Читать книгу Infectious Disease Management in Animal Shelters - Группа авторов - Страница 104

A final core diagnostic tool with which the shelter practitioner should be proficient is the appropriate use of response to treatment to make a presumptive diagnosis. Response to treatment refers to the empirical prescribing of medications or courses of treatment without confirmation of a diagnosis. Rather, a presumptive diagnosis and treatment are based on historical information and physical examination findings, and the diagnosis is presumed to be correct based on the resolution of the clinical problem. Careful utilization of this technique can provide benefits of immediately addressing existing conditions, minimizing opportunities for infectious disease transmission, and, when the presumptive diagnosis is correct, reducing the time and costs associated with obtaining a definitive diagnosis before initiating treatment. However, there are significant downsides to relying on this technique on a routine basis. When used indiscriminately, reliance on response to treatment can result in misdiagnosis; misuse of pharmaceuticals; prolonged time to diagnosis, treatment, and disease resolution; and an overall ineffective use of resources. Utilizing response to treatment as a basic diagnostic tool may be considered in the following circumstances:

 An urgent threat to animal health or welfare

 Severe medical resource limitations

 Diagnostic testing options are limited in accuracy, availability, or practical turnaround time

 Inability to obtain veterinary care (e.g. after‐hours or irregular access to veterinary support)

 Treatment is likely to provide substantial benefit but unlikely to cause harm.

In each case, a response to treatment protocol should be developed under the direction of a veterinarian familiar with the shelter population, community resources, and limitations. Model protocols include the following components:

 Re‐evaluation of patient status after starting treatment and regularly thereafter

 The appropriate use of first‐line antimicrobials (e.g. amoxicillin vs. amoxicillin and clavulanic acid) (See Chapter 7 for more information.)

 Defined end‐points after which definitive diagnostics or a revised treatment plan will be pursued

 Periodic review of SOPs including evaluation of antimicrobial choices based on definitively diagnosed conditions.

Common shelter scenarios in which response to treatment may be beneficial include mild upper respiratory infections (URIs), mild enteritis, first‐time urinary tract infections (UTIs), minor wounds, and superficial pyoderma.