Internet advice: The good, the bad and the ugly
The internet can be a strange place at times. You can find great, reputable and unbiased information right next to complete garbage. Often, the garbage is pretty apparent, but sometimes it's dressed up well or mixed in with some good information. That's a problem with veterinary advice and information sites.
Among the creative myths identified in a couple of minutes of searching:
- Metronidazole is a proven treatment for parvovirus: No. Metronidazole is an antibiotic that doesn't have any effect on viruses. Antibiotics are sometimes used in the treatment of parvovirus, but they are drugs that are used to prevent or treat problems caused by bacteria from the gut entering the bloodstream as a result of the intestinal tract disease. Metronidazole won't do that.
- MRSA is a virus: You can't make much more of a basic mistake than confusing a virus and a bacterium. Anyone who says this when purportedly writing medical advice is completely clueless.
- If your dog gets an MRSA infection, your veterinarian will likely prescribe vancomycin: Only in extreme circumstances (if ever) should this ever happen. For more information on vancomycin and its use in treating animal and human infections, see our archives. (This gem is on a page that says it's information from infectious disease specialists).
-MRSA in dogs can easily become resistant to vancomycin so linezolid may be required: Fortunately, vancomycin resistance is extremely rare, having been found only a few times in people, in specific circumstances. It's never been found in a dog. Hopefully it will stay that way. (This site didn't even spell vancomycin correctly.)
- Cats can easily get a urinary tract infection if their litterboxes are not cleaned: No. There is no evidence of this and no reason to think it's an issue. Poor litterbox maintenance can lead to urinating outside of the litterbox or other problems like idiopathic cystitis, but not infection.
- In order to have a very healthy dog, it is often required to supplement your pet's diet to provide a high amount of probiotics: Nope. Certain probiotics might be useful in certain animals in certain situations, but we have no proof of this in dogs and cats, and they are certainly not needed for all animals.
There's no way to guarantee that a website is reputable or that the writers are knowledgeable, but here are some things I consider when scrutinizing information on the internet:
- Who set up the website? Is it clear who's in charge?
- Who wrote the information? Is it someone with actual credentials? For veterinary medical advice, is it a veterinarian? If it's a veterinarian, is it a specialist? If it's not a veterinarian, what expertise does the person have? Some people without veterinary degrees have expertise in some fields, but try to determine whether they truly have the qualifications to give advice on a particular topic. That's harder to do these days given the proliferation of mail-order "PhD" degrees, something that's not uncommonly encountered in unqualified people making poor veterinary recommendations.
- Why is the website there? Is it an educational site or is it there to make money? Commercial sites aren't necessarily bad but you have to consider any conflicts of interest or ulterior motives. If there is an article about something, and the last sentence tries to sell you a product to fix that problem, be careful.
- Does the information make sense and is it consistent with other websites? You can probably find a site somewhere to support any notion that you have, but does it really make sense?
- Is the site relevant to your geographical area? This is particularly important for infectious diseases since they can vary greatly between regions. A disease may be a big problem in one area, and a website might provide excellent advice... but only for that area. It may be completely irrelevant or inappropriate for other regions.
- Can they spell? The odd typo probably isn't a major issue (I do it myself). However, rampant and blatant abuse of the English language and an inability to spell important words properly should be red flag.
Searching the internet for pet health information is certainly not a bad thing to do. But, you have to critically assess what you read and remember that it's not always right. Use the internet as a resource but make sure that it's to supplement advice from your veterinarian, not to replace it.
Big gun antibiotics in pets
Antibiotic resistant bacteria are a huge problem in human medicine, and they're an increasing problem in veterinary medicine. In pets, we are seeing dramatic increases in multidrug-resistant bacteria, some as a result of transmission from humans and some that are developing in animals. Regardless of the source, infections caused by resistant bacteria are a major problem. As resistance increases and we have fewer and fewer treatment options for some infections, the potential need to use certain antibiotics that are important for serious infections in humans ("big-gun" antibiotics) increases. This is a very contentious issue because concerns have been raised over the use of these drugs in animals and the potential impact on humans.
There are two extremes to the argument:
- These are critically important drugs in human medicine and they should never be used in animals.
- These drugs are used thousands of times a day in people and very rarely in animals, so the impact of periodic use in animals should be minimal, and failure to use them would result in animal deaths from potentially treatable infections.
I take the middle ground here. I am very concerned about antibiotic resistance (in pets and people) and I want to make sure that what I do does not have a negative impact on public health. I also realize that very rare and appropriate use of these drugs will realistically be unlikely to have any negative impact on public health, and that withholding treatment could cause animal suffering, death and prolonged infections that could be transmitted to their owners. The key, to me, is ensuring that use of these drugs is truly very rare and appropriate. At the Ontario Veterinary College, we have strict guidelines for use of "big-gun" antibiotics to try to ensure that there are used rarely and properly. For example, vancomycin can be used, but only when:
- An infection is present and it is known that the bacterium is resistant to all other options and susceptible to vancomycin.
- Local antibiotic administration or other types of alternative treatment are not options.
- It's a serious infection that needs to be treated but it is treatable (i.e. no throwing a big gun drug at a patient that clearly has a terminal disease and does not have a realistic chance of surviving).
- Approval is obtained from the Chief of Infection Control (i.e. me).
With this approach, we've only had 1 case where vancomycin was used, and that was in 2001. That's a pretty good record for a busy referral centre with a tertiary care caseload that sees "the worst of the worst." There have been a few instances when vancomycin was requested but with discussion and review of the case, better alternatives were identified. I'm certain that these guidelines have reduced the use of vancomycin and increased awareness of the problem, but have had no negative impact on patient care.
Antimicrobial resistance isn't going away. We can control it but not eradicate it. Scrutiny of antibiotic use in veterinary medicine is also not going to go away, and in some ways, that's a good thing. It should provide impetus to make sure that we improve how we use drugs, from the big guns down to our day-to-day drugs. Realistically, it's the regular use (appropriate use, overuse and misuse) of less exotic antibiotics that is having a bigger impact on antimicrobial resistance, and we need to pay attention to that as much as to the high-profile drugs.
MRSA and vancomycin in dogs
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Methicillin-resistant Staphylococcus aureus (MRSA) infections are an emerging problem in dogs and cats. They're a huge problem in human medicine, and the emergence of MRSA in pets can be directly traced to the spread of MRSA in people.
A big problem with MRSA infections is that they can be difficult to treat because they can be resistant to many antibiotics (not just methicillin). This complicates treatment, but it's important to remember that most MRSA infections are treatable.
An important concern with MRSA is that it may lead to unnecessary veterinary use of drugs that are critically important for treatment of life-threatening infection in humans. Vancomycin is an antibiotic that is occasionally used to treat MRSA infections in dogs, although I've never had to use it. I stumbled across a supposed "veterinary information website" today that stated vancomycin is the main treatment for MRSA in dogs. It quickly became clear the authors had no clue about the topic, because they kept calling MRSA a virus (always scrutinize the source of information, especially on the internet). Information like this doesn't help with prudent use of drugs like vancomycin. It's important for pet owners and veterinarians alike to realize that these "big-gun" antibiotics (such as vancomycin) are rarely needed for MRSA infections in dogs and cats. There are almost always other, and usually better, options.
Vancomycin is also sometimes inappropriately used in animals, which can lead to worsening of infection. For example, if vancomycin is mistakenly given orally, the drug is not absorbed from the intestinal tract and therefore has no chance of fighting infection elsewhere on the body.
In general, MRSA infections are quite treatable. Survival rates tend to be high and, with proper treatment, should be no lower for MRSA infections versus infections caused by susceptible strains of S. aureus. A comparison of MRSA versus susceptible S. aureus infections presented last year reported no difference in survival rates, with an overall survival rate of >80%. The key is diagnosing the infection early and getting started on the right treatment. That means getting cultures done earlier, rather than later.
While increasing antibiotic resistance may lead to more need for "big-gun" antibiotics in some cases, we need to act prudently and restrict their use to situations in which they are absolutely required. Use in animals needs to be very prudent to avoid contributing to antibiotic resistance in people. Inappropriate use in animals could lead to more calls to restrict veterinary access to various drugs, which could threaten treatment of other animals with other types of infections.
Don't confuse "big-gun" antibiotics with the best treatment.
More information about MRSA can be found on the Worms & Germs Resources page.
