Objectives To describe antibiotic prescription by veterinarians in general practices in the United Kingdom before referral and analyse if UK antibiotic stewardship guidelines were followed. Materials and Methods The clinical records from dogs and cats referred to the Internal Medicine and Oncology departments of two referral hospitals were retrospectively reviewed. Results There were 917 cases included, of which 486 (53.0%) had been prescribed antibiotics for the presentation they were subsequently referred for. Bacterial culture or cytology to guide antibiotic prescription had been performed in 43 of 486 (8.8%) and nine of 486 cases (1.8%) respectively. In four cases, both cytology and culture were performed. For those animals who had received antibiotics, 344 of 486 (70.8%) prescriptions did not comply with UK antibiotic stewardship guidelines. Following investigations at a referral centre, a bacterial aetiology was found or suspected in 17.9% of the cases that received antibiotics. Clinical Significance Use of diagnostics, including culture and cytology, to prove or determine the likelihood of a bacterial aetiology was infrequently performed before referral and may have contributed to overprescription of antibiotics. Encouraging veterinarians to undertake appropriate diagnostics, in combination with education around compliance with antibiotic stewardship guidelines, might reduce antibiotic prescription.
A 9-year-old Maltese dog was presented with a history of chronic cough. On the radiographic and CT studies a long smoothly marginated tracheal mass with bilateral bronchial extension was detected. These findings were confirmed by bronchoscopy and dynamic grade II tracheal collapse was also observed. Biopsies were performed and histopathology revealed marked polypoid proliferation of the tracheal mucosa with intense lymphoplasmacytic and macrophagic infiltration consistent with polypoid tracheobronchitis. Prednisone was started but due to the absence of a complete response, cyclosporine was added. Six weeks later the cough had resolved, and the mass was not visible at radiographic follow-up. Prednisone was discontinued without recurrence, but when cyclosporine was tapered, the mass and clinical signs reappeared. Three years later the patient was still on treatment with cyclosporine, without clinical signs and no evidence of the mass was observed at the follow-up CT scan.
Case summary An 11-month-old female domestic shorthair cat presented with a 24 h history of inspiratory dyspnoea, abnormal upper respiratory tract sounds, gagging, retching and making exaggerated swallowing motions. Retroflexed nasopharyngoscopy revealed a large, right-sided nasopharyngeal mass that was seen to exude purulent material and a possible small foreign body when pressure was applied with forceps. Thorough expression of the mass alleviated clinical signs. Cytology revealed septic neutrophilic inflammation, and a Pasteurella species with no noted antimicrobial resistance was cultured. The cat was discharged with oral antibiotics and analgesia and made a full recovery, with no recurrence of clinical signs at the 6-month follow-up. Relevance and novel information Abscess formation in the nasopharyngeal region has not been previously reported in cats, to the authors’ knowledge. The cause of the abscess was suspected to be a foreign body, but other aetiologies could not be fully excluded. This case demonstrates that nasopharyngeal abscesses are a rare but potentially significant differential diagnosis for upper respiratory tract obstruction in cats.
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