UNIVERSITY OF MELBOURNE

GUIDE FOR
ANTIMICROBIAL
USE IN
DOGS AND CATS
For more information and further resources visit
www.fvas.unimelb.edu.au/vetantibiotics
Version 1
 We all have an important
role to play in the fight
against antimicrobial
resistance.
As part of our commitment to the implementation
of the National Antimicrobial Resistance Strategy
2015-2019, AgVic and The University of Melbourne
have created education materials about antimicrobial
resistance (AMR) and antimicrobial stewardship (AMS).

The resources aim to provide a practical guide for the

prescribing of antimicrobials that can help start the
conversation about AMR with clients.

Play your part in preventing

FREE RESOURCES
antibiotic resistant infections. • A5 antibiotic category cards for cattle, horses, sheep, chickens and pigs
• Pocket guide for antimicrobial use in horses • A3 waiting room posters
For more information visit • A5 prescribing tearaway pads • A4 fact sheet on MRSP • A6 sticker sheets
agriculture.vic.gov.au/amr • DL Double-sided prescribing leaflets • A4 S4 medicated feed order posters
• A2 Australian Prescribing Guidelines for horses • Antibiotic Guardian lapel pins

You can order our resources by emailing

[email protected]
Antibiotic Pharmacokinetics & Pharmacodynamics Dogs & Cats
Bacteriostatic Vs Bactericidal Time-Dependent Vs Concentration Dependent

Bacteriostatic
Time-Dependent
“ECSTaTiC for bacteriostatic”
• Optimise killing by maximising time above MIC.
Erythromycin (macrolides)
• More frequent administration or extended infusion increases
Clindamycin
efficacy by extending T>MIC.
Sulphonamides
Trimethoprim • Goal exceed MIC by 1-5 times for 50-80% of dosage interval.
Tetracyclines • E.g. penicillin, cephalexin, TMS, tetracyclines, clindamycin.
Chloramphenicol

Bactericidal
“Very Proficient For Complete Cell Murder”
Vancomycin
Penicillin
Fluoroquinolones
Cephalosporins Concentration Dependent
Carbapenems • Optimise killing by maximising peak concentration.
Metronidazole
• Higher doses at less frequent intervals (ie. once daily) increases
efficacy by maximising Cmax:MIC ratio.
Intrinsic resistance Vs Acquired resistance
• Goal Cmax:MIC >8.
Intrinsic resistance • E.g. aminoglycosides, fluoroquinolones, metronidazole.
All members of a bacterial genus or species have
properties that make them naturally resistant to Cmax
certain antimicrobials.

Acquired resistance
Previously susceptible bacteria acquire new
genes or a mutation occurs conferring resistance.
 Spectrum of Activity Against Common Bacteria Dogs & Cats
A guide to empirical therapy while awaiting susceptibility results.

Penicillin

Ampicillin / amoxycillin

Doxycycline

Trimethoprim sulpha

Chloramphenicol

Amoxycillin clavulanate

Cefazolin / cephalexin

Gentamicin

Metronidazole

Clindamycin

Cefovecin

Enrofloxacin
Drug

Bug
Traffic-light system is based
Staphylococcus pseudintermedius (CoP) § ± ± + ± ± + ± ± on the ASTAG antimicrobial
Staphylococcus aureus (CoP)
‡ + + + ± + + + + importance rating system.
Staphylococcus felis (CoN) + + + + + + + + + + +
Gram +ve

4 Drug of choice.
β-haemolytic Streptococci (eg S. canis) 4 4 ± + + + IR + + ± + Good susceptibility.
Enterococcus faecalis § 4 ± IR + IR IR IR IR ± ± Variable susceptibility.
Enterococcus faecium § ± IR IR IR IR IR IR Intrinsically resistant.
Actinomyces spp. 4 4 + + CoP Coagulase positive.
Escherichia coli IR ± + ± + + + IR + + CoN Coagulase negative.
Enterobacter spp. § IR IR + ± IR IR IR + § Susceptibility poorly
Klebsiella spp. § IR IR + ± +* +* IR + + predictable, multidrug
Gram -ve

resistance increasing in
Proteus spp. IR +** IR + + + IR + + frequency, culture and
Pseudomonas spp. § IR IR IR IR IR IR IR 4 IR IR ± susceptibility testing
Pasteurella spp. 4 + + + + + + is strongly recommended.

Bordetella bronchiseptica ± 4 + + + ‡ Multidrug resistant

Staphylococcus aureus
Mycoplasma spp. IR IR 4 IR IR IR IR ± likely to be of human
Anaerobes + + ± + + IR 4 + ± origin. Review aseptic
Staphylococcus pseudintermedius 4 ± 4 + + + + + technique.
Urinary isolates

Enterococcus faecalis 4 + IR + IR IR IR IR * Klebsiella aerogenes

intrinsically resistant.
Escherichia coli 4 + 4 + + + + +
Proteus vulgaris
Proteus mirabilis IR + IR + + + + + **
intrinsically resistant.
Proteus spp. (excluding P. mirabilis) IR IR IR + + + + +
 Antibiotic Pharmacotherapy by Class Dogs & Cats
Drug Importance
Class Rating Antibiotic Route Drug Dose Adverse Reactions Clinical Pearls

Low Amoxycillin IV 11-22mg/kg Anaphylaxis rare, other mild Anaerobic activity useful for cat-bite
IM q8-12h hypersensitivity reactions more infections, periodontal disease, tooth
PO common (urticaria, fever, abscesses, wound infections.
angioneurotic oedema). Drug of choice for streptococci,
Anorexia, vomiting, diarrhoea. clostridia, actinomycosis and
Pasteurella multocida.
Greater activity against Gram-
negative bacteria than penicillin,
including E. coli and Proteus mirabilis.
Very high urinary concentrations,
useful for UTIs, even penicillinase-
producing S. aureus.
Not recommended for pyelonephritis
or prostatitis.
Beta-lactams

Excreted in bile, therefore good for

cholestatic infections.

Low Ampicillin IV 10-20mg/kg Hypersensitivity reactions Slow IV (over 3 mins).

IM q6-8h and gastrointestinal disturbance Spectrum of activity equivalent
SC possible. to amoxycillin.

Low Penicillin IM 20-40,000 IU/kg Hypersensitivity reactions. Indicated for Gram-positive

q12h aerobic and anaerobic bacteria
(streptococci, clostridia) and for
infections caused by susceptible
Gram-negative bacteria eg.
P. multocida.

Medium Amoxycillin PO 12.5-25mg/kg Pain on injection. Clavulanic acid extends the range
clavulanic acid IM q8-12h Anorexia, vomiting, diarrhoea. of amoxycillin against β-lacatamase
SC Hypersensitivity reactions. producing pathogens, such as
IV Anaphylaxis after intravenous methicillin-susceptible staphylococci.
administration during general Higher dose recommended for
anaesthesia. Gram-negative infections.
 Antibiotic Pharmacotherapy by Class Dogs & Cats
Drug Importance
Class Rating Antibiotic Route Drug Dose Adverse Reactions Clinical Pearls

Medium Cefazolin IV 20-35mg/kg q8h Hypersensitivity reactions, 1st generation cephalosporin active
IM for therapy, pain on IM injection. against methicillin-susceptible
22 mg/kg staphylococci, streptococci,
surgical some Gram-negative aerobes,
prophylaxis unpredictable against anaerobes.
Greater Gram-negative activity
than cephalexin and cephalothin.
Good bone penetration.
For surgical prophylaxis administer
IV 30-60 mins before first incision.
Repeat intra-operative dosing
interval q4hrs for common skin
flora (staphylococci, streptococci),
Beta-lactams

q2hrs for E. coli.

Medium Cephalexin PO 22-30mg/kg q12h Vomiting and diarrhoea common 1st generation cephalosporin, similar
when administered without food. activity to cefazolin except less
Hypersensitivity reactions possible. Gram-negative activity.
Give with food to reduce GIT side
effects, can also lower dose if side
effects occur. Only use for skin
disease when topical therapy
insufficient to control pyoderma.

High Cefovecin SC 8mg/kg Vomiting, diarrhoea, 3rd generation cephalosporin.

hypersensitivity. Similar spectrum of activity to
amoxycillin clavulanate.
Reserve** for infections where no
effective alternative.
Label restraint FOR USE ONLY
in dogs and cats where indicated
by antibiotic sensitivity testing
according to principles of prudent use.
 Antibiotic Pharmacotherapy by Class Dogs & Cats
Drug Importance
Class Rating Antibiotic Route Drug Dose Adverse Reactions Clinical Pearls

High Ceftazidime IV 25-50mg/kg Gastrointestinal disturbance. 3rd generation cephalosporin with

q8-12h 10 times greater activity against
P. aeruginosa.
To exceed Slightly less active against all
P. aeruginosa other organisms than other
MIC 30mg/kg cephalosporins.
q4h or constant Reserve** for P. aeruginosa
IV infusion of infections with confirmed
4.1mg/kg/h susceptibility.
Beta-lactams

High Cefotaxime IM 20-40mg/kg q8h Pain on IM injection, gastrointestinal 3rd generation cephalosporin.
disturbances common due to Due to expense and potential to
broad antibacterial action. select for resistant infections,
Superinfection with resistant these drugs should be reserved**
microorganisms, including yeasts, for life-threatening infections,
may be anticipated. such as bacterial meningitis caused
by Gram-negative bacteria
(especially Enterobacteriaceae).
May be used in combination with an
aminoglycoside for MDR infections
in compromised animals
(neutropaenic).
Tetracyclines

Low Doxycycline PO 5mg/kg q12h or Administration to growing puppies Excellent penetration into most
10mg/kg q24h and pregnant bitches results in tissues (including prostate).
yellow discolouration of teeth. Broad spectrum acitivity, including
many intracellular pathogens such
as Chlamydia, Coxiella, Nocardia
and some Mycoplasma species.
 Antibiotic Pharmacotherapy by Class Dogs & Cats
Drug Importance
Class Rating Antibiotic Route Drug Dose Adverse Reactions Clinical Pearls

Low Trimethoprim PO 15-30mg/kg q12h Chronic use (>2 weeks) can lead Broad spectrum activity, including
sulphonamide IV to crystalluria, haematuria, urinary Nocardia spp., Toxoplasma spp. and
obstruction, haematopoietic other protozoa.
disorders (anaemia, leukopaenia, Well absorbed from gastrointestinal
thrombocytopaenia) and tract, excellent penetration into
dermatological reactions. many tissues including meninges,
Sulphonamides

Do not use in Doberman Pinschers. prostate and urinary tract.

~0.25% of dogs may suffer ISCAID recommended first line
idiosyncratic drug reactions 10-21 empirical treatment option for
days after exposure, including sporadic bacterial cysitis (simple
fever, arthropathy, blood dyscrasia, uncomplicated UTI) for 3-5 days (low
epistaxis, hepatopathy, skin risk of adverse effects with short
eruptions, uveitis, KCS. course).
In dogs <12kg, 1 week TMS decreases For therapy >7 days baseline
tear production by 15%, overdose Schirmer’s tear testing recommended
can lead to KCS. with periodic re-evaluation.
Can cause hypothyroidism and/or
lowered T4 in dogs.
Cats salivate if tablet protective
coating broken.

Medium Gentamicin IV Dogs: 9-14mg/kg Ototoxicity possible. Excellent activity against

IM q24h Nephrotoxic especially if Gram-negative bacteria and
hypovolaemia, hypokalaemia, some staphylococci.
Aminoglycosides

Cats: 5-8mg/kg hyponatraemia, elevated trough No anaerobic activity.

q24h concentrations, pre-existing renal Synergistic in combination with
disease, concurrent nephrotoxic β-lactam.
drug administration, prolonged Inactivated by purulent debris.
therapy (>7-10 days), age Ensure adequate fluid and
(neonates, geriatrics). electrolyte balance during treatment.
Pain on IM injection. Clinical monitoring for toxicosis may
include monitoring trough levels,
daily monitoring of urine for epithelial
casts and daily serum creatinine.
 Antibiotic Pharmacotherapy by Class Dogs & Cats
Drug Importance
Class Rating Antibiotic Route Drug Dose Adverse Reactions Clinical Pearls

Medium Metronidazole PO Dogs: Care in liver disease, can predispose Not indicated in acute
IV 10-15mg/kg to CNS toxicity - reduce dose to gastrointestinal disease unless
Nitroimidazoles

PO q12h 7.5 mg/kg. evidence of sepsis.

(10mg/kg Gastrointestinal disturbance, Excellent anaerobic activity.
SLOW IV) hepatotoxicity, CNS signs, Critical drug for managing human
haematuria, neutropenia. Clostridium difficile infections.
Cats: Potentially teratogenic in first Drug interactions: phenobarbital
10-15mg/kg q24h third of pregnancy. may enhance metabolism;
Can impact faecal microbiome cimetidine may decrease
long-term. metabolism and increase dose
related adverse effects.

High Nitrofurantoin PO 4.4-5mg/kg q8h Gastrointestinal disturbances, Lower urinary tract infections only.
hepatopathy, male infertility in Reserve** for exceptional cases.
dogs. Do not use for pyelonephritis or other
conditions where tissue (vs. urine)
levels are needed.
Avoid in cases with renal impairment.
No activity against Pseudomonas,
Nitrofurans

Proteus, Serratia, Acinetobacter spp.

Probenecid inhibits renal excretion.
Antagonistic to fluoroquinolones.
 Antibiotic Pharmacotherapy by Class Dogs & Cats
Drug Importance
Class Rating Antibiotic Route Drug Dose Adverse Reactions Clinical Pearls

Medium Clindamycin IV 11mg/kg q12h Oesophagitis and oesophageal Active against staphylococci, streptococci,
IM stricture have been reported in Actinomyces, Nocardia, and Mycoplasma
For IV: cats associated with use of spp. plus anaerobes (Bacteroides spp.,
dilute 1:10 in generic capsules - follow capsules Fusobacterium spp., Clostridium
Lincosamides

0.9% saline, with water or food. perfringens).

administer over Diarrhoea, neuromuscular Only use for skin disease when topical
60mins blockade. therapy insufficient to control pyoderma.
11mg/kg Oral suspension may be Cross-resistance to lincosamides
q12-24h unpalatable for cats. in bacteria resistant to macrolides.
Pain on IM injection. High concentration in prostate.
Toxoplasmosis: Use for toxoplasmosis controversial
25mg/kg q12h as may help clinical signs but not clear
infection from CNS or eye.
Erythromycin and chloramphenicol
are antagonistic.

Low Chloramphenicol PO Dogs: Anorexia, hypersalivation, Mostly used topically.

IV 40-50mg/kg vomiting with systemic use. May be used systemically for multidrug
IM q6-8h Dose related reversible bone resistant organisms.
marrow suppression may develop Broad spectrum.
Cats: with prolonged treatment - usually Avoid systemic use in cases with hepatic
Phenicols

12.5-20mg/kg q12h resolves within days. failure, renal failure, pre-existing

Topical

Cats more susceptible - within 2 haematologic abnormalities, pregnancy,

weeks of treatment. lactation and in young animals.
Wear gloves and mask when Eliminated by glucuronidation mechanisms,
handling medication as cats excrete higher proportion unchanged
idiosyncratic aplastic anaemia in urine than dogs.
can develop in people handling Potent inhibitor of P450 enzymes -
this drug. reduced hepatic clearance of
phenobarbital, pentobarbital.
Polypeptides

High Polymyxin B Nephrotoxic if administered Used topically for treatment of bacterial

systemically. keratitis, otitis externa and skin infections.
Topical

Potentially ototoxic. Active topically against Pseudomonas

Ophthalmic formulations spp. and other Gram negatives (except
associated with anaphylaxis Proteus, Morganella and Serratia spp.).
in cats. Inhibited by the presence of purulent
exudate.
 Antibiotic Pharmacotherapy by Class Dogs & Cats
Drug Importance
Class Rating Antibiotic Route Drug Dose Adverse Reactions Clinical Pearls

High Enrofloxacin PO Dogs: Blindness, due to retinal 2nd generation fluoroquinolone

IV 5-20mg/kg q24h detachment, and neurological active against Pasteurella spp.,
signs in cats. Gram-negative enteric bacilli,
Cats: Not always associated with dose staphylococci (higher MIC).
5mg/kg q24h, or route of administration, however Variable activity against Pseudomonas
SLOW IV greater risk with advancing age. aeruginosa (highest MIC).
Anorexia, vomiting, diarrhoea. Poor activity against streptococci,
CNS effects with high doses or enterococci and anaerobes.
rapid IV. Not indicated in superficial pyoderma.
Reserve** for infections where
Caution in animals prone to seizures.
culture and susceptibility indicate
Canine toxic shock syndrome and
no effective alternative.
necrotizing fasciitis caused by
Use is a known risk factor for
Fluoroquinolones

fluoroquinolone use in
selection of methicillin-resistant
Streptococcus canis infections. staphylococci.
Arthropathy in dogs during growth, If organism resistant to one
small dogs <8 months old, or large fluoroquinolone, typically resistant
breeds less than 12-18 months. to all (cross-resistance).
Avoid use in cats - especially those Good distribution to bone, prostate
with renal disease. and skin. Concentrated in urine, bile
and within phagocytic cells.
Enrofloxacin is partially (~20%)
de-ethylated to ciprofloxacin.
Oral absorption inhibited by antacids,
sucralfate, supplements containing
aluminium, calcium, iron and zinc.
Chelation/precipitation in IV fluids
with calcium or magnesium.
Reduced hepatic clearance of
theophylline.
Antagonism with chloramphenicol,
rifampicin.
 Antibiotic Pharmacotherapy by Class Dogs & Cats
Drug Importance
Class Rating Antibiotic Route Drug Dose Adverse Reactions Clinical Pearls

High Marbofloxacin PO 2.75-5.5mg/kg Anorexia, vomiting, diarrhoea. 2nd generation fluoroquinolone.

q24h CNS effects with high doses or Reserve** for infections where
rapid IV. culture and susceptibility indicate
Caution in animals prone to seizures. no effective alternative.
Arthropathy in immature animals. Similar activity, tissue distribution,
drug interactions to enrofloxacin.
Concentrated in urine, may be used
for confirmed pyelonephritis in cats
based on susceptibility testing.
Fluoroquinolones

High Pradofloxacin PO Dogs: Higher doses in dogs associated 3rd generation fluoroquinolone.
3-5mg/kg q 24h with myelosuppression. Reserve** for infections where
Do not use in dogs less than 1 year culture and susceptibility indicate
Cats: of age, or in pregnant or lactating no effective alternative.
5-10mg/kg q24h animals. Greater activity against
Gastrointestinal disturbances. Gram-positive cocci and anaerobes
Caution in animals prone to seizures. than other fluoroquinolones.
Similar drug interactions to
enrofloxacin.

High Ciprofloxacin PO 25mg/kg Avoid. Oral absorption in dogs highly

variable (~50%), lower than humans.
Only reaches therapeutic targets for
bacteria with MIC ≤0.06 µg/ml
(vs ≤1 µg/ml in humans).
Generally not effective for
staphylococci or P. aeruginosa in
dogs and cats.

* Black shading represents high importance rated antibiotics not registered for use in animals
that should be avoided or ONLY used in exceptional circumstances.
** Exceptional circumstances defined as use in an animal based on culture and susceptibility,
where there is no effective alternative therapy and a reasonable chance of survival.
NB. Many recommendations in this guide represent off-label use of antimicrobials.
Compliance with legal requirements in your jurisdiction is your responsibility.
Recommendations only apply to dogs and cats and cannot be safely extrapolated to other
small animal species.
 MRSP dermatology fact sheet
Methicillin-resistant Staphylococcus pseudintermedius (MRSP)

BIOSECURITY
HOSPITAL
PERSONAL PATIENT Clean gross contamination/biofilm
• Staphylococcus pseudintermedius with detergent first then disinfect.
(SP) are normal skin/mucosal flora Routinely wash Isolate MRSP patients.
found on dogs and cats. hands before &
after each patient.
• Methicillin resistance = resistance
to all β-lactam antimicrobials
Use liquid soap
(including β-lactamase inhibitor
or alcohol-based
combinations).
hand sanitiser.
• Emerging opportunistic pathogen Consider in-contact pets carriers. Routine cleaning and disinfection
in Australia – 12% clinical SP all that is required.
Wear gloves when Pets may carry MRSP after
infections MRSP, 8% healthy urban MRSP readily inactivated by
handling patients. clinical resolution.
dogs MRSP carriers. commonly used disinfectants.

• MRSP vs Methicillin-susceptible SP
• No more pathogenic
• No difference in clinical disease.
TREATMENT OPTIONS ZOONOTIC RISK
• Many MRSP carry other resistance Avoid contact with
genes, sometimes extensive drug skin, nose, mouth,
Critical to identify & address Dogs are the natural SP host.
resistance. perineum and faeces
underlying cause. Infection in people is rare,
but possible. of infected dogs.

Warn owners of zoonotic

potential, particularly those
Try topical! with breaches in their skin
MRSP is not resistant to barrier or poor skin integrity
Penicillin antiseptics (eg. chlorhexidine, bleach). (ie. wounds, elderly people).

Amoxycillin
If needed, systemic therapy Minimise contact between infected
based on C&S. dogs, other animals and people. Wash or alcohol-sanitise
Cephalosporins* hands after handling
No dominant susceptibility Exposed bedding and surfaces will
also be contaminated. infected dog.
Carbapenems pattern, often MDR.

Amoxy/clav
For more information and further resources visit

*Except a few anti-MRSA cephalosporins agriculture.vic.gov.au/amr

www.fvas.unimelb.edu.au/vetantibiotics Version 1