Not using antimicrobials is easier on the cat (no need for pilling or injections), easier on the owner (no need to pill the cat, cheaper), and means there are no risks of adverse drug reactions or promoting antimicrobial resistance.Īnother question that will come up about this case: Did I culture Rumple’s abscess? (Rumple had a soft tissue infection a few years ago, likely also from a bite, but that time he needed antimicrobials.) In most cases, though, cat bite abscesses are discrete abscesses that just need incision and drainage. Sometimes, animals do need antimicrobials if they have an abscess, such as when they have concurrent active tissue infection or systemic disease. It’s easier and quicker to give an antibiotic than to explain to an owner why it’s not being given.More fear of someone complaining that the veterinarian didn’t use antimicrobials if things don’t go well, than concern about adverse effects of antimicrobials (in the individual or the population).Veterinarians thinking the client expects it.Lack of confidence treating without antimicrobials.Lack of education on abscess management.Why is that? There are lots of potential reasons: What percentage of cats in Rumple’s situation would have been treated unnecessarily with an antimicrobial? We also tend to be quick to ascribe good responses to what we did, vs what was going to happen anyway. However, as clinicians, we often feel a need to “do something,” even though that “something” may not be required. If I’d given Rumple antimicrobials when I drained the abscess, one might have thought “ wow, look how well the antibiotics worked – it cleared up right away,” but this shows that they weren’t needed. A few days later, the site has a bit of a scab but is otherwise normal (see last picture below). It stopped draining quickly so he didn’t need any more wound care. (Abscesses can be really rewarding to treat when they drain like that!) I flushed it out quickly (he’d had enough of me at that point), and that was it.
There was a soft spot under a scab that I opened up with a hemostat and we got big gush of pus. Since he was systemically healthy and there was no evidence of a tissue infection beyond the abscess, incision and drainage was all he needed. Clipping around a cat bite abscess in preparation for incision and drainage. More importantly, we have a much more effective treatment: incision and drainage, as illustrated below. The drugs don’t penetrate the abscess well, and the environment inside the abscess can hinder them from working. It wasn’t overly painful, there was no inflammation around the site and he seemed perfectly normal otherwise, all of which is consistent with a localized abscess.Īntimicrobials don’t work well for an abscess. However, a few days ago, I felt a soft fluctuant swelling on his neck, just past his head. We figured he’d tangled with something outside (we occasionally see other cats around here, as well as the usual wildlife). That creates some risks.Ī week or so ago, we noticed a scab on Rumple’s ear and one on his neck. He’s a big suck who spends a lot of time inside, but wouldn’t tolerate being inside 24/7. He was deemed unsuitable for a household, so we got him as a barn cat, but he migrated from the barn to the deck to the garage to being a part time indoor cat afterall (as I write this, he’s stretched out sleeping on my bed). Rumple’s an indoor-outdoor cat that we adopted years ago through Guelph Humane Society’s working cat program. Rumple’s been featured a few times before, and his latest escapade is a great antimicrobial stewardship case. My own animals provide frequent fodder for this blog, both good and bad.
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