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James-Jenks EM, Pinard CL. Topical Ocular Therapeutics in Small Animals. Vet Clin North Am Small Anim Pract 2023; 53:473-492. [PMID: 36813396 DOI: 10.1016/j.cvsm.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
This article reviews the administration of common topical ophthalmic medications, in relation to factors influencing absorption including composition of topical ophthalmic preparations, and potential systemic effects. Commonly prescribed, commercially available topical ophthalmic medications are discussed with respect to pharmacology, their indications for use, and adverse effects. Knowledge of topical ocular pharmacokinetics is essential for the management of veterinary ophthalmic disease.
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Affiliation(s)
- Elizabeth M James-Jenks
- Department of Clinical Studies, University of Guelph, Ontario Veterinary College, 50 Stone Road East, Guelph, Ontario N1G 2W1, Canada.
| | - Chantale L Pinard
- Department of Clinical Studies, University of Guelph, Ontario Veterinary College, 50 Stone Road East, Guelph, Ontario N1G 2W1, Canada
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Helgeson ME, Pigott AM, Kierski KR. Retrospective review of diphenhydramine versus diphenhydramine plus glucocorticoid for treatment of uncomplicated allergic reaction in dogs. J Vet Emerg Crit Care (San Antonio) 2021; 31:380-386. [PMID: 33749168 DOI: 10.1111/vec.13054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 06/17/2019] [Accepted: 06/23/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To report the outcome of treatment of uncomplicated allergic reactions in dogs with diphenhydramine vs diphenhydramine plus glucocorticoid and to determine the incidence rate of uncomplicated allergic reactions DESIGN: Retrospective study between January 1, 2012 and August 15, 2018. SETTING Privately owned, 24-hour emergency and specialty referral veterinary hospital. ANIMALS Eight hundred and eighty cases of dogs treated for uncomplicated allergic reaction with diphenhydramine alone or in combination with a glucocorticoid. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Two hundred ninety-nine dogs were treated with diphenhydramine alone, and 581 were treated with diphenhydramine plus Dex SP. There was no difference between the 2 groups for response to initial therapy, need for additional veterinary intervention after discharge, or persistent signs at follow-up. The cumulative incidence of emergency department presentation for uncomplicated allergic reaction in this hospital was 1.2%. CONCLUSIONS There was no difference in measured outcomes between dogs treated with diphenhydramine alone vs those treated with a glucocorticoid in addition to diphenhydramine in this population of dogs.
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Affiliation(s)
- Megan E Helgeson
- Department of Emergency and Critical Care, Lakeshore Veterinary Specialists, 2100 W Silver Spring Drive, Glendale, Wisconsin, 53209, USA
| | - Armi M Pigott
- Department of Emergency and Critical Care, Lakeshore Veterinary Specialists, 2100 W Silver Spring Drive, Glendale, Wisconsin, 53209, USA
| | - Kate R Kierski
- Department of Emergency and Critical Care, Lakeshore Veterinary Specialists, 2100 W Silver Spring Drive, Glendale, Wisconsin, 53209, USA
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Flanagan S, Schick A, Lewis TP, Chu Tater K, Rishniw M. A survey of primary care practitioners' referral habits and recommendations of allergen-specific immunotherapy for canine and feline patients with atopic dermatitis. Vet Dermatol 2020; 32:106-e21. [PMID: 33275300 DOI: 10.1111/vde.12918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND A recent pilot study of primary care veterinarians' attitudes regarding canine atopic dermatitis and initiation of allergen-specific immunotherapy (ASIT) revealed several barriers to specialist referral (in the USA) and use of ASIT as a treatment modality. HYPOTHESIS/OBJECTIVES The primary objective was to collect data on referral habits and ASIT practices among a much larger cohort of primary care veterinarians located around the world, and to explore barriers to referral and management of atopic diseases of dogs and cats with ASIT. METHODS AND MATERIALS An online survey, administered through the Veterinary Information Network (VIN, Davis, CA, USA), asked participants to self-report their referral habits and immunotherapy recommendations, and rate barriers and motivating factors using Likert-scale responses. RESULTS Of 827 survey responses, 97.6% identified as primary care practitioners. A larger number of practitioners (84.5%) reported seeing atopic dogs often, compared with atopic cats (9.7%). Fewer of these veterinarians (56.6%) referred atopic cats for specialist care, compared to atopic dogs (73.5%). Timely communication, sharing long-term management of the case, and provision of local continuing education were identified as factors associated with increased willingness to refer. A higher proportion of practitioners reported recommending ASIT for dogs (44.3%) than for cats (16.0%). Only 56.0% of respondents considered success rates of ASIT to be acceptable, while 27.9% were neutral on the topic. CONCLUSIONS AND CLINICAL RELEVANCE Dermatology specialists might build stronger relationships with referring veterinarians through timely case follow-up and provision of continuing education regarding the long-term benefits of ASIT and symptomatic management practices.
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Affiliation(s)
- Sarah Flanagan
- Dermatology for Animals, 86 W. Juniper Ave, Gilbert, AZ, 85233, USA.,Dermatology for Animals, 22,595 N. Scottsdale Rd, Scottsdale, AZ, 85255, USA
| | - Anthea Schick
- Dermatology for Animals, 22,595 N. Scottsdale Rd, Scottsdale, AZ, 85255, USA
| | - Thomas P Lewis
- Dermatology for Animals, 86 W. Juniper Ave, Gilbert, AZ, 85233, USA
| | - Kathy Chu Tater
- Veterinary Information Network, 777 West Covell Boulevard, Davis, CA, 95616, USA
| | - Mark Rishniw
- Veterinary Information Network, 777 West Covell Boulevard, Davis, CA, 95616, USA.,College of Veterinary Medicine, Cornell University, 602 Tower Rd, Ithaca, NY, 14853, USA
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Smith MR, Wurlod VA, Ralph AG, Daniels ER, Mitchell M. Mortality rate and prognostic factors for dogs with severe anaphylaxis: 67 cases (2016-2018). J Am Vet Med Assoc 2020; 256:1137-1144. [PMID: 32364451 DOI: 10.2460/javma.256.10.1137] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine mortality rates for dogs with severe anaphylaxis and identify potential prognostic factors. ANIMALS 67 dogs with suspected anaphylaxis graded as severe. PROCEDURES Dogs were classified on the basis of outcome as survivors and nonsurvivors. Medical records were reviewed, and data were extracted including signalment, examination findings, time to hospital admission from onset of clinical signs, CBC results, serum biochemical analysis results, coagulation testing results, and findings on abdominal ultrasonography. Initial treatment within the first 6 hours after hospital admission was recorded for analysis, specifically including the use of epinephrine, diphenhydramine, corticosteroids, antimicrobials, fresh-frozen plasma, and supplemental dextrose. RESULTS The overall mortality rate was 14.9% (10/67) for dogs with anaphylaxis graded as severe. Serum phosphorus concentration and prothrombin time (PT) were significantly higher in nonsurvivors, compared with survivors. Nonsurvivors had lower presenting body temperatures than survivors. Serum phosphorus concentration ≥ 12.0 mmol/L, hypoglycemia within 6 hours after hospital admission, high PT value, concurrently high PT and partial thromboplastin time (PTT) values > 50% above the reference range limit, and the need for supplemental dextrose were associated with death. The incidences of coagulopathy and peritoneal effusion were unexpectedly high (85.2% and 65.5% of dogs, respectively) but were not indicative of survival. CONCLUSIONS AND CLINICAL RELEVANCE Despite the poor presenting clinical condition seen in dogs with severe anaphylaxis, the rate of survival with treatment was fairly high. Coagulopathy and the presence of peritoneal effusion were common findings in dogs with severe anaphylaxis. Serum phosphorus concentration ≥ 12.0 mmol/L, high PT value, concurrent increases of PT and PTT values > 50% above reference range limits, hypoglycemia within 6 hours after hospital admission, and the need for supplemental dextrose were associated with death.
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de Vlaming A, Wallace ML, Ellison GW. Clinical characteristics, classification, and surgical outcome for kittens with phimosis: 8 cases (2009-2017). J Am Vet Med Assoc 2020; 255:1039-1046. [PMID: 31617807 DOI: 10.2460/javma.255.9.1039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe clinical characteristics and surgical outcomes for kittens with phimosis and to develop a system to classify phimosis on the basis of gross pathological lesions. ANIMALS 8 kittens with phimosis. PROCEDURES Medical record databases of 2 veterinary teaching hospitals were searched to identify records of cats ≤ 20 weeks old (ie, kittens) with phimosis that underwent surgical intervention between 2009 and 2017. For each kitten, information extracted from the record included signalment, history, clinical signs, physical examination findings, treatments, and details regarding the surgical procedure performed, postoperative complications, and outcome. RESULTS The most common clinical signs were stranguria (n = 6), marked preputial swelling (5), and a small (6) or inevident (2) preputial orifice. Six kittens had type 1 phimosis (generalized preputial swelling owing to urine pooling without penile-preputial adhesions) and underwent circumferential preputioplasty. Two kittens had type 2 phimosis (focal preputial swelling and urine pooling in the presence of penile-preputial adhesions) and underwent preputial urethrostomy. No postoperative complications were recorded for kittens that underwent preputial urethrostomy. All 6 kittens that underwent circumferential preputioplasty had some exposure of the tip of the penis immediately after surgery, which typically resolved over time. At the time of last follow-up (mean, 1.4 years after surgery), all 8 patients were able to urinate and had no signs of phimosis recurrence. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that circumferential preputioplasty and preputial urethrostomy could be used to successfully manage kittens with type 1 and type 2 phimosis, respectively.
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Goldreich JE, Franklin-Guild RJ, Ledbetter EC. Feline bacterial keratitis: Clinical features, bacterial isolates, and in vitro antimicrobial susceptibility patterns. Vet Ophthalmol 2019; 23:90-96. [PMID: 31291056 DOI: 10.1111/vop.12693] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 04/05/2019] [Accepted: 06/18/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe clinical characteristics, bacterial isolates, and in vitro antimicrobial susceptibility patterns for cats with bacterial keratitis. ANIMALS STUDIED Eighty one cats with bacterial keratitis. PROCEDURES Medical records of cats with a clinical diagnosis of bacterial keratitis, confirmed by corneal culture, were reviewed from June 2004 to July 2017. Animal signalment, bacterial isolates, aerobic bacteria in vitro antimicrobial susceptibility test results, and pertinent clinical features were recorded. Percentages of susceptible aerobic bacterial isolates were statistically compared among selected antimicrobials. RESULTS There were 102 aerobic bacterial isolates recovered from corneal samples of the 81 cats presented with bacterial keratitis. The most frequent bacteria isolated were Staphylococcus species, which constituted 55% (56/102) of total isolates. All aerobic bacterial isolates grouped together had the highest percentage of susceptibility to ofloxacin (100%), ciprofloxacin (94%), chloramphenicol (93%), doxycycline (92%), ticarcillin (90%), gentamicin (89%), moxifloxacin (89%), tobramycin (86%), neomycin (85%), amikacin (84%), and cefazolin (84%). The same isolates had the lowest percentage of susceptibility to polymyxin B (2%), bacitracin (15%), and clindamycin (31%). When analyzed separately, the isolated Staphylococcus species had the highest percentage of susceptibility to ofloxacin (100%), tobramycin (93%), and neomycin (85%) and the lowest percentage of susceptibility to polymyxin B (3%) and bacitracin (13%). CONCLUSIONS Members of the Staphylococcus genus were the most frequent bacteria isolated from cases of feline bacterial keratitis. On the basis of in vitro susceptibility testing and mechanism of action, ofloxacin, ciprofloxacin, ticarcillin, gentamicin, or moxifloxacin are recommended for initial antimicrobial therapy of suspected bacterial keratitis in cats.
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Affiliation(s)
- Jennifer E Goldreich
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY
| | | | - Eric C Ledbetter
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY
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Anaphylaxis to polymyxin B-trimethoprim eye drops. Ann Allergy Asthma Immunol 2016; 116:372. [PMID: 26922212 DOI: 10.1016/j.anai.2016.01.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 01/04/2016] [Accepted: 01/13/2016] [Indexed: 11/24/2022]
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Shmuel DL, Cortes Y. Anaphylaxis in dogs and cats. J Vet Emerg Crit Care (San Antonio) 2013; 23:377-94. [PMID: 23855441 DOI: 10.1111/vec.12066] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 05/27/2013] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To review and summarize current information regarding the pathophysiology and clinical manifestations associated with anaphylaxis in dogs and cats. The etiology, diagnosis, treatment, and prognosis is discussed. ETIOLOGY Anaphylaxis is a systemic, type I hypersensitivity reaction that often has fatal consequences. Many of the principal clinical manifestations involve organs where mast cell concentrations are highest: the skin, the lungs, and the gastrointestinal tract. Histamine and other deleterious inflammatory mediators promote vascular permeability and smooth muscle contraction; they are readily released from sensitized mast cells and basophils challenged with antigen. Anaphylaxis may be triggered by a variety of antigens including insect and reptile venom, a variety of drugs, vaccines, and food. DIAGNOSIS Anaphylaxis is a clinical diagnosis made from a collection of signs and symptoms. It is most commonly based on pattern recognition. Differential diagnoses include severe asthma, pheocromocytoma, and mastocytosis. THERAPY Epinephrine is considered the drug of choice for the treatment of anaphylaxis. It acts primarily as a vasopressor in improving hemodynamic recovery. Adjunctive treatments include fluid therapy, H1 and H2 antihistamines, corticosteroids, and bronchodilators; however, these do not substitute for epinephrine. PROGNOSIS Prognosis depends on the severity of the clinical signs. The clinical signs will vary among species and route of exposure. The most severe clinical reactions are associated when the antigen is administered parenterally.
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Affiliation(s)
- Daniella L Shmuel
- Oradell Animal Hospital, Emergency and Critical Care, 580 Winters Avenue, Paramus, NJ 07652, USA.
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