It’s easy to forget that antibiotics have been formally in use for less than a hundred years. I mean, what did we ever do without these bacteria-killing drugs?
I prescribe antibiotics every day of my life in veterinary practice. Which means I revere them for their effectiveness and rely on their actions. Indeed, I treat them like gold. (Gram per gram, some of them probably cost as much.)
But that reverence also means I look hard for ways to do without. After all, antibiotics have been courting bacterial resistance since the first day they came on the scene. Every time I use them I understand that some percentage of wily bacteria may well find ways to thwart their killing power with genetic somersaults worthy of a Greg Louganis dive.
Add up all the molecular gymnastics and it’s postulated that, one day soon, these drugs will no longer work their 20th century magic. Blip. Gone. What next?
So what’s a vet to do?
In food supply veterinary medicine, the stress is more acute. That’s because modern industrial agriculture practices rely on these drugs to get animals up to size with a speed unheard of even fifty years ago. And though the residual drugs in our animal proteins may not affect humans (at least that’s what the Industry says), their widespread use doubtless advances the day these drugs will no longer do their intended thing.
That’s why I predict that the political forces mounting against the use of antibiotics in food animal species will one day spill over to the small animal side of the veterinary coin. Backlash against antibiotic use for non-human species will mean new regulations against their use in pets––probably within the next twenty years, if not sooner.
So I’m getting ready, anticipating the changes with antibiotic alternatives and doing my best not to contribute to the problem by limiting antibiotic consumption in my patients wherever I can.
But it isn’t always so doable in practice. Pet owners want fast, easy results. And alternative approaches don’t always do the trick with the alacrity of a simple pill or the jab of a needle. Nonetheless, there is a contingent of pet owners ready and willing to try my way first. And that’s all I ask. If it doesn’t work––no matter––we can always move along to the bigger guns.
After all, these are not the deathly ill animals with fulminating infections and fantastic fevers we’re talking about, rather the ones with simple everyday infections for whom a soaked paw or a flushed ear may mean one less course of an expensive and potentially resistance-incurring antibiotic. Consider these ideas, if you will:
#1 Treat locally whenever possible
I’m not saying you do without, I’m just suggesting you keep the antibiotic confined to one organ system or area. Medicated shampoos, topical creams and lotions, medicated flushes, ear and eye drops, etc.
#2 Use antibiotic alternatives
Disinfectants, Epsom salts, honey and other alternatives (modern and ancient, alike) may be indicated for plenty of superficial infections. Even some deep puncture wounds, when treated early and often with Epsom salt soaks, can get away with zero antibiotics. Just don’t try this at home without your veterinarian’s look-see.
#3 Try probiotics
They’re getting more popular every day. Instead of treating a gastrointestinal bacterial overgrowth with antibiotics (as we’re so often wont to do), try the probiotic approach. These healthy bacterial cultures can reestablish the balance between “good” and “bad” bacteria in the GI tract. Why kill when promotion works just as well?
#4 Treat the source
Skin infections secondary to allergies are among the most common reasons veterinarians prescribe antibiotics. With good reason. But treating the cause of the infection, though it’s a more complex undertaking, is probably the only thing that’ll keep one more pet off the lifelong rollercoaster ride of rotating antibiotics.
#5 Prevention
Preventing problems. It sounds so simple in theory. Yet it’s not a more popular approach because hard work is not a sexy antidote to a simple pill. Getting your hands dirty and spending your free time brushing teeth or cleaning ears is not an attractive option for many. It works, nonetheless.
***
Want to offer your own additions to my list? Go ahead...
Add Comment32 Comments
omg a vet that deosent hand out clavomox like candy
had a huge fight with the vet we take the rescues to about my cat he said clavomox i said does he ahve a bacterial infection he says dont know i say well in that case why are you giving me a medicine how bout finding out first/
he didnt like that and i found another vet
jim hall June 15th, 2009 01:12:58 PM
AMEN DR PATTY!! I have been an advocate for careful and thoughtful use of antibiotics since the minute I graduated. The majority of vets don't think twice about administering them, and it drives me insane. I'm glad to hear that there are more people concerned about the mindless use of some of our most powerful drugs! Rock on!
Cat ERVet June 15th, 2009 01:35:13 PM
It's really nice to see a vet who is mindful about the use of antibiotics, and looks for alternatives. It's very distressing to see antibiotics used as if they're some kind of infallible magic with no consequences, and the prospect of more resistant bacteria developing is really scary. Antibiotics are wonderful, amazing things and I wish more people would reserve their use for situations that genuinely merit it, instead of as the first solution that is blindly thrown at any sketchily-diagnosed problem.
If I or my pets get sick, I want to know that there are antibiotics out there that will work when I need them to.
My foster cat has had all kinds of infections and been on piles of antibiotics since she was rescued. She had an eye that was so badly damaged by infection that it had to be removed, an ear infection that took 10 months to get rid of and now a mycoplasma infection in her good eye that I've been fighting (unsuccessfully) for almost two months. It scares me - what if antibiotics are ineffective and I can't rid her of this eye infection? She doesn't have any eyes left to spare. What if she ends up with another infection down the line?
It's so easy to take antibiotics for granted until you run into a situation where they're just not working. You feel incredibly powerless when that happens. It's so important to use them sparingly and preserve their efficacy for as long as possible.
Anlina Sheng - abnormalloveofcats.com June 15th, 2009 02:01:33 PM
I'm sympathetic to the vets who, whether they admit it or not, rely too heaily on antibiotics. Most of our vets at the clinic I work at tend to think out loud when devising their treatment plans...and a lot of the time, I see them looking up antibiotic doses "just in case". It might very well be a viral infection (upper respiratory, especially)...but what if it's not? And most clients' eyes bulge out of their heads if pricier diagnostics like transtracheal wash or culture and sensitivity are offered - so they definitely play their part, too. Couple that with the very real possibility that the pet fails to improve and is taken to another clinic, where another vet is shocked (and tells the client so) that the pet hasn't been put on antibiotics "because it's standard". That kind of thing happens a lot, and no doctor wants unhappy clients throwing out the word "malpractice" on the other end of the phone line. So, some are definitely between the proverbial rock and hard place...doesn't make their approach right, just understandable. As far as the ag industry goes (and I'm an animal science major within the agricultural department of a former land grant university in a city full of livestock producers), the use of subtherapeutic doses of antibiotics in animal feed to increase things like average daily gain ( a measurement of how much an animal grows per unit of feed consumed) is, IMO, purely profit-driven and irresponsible. Very few producers have a science or veterinary background...they just know that if they dump so many pounds of, say, tetracycline into so many pounds of animal feed, their animals put on x more amount of weight, which translates into higher profit margins. It's unbelievable that it's been so unregulated for so long.
anna June 15th, 2009 04:22:28 PM
My best ways to prevent the need for antiobiotics in my animals is:
good food - that advice stands alone
healthy lifestyle - fit dogs with well controlled stress levels are more likely to be able to heal small wounds and injuries without antibiotics.
good husbandry - small wounds caught early can usually be handled with simple cleaning. Also using good sense - keep your fences in safe repair and discourage habits that can cause injury. Keep your dogs clean, but don't scour them with harsh shampoos daily in overkill. Keep parasites under control.
products I like - for dogs (never cats!) tea tree oil is an excellent antiseptic. Also colloidal silver is great to rinse puncture wounds. Betadine and superglue safely closes torn pads and minor lacerations.
and above all: LEARN PATIENCE. Overnight and "instanct" cures are never without side effects. Think beyond today. Maybe your dog is a little uncomfortable right now, but what is the gain? Does he really need that steriod shot? or do you?
Wendy June 15th, 2009 05:42:11 PM
really, I can spell "instant". Where is the edit feature on this thing?
Wendy June 15th, 2009 05:43:14 PM
When human doctors and veterinary doctors do prescribe antibiotics, the most important thing they need to say - and so often don't - is that all the pills need to be taken, at the correct (or as close as can be) times, until all the pills are gone. So many times, when I was a kid, as soon as we started feeling better, my mom (and other kid's moms too) would set aside the rest in the bottle so they could 'get some pills in, in case an appointment couldn't be made quickly enough.' I still know of parents (and non parents, of course) who do this today. And there have been numerous times I hear clients say, when they come back in for the second (3rd, 4th) time for an infection (skin/ear/etc.), "Well, I don't know if I need a bunch more pills. I've got some left, can I just give her the rest of the ones I've got at home?" (Or something to indicate they didn't give all the pills - I get this about HW prevention a lot, too.)
And I second (loudly), Wendy's comment on good food. You can spend 15-25% more on food, and, in many cases, stop spending more than that increase in antibiotics, shampoos, and sprays for allergies. However, this is often a clear case of 'penny wise and pound foolish' or a dog that just doesn't get treated at all, which really sucks. Of course, getting those vets who either don't care, or think they know enough already, to learn about better nutrition, change their take on allergies, and promote better food, is often even harder than getting clients to comply about giving all the antibiotics in the first place.
KateH June 15th, 2009 06:04:58 PM
KateH, I agree that clients who don't give all the antibiotics drive me crazy! I am always careful to reiterate to them (more than once) that ALL the pills should be given. I have started telling them why as well. The vet does as well. I haven't had much success getting the receptionists or other techs to do the same. They hand the client the bottle, mumble "Give one every 12 hours till gone" and dash off to the next patient. An additional 30 seconds would make such a difference!
Sassy June 15th, 2009 07:38:15 PM
Uh, Dr. Khuly, what is being done to the dog in the picture for this post? It sure doesn't look like it's enjoying it. :-)
KateH June 15th, 2009 08:19:03 PM
I have to admit I'm less than thrilled with the over use of antibiotics.. and the demand that people put on the practioners to prescibe them..Doesn't happen in my office unless there is a need for it..
Socks is on his third in a year.. I'm not sure this one was necessary.. He had a cyst removed from his back, and was put on a cephalosporin.. He has a ten day supply.. A couple of months ago he was given a Baytril shot, and Chlorenphenical tabs.. for bronchitis.. A couple of months before it was the ears, and a different antibiotic.. I know my vets are knowledgable, but the thought of all the antibiotics makes me not a happy camper.. I was talking to a couple of physician friends (endocrine, gyn, and ophth.) that use the same guys, and they agree... but none of us know better.. so we give them..
barri June 15th, 2009 09:15:48 PM
Like barri, I wonder about the prescribing of antibiotics as a preventative. Our cat got a teeth cleaning some years back, and we took home antirobe aquadrops. I asked if they found an infection, and the front desk said no, it was in case his gums got nicked during the cleaning. I can see their point, we might not notice until the infection got bad, but it did make me wonder if I was contributing to bacterial resistance.
lin June 16th, 2009 12:20:27 AM
Dr Patty, could you do a post a bout probiotics some time? I'm interested but I'm not sure which ones would be okay for dogs.
Catherine McArdle June 16th, 2009 01:53:44 AM
Oh, but this topic is so very much more complicated than this since docs have been handing out antibiotics like candy to humans for decades now and the resistant bacteria are already running rampant!
PJBoosinger June 17th, 2009 04:48:42 AM
KateH: Sorry about the pic: He's getting a shot. Looks unhappy, right?
Catherine: I'll work on one...just cuz you asked. ;-)
Dr. Patty Khuly June 17th, 2009 10:36:20 AM
I'm very interested in learning more about probiotics too, specifically is there such a thing as giving too much.
regina June 17th, 2009 11:20:40 AM
What do you do to prevent skin infections in dogs with allergies? My dog eats raw, no grains or soy. I think he's got seasonal/environmental allergies. He's currently on a course of Keflex because the antibacterial shampoo applied locally wasn't working. How do I keep him from getting another infection?
Mandy June 19th, 2009 10:29:03 PM
Mandy: Address the allergies with testing. Try a heavy-duty food trial first (for 8-12 weeks) then move along to the big guns: skin or blood testing. btw, I'm planning a post on the controversy over whether to use the skin testing or blood testing for seasonal/environmental/inhalant allergies (atopy). Stay tuned. In addition, I would consider looking into a more specific medicated shampoo. For example, if there's bacteria as well as yeast, your shampoo should address both kinds of infection. I like to use the shampoos every three days during the worst times of year. And always let the shampoo sit on the skin for 5-10 minutes before rinsing.
Dr. Patty Khuly June 20th, 2009 07:10:37 AM
I do Bulldog Rescue in Northern Nevada and we have a sweet little girl that came in, about 3 years old with pretty bad Demodex Mange. The shelter where she came from did one Mitaban dip and our vet has done one. It's very harsh for Jaz and I would love to find an alternative method for her. She is on Chlorpheniramine and Deramaxx as well as Cephalexin. I've got her on Natural Balance grain free food with yogurt mixed in. I have ordered Neem oil for her dry skin. Is there an alternative to the dips? or meds I can use to boost her immune system? This is the sweetest little itchy girl and I would love to help with less harsh treatments.
Karen June 20th, 2009 12:01:31 PM
Karen - ivermectin is used off label in dogs as an oral treatment for demodectic mange...our clinic much prefers it over the harsh amitraz dips. The treatment protocol usually lasts about a month (with the drug given daily).
anna June 21st, 2009 01:38:20 PM
KateH writes: "When human doctors and veterinary doctors do prescribe antibiotics, the most important thing they need to say - and so often don't - is that all the pills need to be taken, at the correct (or as close as can be) times, until all the pills are gone."
AMEN to that!!!
Any other way of using antibiotic (or antifungal drugs) will select for resistant strains of the bugs they were meant to fight.....
stefafra June 21st, 2009 03:49:51 PM
Anna-Thanks, we had discussed Ivermectin and on her next vet visit she will be checked for heartworm and if she is negative we will start the Ivermectin. Should this replace the dips?
Karen June 21st, 2009 09:06:58 PM
Karen - in most situations, yes, the daily oral ivermectin replaces the amitraz dips. Ivermectin is a broad-spectrum parasiticide used for deworming, killing larval heartworms, treating for ear mites, and demodex mites. Of course, the dosages, route, and duration of treatment are different for each condition. Good luck!
anna June 21st, 2009 09:38:04 PM
Of course, your vet is the best one to evaluate your pet's situation and appropriate therapy. :)
anna June 22nd, 2009 01:46:34 AM
Thank you Dr Khuly! The shampoo was Malaseb, the vet said the infection was staph. I did not leave it on 5-10 minutes, I can make a point of doing that. We just moved and go to see the new vet tomorrow. I will ask him about food elimination and allergy testing. His ear infections got much better when we went raw/grain free about 4 years ago, but then we moved East from CA and the skin issue started. For that reason I think it is environmental, but I'm willing to work on food allergies too.
Mandy June 24th, 2009 10:15:04 PM
Thank you - an excellent article Dr. Khuly. I'm looking to learn more about pets and natural antibiotics. Just like people, many times uderlying issues put strain on the body's system which help promote an infection (like allergies for instance, or food allergies).
As a Microbiologist and Researcher, I've written about natural MRSA treatment and Staph infection treatments for people. Obviously, the overuse of antibiotics (for people and pets alike) has helped create antibiotic resistance. My book MRSA Secrets Revealed is a comprehensive guide that covers natural approaches and treatments in a step-by-step fashion to stop the current infection, and to get to the root cause of the infection. It does not as yet address our pet friends, and I'm getting to that soon.
Thank goodness for the many amazing antimicrobial options that Mother Nature provides people and our pet companions.
Michelle Moore, Microbiobologist and Researcher
Michelle Moore August 7th, 2009 04:27:50 PM
That is interesting. I am trying to learn more about dogs and animals with skin infections...I am wandering what you would do about a skin infection with a dog that already has a skin allergy. I am a recently retired Bacteria Researcher. I am now a nutritionist, Health Consultant, through my career I have seen thousands of patients affected by MRSA. I suffered from Staph infection for many years until I was able to put my expertise to good use by trying many natural treatments until I discovered something really special...a safe & effective staph infection treatment without antibiotics. I have now been 100% MRSA staph infection free for the past 10 years. This last year I wrote a book called Staph Infection Secrets Revealed.
Lisa Goldstein
Author, Bacteria Researcher, & Nutritionist
Lisa Goldstein March 1st, 2010 05:26:54 PM
That is interesting. I am trying to learn more about dogs and animals with skin infections...I am wandering what you would do about a skin infection with a dog that already has a skin allergy. I am a recently retired Bacteria Researcher. I am now a nutritionist, Health Consultant, through my career I have seen thousands of patients affected by MRSA. I suffered from Staph infection for many years until I was able to put my expertise to good use by trying many natural treatments until I discovered something really special...a safe & effective staph infection treatment without antibiotics. I have now been 100% MRSA staph infection free for the past 10 years. This last year I wrote a book called Staph Infection Secrets Revealed.
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