapy Surgery Consider referral to

antimicrobial recommended not indicated specialist
susceptibility test

8 AMU guidelines | Dogs and cats | Version 4.0 | September 2018

The urinary tract Many antimicrobial drugs are concentrated in the urine,
particularly ß-lactams, so in vitro resistance does not
Urinary tract infections are usually caused by coliforms, but
necessarily indicate that the drug will not be effective in vivo.
G+ bacteria are also reasonably common. Uncomplicated
Ensure that sensitivity testing is carried out at concentrations
cystitis in female dogs should probably be treated for
of antimicrobial drugs relevant to urinary tract concentrations
seven days, although there should be improvement in
of drug in vivo.
hours and clinical resolution in three days. A single large
dose of antibiotic may even be sufficient. If there is some In male dogs the prostate is usually involved and four to
predisposing factor for cystitis, all that long courses of five weeks of treatment may be required. Penetration of the
antibiotics do is to ensure that resistant bacteria develop. If drug to the site of the infection is a major problem. Normal
there is no improvement in three days, the animal should prostatic fluid has a pH of about 6.4, so weak bases penetrate
be reexamined and the diagnosis confirmed. A culture and best. This is important in chronic prostatitis – in acute
sensitivity is strongly recommended. Cystitis in cats is very cases the barrier is usually broken down by inflammation.
rarely caused by bacteria: antibiotics that should not be used Castration or an antiandrogen such as delmadinone are usual
without prior culture and sensitivity testing include third adjuncts to antibiotics for prostatitis.
generation cephalosporins, fluoroquinolones and amoxicillin/
Pyometra arises due to an interaction between the
clavulanic acid.
progesterone-affected endometrium and commensal
The concentration and activity of an antibiotic in urine flora. E.coli is the dominant bacterium in both dogs and
varies according to the pH. Although urinary pH can be cats. The treatment that gives the most reliable results
altered to suit the chosen antimicrobial drug, it is more is an ovariohysterectomy. Unless the animal is seriously
sensible to consider the activity / pH spectrum of the systemically ill, antibiotics are not indicated. If medical
drugs available, and to choose a drug which is active in treatment with aglepristone is used, antibiotics effective
the conditions to be found. Remember, though, that as an against G- bacteria should probably be included.
infection is controlled, the pH of the urine may alter. Drugs
with optimum activity in acidic urine are themselves acids
or neutral: penicillins, tetracyclines, nitrofurantoin, hexamine.
Drugs active in alkaline urine are themselves bases or neutral:
erythromycin, aminoglycosides. Drugs relatively unaffected
by pH: cephalosporins, sulphonamides, chloramphenicol,
fluoroquinolones.

For the New Zealand veterinary profession 9

Ready reference table for urogenital antibiotic therapy

Body system Urogentital

Common conditions Upper urinary tract infection Lower urinary tract infection Pyometra
(pyelo-nephritis)
Cytology and culture Usually not indicated (unless rupture,
see peritonitis)

+ +

if recurrent infection (urine collected

of urine (collected by cystocentesis) cystocentesis)
Likely pathogen Escherichia coli Escherichia coli Escherichia coli
Empirical anti-microbial choice Amoxicillin-clav or fluoro-quinolones Amoxicillin or TMPS while
while

pending pending
If signs of systemic infection see sepsis
Remarks on therapy Amoxicillin three times daily

amoxicillin-clav three times daily

In severe* cases use fluoroquinolones

Medical treatment (occasional, not
recommender) four to five days
fluoroquinolones (or TMPS) and e.g.
alepristone

Reference key R

Cytology Culture and Hospitalisation Antimicrobial therapy Surgery Consider referral to

antimicrobial recommended not indicated specialist
susceptibility test

The respiratory system

The upper respiratory tract is frequently infected with viral rhinitis in dogs requires a thorough investigation and
pathogens. Elimination of normal flora by antibiotics can empirical antibiotic therapy has no place.
make the disease better or worse. Therefore, although culture Bacterial infections of the lower respiratory tract are
and isolation is complicated by an abundant commensal relatively rare. Usually the bacteria concerned are aerobes
population, it is very important to make a diagnosis. Purulent and approximately two thirds are G-. Except in the case
discharge is not pathognomonic for bacterial infection. of aspiration pneumonia, pure infections are common.
Antibiotics are probably not indicated in the majority of Therefore, culture and sensitivity testing is usually required.
upper respiratory tract infections in any species. Chronic

10 AMU guidelines | Dogs and cats | Version 4.0 | September 2018

Ready reference table for respiratory antimicrobial therapy
Body system Respiratory
Upper Lower
Common Rhinitis Acute bronchitis (e.g. kennel cough) Pneumonia Pyothorax
conditions
Cytology and Usually not indicated, limited clinical Usually not indicated, limited clinical Usually not indicated, since
culture significance due to presence of significance due to presence of broncho-alveolar lavage is
commensal flora commensal flora difficult to perform effectively

Samples collected by biopsy may be

considered in chronic cases
on aspirate by
thoraco-centesis
(both aerobic
and anaerobic
incubation)
Likely pathogen Variable Viral Variable Variable (including
anaerobes)
Empirical anti- Doxycycline or cephalexin or If cocci use
microbial choice amoxicillin or amoxicillin-clav amoxicillin-clav,
if rods use fluoro-
quinolones while

With secondary chronic purulent

rhinitis consider doxycycline
pending

Remarks on Always address primary cause in In secondary pneumonia suspect

therapy chronic purulent rhinitis Bordetella bronchiseptica and
treat with doxycycline of TMPS or
amoxicillin-clav In severe* cases use a
fluoroquinolone and penicillin
Amoxicillin-clav three times daily G or amoxicillin or ampicillin IV Drainage and
lavage are
Amoxicillin or ampicillin essential for clinical
preferably as a CRI (constant resolution
rate infusion) or three times
daily

Amoxicillin-clav
three times daily
Amoxicillin-clav three times
daily

Reference key R

Cytology Culture and Hospitalisation Antimicrobial therapy Surgery Consider referral to

antimicrobial recommended not indicated specialist
susceptibility test

For the New Zealand veterinary profession 11

Mouth Gastrointestinal tract
The oral cavity is normally a very bacteria-rich environment Antimicrobial therapy is NOT indicated for routine
and the majority of bacteria have not yet been identified. treatment of undiagnosed or non-specific acute or chronic
Cleaning and surgery is often sufficient for infections or gastrointestinal disease. The only specific indication for
inflammation in the oral cavity to be self-limiting. Antibiotic antimicrobial therapy is invasive bacterial infection, secondary
therapy is not justified either before or after routine dental to severe mucosal damage. This applies also to diseases
prophylaxis. such as salmonellosis, or when systemic sepsis can occur
secondary to viral infection e.g. canine parvoviral enteritis. In
Chlorhexidine is a well-tested antiseptic in the oral cavity and
those cases, intravenous systemic therapy is indicated, but
can be used in conjunction with surgical procedures as well
oral therapy is not.
as for follow-up care.
Vomiting and diarrhoea are an animal’s primary defence
mechanisms for removing pathogenic organisms acutely.
Examples where prophylactic antibiotics Supportive therapy are all that is usually necessary in the first
can be justified 24 hours.
• Immunodeficiency disease or immunosuppressive therapy. Normal flora are affected by most antimicrobial drugs.
• Simultaneous aseptic operation (e.g. when the patient Anaerobes predominate distal to the ileum, but are difficult to
is elderly or has an existing condition that means that culture. Broad spectrum antibiotics play particular havoc with
repetitive anaesthetic treatment is not recommended). the gut microbial population, often referred to as ‘antibiotic
responsible diarrhoea’ in dogs. There is little consensus on the
• Pulp amputation (when the objective is a decontamination
issue with some authors suggesting oral antibiotics be trialed
of the operational area).
for weeks prior to biopsy but others believing long term
• Heart murmurs are NOT an indication for antimicrobial antibiotic therapy should only be considered after dietary
treatment. Only cases of endocarditis, which is an therapy, and a full work up (including biopsy where indicated)
extremely unusual diagnosis in dogs, can be justifiably with appropriate therapy (e.g. immunosuppressive therapy
treated with prophylaxis. when indicated) has failed.
Peritonitis occurs after perforation of the bowel. The
Ready reference table primary problem must be sorted out which usually means
surgery. Flushing the peritoneal cavity is essential. Vigorous
for oral cavity antibiotic antimicrobial therapy is required using a broad spectrum
combination including anaerobic cover.

therapy In people, antibiotic treatment has been shown to prolong

shedding of Salmonella. Salmonella infections in other
species should not be treated with antibiotics unless a
Body system bacteraemia develops. Remember that Salmonella infections
are zoonotic and potentially lethal in children and old people.
Common conditions Oral infection (e.g. gingivitis,
stomatitis, periodontitis)
Cytology and culture Not indicated, limited clinical
significance due to presence of
commensal flora
Likely pathogen Variable (including anaerobes)
Empirical anti-microbial choice

Remarks on therapy

And/or dental treatment

If signs of systemic infection

(fever, lymph-adenopathy) use
clindamycin
R

12 AMU guidelines | Dogs and cats | Version 4.0 | September 2018

Ready reference table for gut antibiotic therapy
Body system Gastro-enteric Abdominal cavity
Common Gastroenteritis Anal gland Hepatic disease Peritonitis
conditions abscessation (cholecystitis,
cholangitis, cholangie-
hepatitis)
Cytology and Usually not indicated
culture
On specific suspicion
submit
+ + +

For Salmonella,
Campylobacter and of wound of aspirate or biopsy of aspirate obtained by abdomino-centesis (both aerobic and
toxigenic clostridia cavity if severe anaerobic incubation)
tissue damage
and/or fever
(after wounds
cleaning)
Likely pathogen Mainly viruses (or Variable Unknown or variable Variable
parasites in young
animals faecal sample
for parasitology on
suspicion)
Empirical Self-limiting, Doxycycline or Fluoro-quinolones and penicillin G or amoxicillin or ampicillin IV
anti-microbial cephalexin while
choice

pending
+
If signs of systemic
infection see sepsis
In severe tissue
damage and/or
fever use TMPS
while pending
Remarks on
therapy

Drainage

Correction of primary cause (if possible), copious lavage essential

Removal
recurrence

Amoxicillin or ampicillin preferably as a CRI (constant rate infusion)

or three times daily

Reference key R

Cytology Culture and Hospitalisation Antimicrobial therapy Surgery Consider referral to

antimicrobial recommended not indicated specialist
susceptibility test

For the New Zealand veterinary profession 13

Eyes
Bacteria are rarely the primary cause of conjunctivitis in dogs. Most antibiotics are applied as drops (or ointments).
Primary bacterial conjunctivitis infections in cats are mainly Subconjunctival injections can be made to prolong a
caused by Chlamydophila felis and Mycoplasma. Herpesvirus drug’s action. These routes can lead to significant systemic
can also cause conjunctivitis in cats. absorption. Powders should never be applied to the eye.
Most infections are superficial and most drugs will easily get Beware – sulphonamides which can cause
to where the bacteria are. Chloramphenicol was widely used keratoconjunctivitis sicca in some breeds.
because it has excellent ability to penetrate both chambers
of the globe. However, infections of the deeper structures
may require systemic antibiotics. Systemic tetracyclines are
usually used in cats. Acyclovir drops are used for herpes virus
infection.

Ready reference table

for eye antibiotic therapy
Body system Eyes
Common conditions Conjunctivitis Corneal ulcers Keratitis Blepharitis
Cytology and culture

+ +

Likely pathogen Rarely bacterial in dogs, Primary ulcers rarely bacterial. Rarely bacterial Staphylococci, Streptococci
Chlamydophila felis and
Mycoplasma in cats.
Empirical anti-microbial Fusidic acid topically in dogs, Primary: fusidic acid Fusidic acid
choice tetracyclines in cats
Deep stromal: tetracyclines
Melting: fluoroquinolones

Remarks on therapy Systemic therapy rarely Consider cyclosporine

indicated

Reference key R

Cytology Culture and Hospitalisation Antimicrobial therapy Surgery Consider referral to

antimicrobial recommended not indicated specialist
susceptibility test

14 AMU guidelines | Dogs and cats | Version 4.0 | September 2018

Blood Bones and joints
A complete work up is necessary to try to find the original Osteomyelitis requires treatment with antibiotics. Although
focus of infection, e.g. vegetative endocarditis (rare), unless most antibiotics should reach adequate concentrations in
it is obvious, e.g. umbilical infection in a neonate. This is bone when dosed appropriately, adequate blood supply
necessary to make sure that the chosen drug gets to the to the site is also necessary. Areas of necrotic bone or
site of the infection. Blood cultures are often negative as sequestra will not heal without surgery. Parenteral antibiotics
bacteraemia tends to be episodic. Multiple cultures may be are indicated if a bacteraemia or septicaemia are present,
necessary. Bacteraemia is thought to precede fever spikes. otherwise oral antibiotics for four to six weeks should be used.
Cephalosporins or amoxicillin/clavulanate are usually used.
Treatment must begin before bacterial isolation and
Tetracyclines should not be used as they bind to calcium in
identification, especially as it is often difficult to isolate the
the bone and their activity is reduced.
causative organism. Early, aggressive, broad spectrum anaerobic
and aerobic treatment at high dose rates is recommended. Discospondylitis usually responds readily to antibiotics.
If good improvement is not seen after five days, the animal

Ready reference table for should be re-evaluated.

blood antibiotic therapy Ready reference

Body system Blood
table for orthopaedic
Common conditions
Cytology and culture
Sepsis
antibiotic therapy
Body system Orthopedic

+ Common conditions Septic arthritis Osteomyelitis

Cytology and culture Radiography and

of multiple blood samples taken over of bone biopsy

a 23-hour period (both aerobic and +
anaerobic incubation)
Likely pathogen Variable (including anaerobes)
Empirical anti-microbial choice Fluoro-quinolone and penicillin G or
amoxicillin or ampicillin IV while of synovial aspirate
or biopsy (synovial
membrane)

pending
Remarks on therapy Before isolation and
sensitivity testing
incubate sample in
blood culture medium
Amoxicillin or ampicillin preferably as
for 24 hours at 37° C.
a CRI (constant rate infusion) or three
times daily

Likely pathogen Variable Variable

Empirical anti-microbial Clindamycin or Clindamycin while
choice cephalexin or
amoxicillin-clav
pending
Remarks on therapy Copious lavage (aseptic) Look for primary cause
of joint space with saline
or Ringer’s lactate

Amoxicillin-clav three Remove implants if

times daily possible

For the New Zealand veterinary profession 15

4. General considerations regarding
the choice of antimicrobial agents
Choice of antimicrobial
Consider Pharmacokinetics and dynamics
Does it kill the bacteria? Antibiotics must get to the site of infection in sufficient
concentration in order to kill bacteria. In some cases, e.g.
Does it get to where the bacteria are?
beta-lactams and macrolides, the time that the antimicrobial
Is clinically significant resistance likely to develop? concentration at the site of infection is greater than MIC is the
• in the animal? factor determining the treatment’s effect (time-dependent
antimicrobials). For other types of antimicrobial agents
• in contacts? such as fluoroquinolones and aminoglycosides, the effect
• in the environment or people? is dependent on the concentration of the antimicrobial
substance: the higher the concentration the better the effect
Then think about side effects, likelihood of owner compliance (concentration-dependent antimicrobials).
with administration instructions, cost, etc.
Prescribing should not be based on convenience, duration
Combination therapy
of action or route of administration.
Antibiotics with different mechanisms can, when given
together, have an increased effect or a reduced effect. The
Susceptibility interactions can be very complex and only well-tested
Higher concentrations than MIC are sometimes required combinations should be used.
to have an effect in vivo, as the drugs are bound in varying
degrees to different tissue components, e.g. plasma proteins.
Duration of treatment
There is limited evidence to support any recommendations.
Antimicrobial susceptibility testing Clinical experience of how different types of infections
When choosing an antibiotic, culture and sensitivity testing respond is usually used. Chronic infections, and especially
is increasingly important to support the decision. Results intracellular infections, usually require a considerably
are usually reported as sensitive, intermediate or resistant. longer course of treatment than acute infections. For acute
If a bacterium is classified as resistant, it generally means infections, a high dose for a short period may be best to
that treatment with any antimicrobial out of the same class reduce resistance development.
of antimicrobial agents will not be successful. Very high
concentrations at the site of infection can be achieved
using local treatment; sometimes even bacteria that have
been categorised as resistant can actually be sufficiently
inhibited and a satisfactory therapeutic effect can be
achieved. Sensitive bacteria should, in principle, be inhibited
by treatment. The investigations are, of course, carried out
in the laboratory using standardised conditions whereas the
actual clinical outcome of a treatment can be affected by
many other factors, e.g. at what point during the course of
infection the treatment is started, the site of infection, the
animal’s own defences and so on. Bacteria that are classed as
intermediary can be treatable if the infection is localised in an
organ system where very high antimicrobial concentrations
can be achieved. Such is the case, for example, with ampicillin
and the urinary tract.

16 AMU guidelines | Dogs and cats | Version 4.0 | September 2018

Antimicrobial decision tree
Use this chart to: Do you know
• Support your decision making or strongly
suspect the
• Avoid unnecessary antimicrobial use condition is a
bacterial
infection or has
secondary
bacterial
involvement?

YES NO

YES Is resolution of NO Consider non-

this infection It might still bacterial causes
dependent on use resolve (e.g. viral, parasitic,
of antimicrobials? non-infectious)

YES Will the animal’s NO Consider use Choose other

wellbeing be It will probably not of antiseptics or therapy based on
threatened if you make a difference other agents based expected cause,
delay therapy? on current current
recommendations recommendations
and scientific and scientific
Consider use of literature literature
antiseptics or other
agents based on
current Take samples for
Choose an
recommendations culture and If not resolving,
Take antimicrobial based
and scientific susceptibility take samples for
samples for on cytology and
literature testing culture and
culture and expected cause,
susceptibility current susceptibility
testing recommendations testing
and scientific
literature

Choose an
antimicrobial
If indicated, change treatment
based on
according to laboratory results and if
laboratory
possible to an antimicrobial with the
findings, current
narrowest spectrum
recommendation
s and scientific
literature

If there is a
poor response to
therapy, review
your diagnosis
and therapeutic
plan

For the New Zealand veterinary profession 17

 Indications where systemic antimicrobial use is normally
unnecessary:
Information to
•
•
Routine dental descaling and polishing
Treatment of in-contact but unaffected cohort animals
animal owners
• Before mating/at weaning time
Inappropriate use of antibiotics
Surgery of uninfected/uncontaminated tissue (antimicrobials) could harm your pet,
• Routine castrations and spays you and your family and is a threat to global
• Routine laparotomy
• Caesarean section
health. Everyone needs to act responsibly,
• Removal of non-infected tumours including you as an animal owner.
• Clean orthopaedic surgery of short duration (<1.5 hours)
• Neurosurgery
• Reconstructive surgery, otoplasty, skin flaps etc
Antibiotics are important
Many infections cannot be managed without antibiotic but
Uncomplicated conditions of known or suspected viral aetiology
resistance towards these is becoming an issue. Owners and
• Acute canine cough veterinarians need to work together to solve this.
• Acute gastrointestinal infection
• Feline upper respiratory viral infections
• Feline calcivirus infection Are antibiotics really necessary?
• Feline leukaemia virus (FeLV)/Feline immunodeficiency virus • Not all infections are caused by bacteria, e.g. some are viral
(FIV) infections and do not respond to antibiotics. Also, not all bacterial
• Rhinitis infections require antibiotic therapy.
• Many wound and skin infections can be resolved by local
Other conditions without pathogenic bacterial involvement wound care and antibacterial washes. Ask your veterinarian
to show you how to do this.
• Feline lower urinary tract disease (FLUTD)
• Juvenile vaginitis
• Acute conjunctivitis Diagnostics are important
• Chronic bronchitis
To investigate if a bacterial infection is the cause of your
• Inflammatory bowel disease (IBD) animal’s illness; the veterinarian might need to collect
• Prostatic hyperplasia or prostatic cysts samples to look for signs of infection or to identify the
• Anal sac inflammation/engorgement without abscessation bacteria involved through bacterial culture. Supporting this
• Wounds with well-established granulation tissue will increase the chance of your animal’s recovery without
unnecessary risks (e.g. treatment failure).
Conditions likely to respond to antiseptics or other topical agents
• Uncomplicated skin lesions or mildly infected wounds and Don't expect antibiotics
bites
Do not demand antibiotics if your veterinarian does not
• Surface and superficial pyoderma prescribe them; in most cases it is not appropriate to use
• Seborrhoeic skin diseases antibiotics in a precautionary manner.
• Otitis externa
• Periodontal disease

Other uncomplicated conditions with bacterial aetiology

• Bite abscesses in cats
• Salmonella gastroenteritis
• Campylobacter spp gastroenteritis
• Clostridium difficile gastroenteritis

This table provides examples and should not be considered comprehensive.

18 AMU guidelines | Dogs and cats | Version 4.0 | September 2018

Always follow your veterinarian's advice
• Give the antibiotics as instructed. Contact your veterinarian
if the treatment is not effective within the recommended
period.
• Do not change dosage or stop therapy in advance and
keep your follow up appointments.
• Do not share antibiotics with other animals or animal
owners.
• Never use leftover medicines.

Handle your animal in a clean way

Always use disposable gloves and wash your hands before
and after attending to wounds or cleaning ears.
• No rings, wristwatches or jewellery should be worn.
• Hands should be washed before handling your animal.
• Disposable gloves should be worn when handling infected
tissue or wounds.

For the New Zealand veterinary profession 19

20 AMU guidelines | Dogs and cats | Version 4.0 | September 2018