PYOMETRA

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Causative agent(s)

Bacteria: Escherichia coli (Most common), Staphylococcus, Streptococcus, Pseudomonas, Proteus spp.

Other causes: Administration of pregestational compounds to delay or suppress oestrus, administration of oestrogens to mis-mated bitches, and post copulation infections.

Clinical Presentation and Epidemiology

The signs are varied and include lethargy, anorexia, dehydration, polyuria, polydipsia, and vomiting. When the cervix is open, a purulent sanguineous to mucopurulent vulva discharge, often containing blood is seen but when the cervix is closed, there is no discharge, and the large uterus may cause abdominal distention. Signs can progress rapidly to shock and death.

Diagnostic Considerations

Diagnosis is based on history, clinical signs, physical examination, complete blood profile, abdominal radiography, abdominal ultrasonography, and vaginal cytology.

Samples to take include blood for haematology and chemistry, blood culture for MCS in severe cases, urine for urinalysis, vulva discharge for cytology and MCS.

Management and Treatment

In view of the high level of microbial resistance being recorded to most antibiotics, it is of utmost importance to carry out MCS before commencement of antibiotic therapy in cases of pyometra and metritis. The antibiotic most susceptible to the bacteria according to the MCS, should only be used.

First Line Antibiotics: (pending MCS result)

Amoxicillin-clavulanate (10-30mg/kg PO, IM, IV q12hr)

 

Second Line Antibiotics: (Any of these antibiotics can be used depending on the MCS) Ciprofloxacin (5-15mg/kg PO, IV q12h)

Levofloxacin (20mg/kg PO, IV q24hr)

Imipenem (5-10mg/kg IM-Using IM preparation, IV-Slow IV q8hr in dogs; 5-10mg/kg IV q8hr in cats.)

Cefixime (5-12.5mg/kg PO q12hr) Ceftriaxone (20mg/kg IM, IV q12hr),

Erythromycin (10-22mg/kg PO q12hr in dogs; 10-22mg/kg PO, IV q8hr in cats). Meropenem (12-24mg/kg IV, SC q8hr)

 

Adjunct/supportive therapy

Fluid therapy, Ozone therapy. Probiotics