antibiotic dosage? and related qns

[Beckysmom]

In re post surgical stage, entropion, neutering and rear dew claws. Things were going great and then... not so great. (Not really B.s fault though.) an incision opened. started to bleed quite a bit. I stopped it with pressure from my hand. The specific area of problem was one leg this time. And reason was the bandage got soaked, (it has been pouring here, and the road is not paved and there are puddles everywhere making it very difficult to avoid water even for limited 'duty" doing walks. Would though that I had thought to try to put on plastic bags on his legs) and when I called I was told to just go ahead and take off the wet bandage. The moment I did that the leg wound popped open. The other leg also had a wet bandage, which I thus left on and tried to dry with a hair blower, rather than having another pop open.

So I went in to vets with B.--they have just a few hours open on Saturdays. His reg vet not there. Instead a new very young vet. [Who was afraid to examine him even with muzzle on ahead of time--(for those not following this story, he tried to bite a tech between his sedation and his surgery), and who may have offered bad advice in saying to cut off the soaked bandage, but that is another story.]

Anyway she prescribed Amoxicillin, 3 tablets, 400 mg. each according to the bottle label, two times per day for ten days. 6 total each day, I asked? Yes, she said.

1) When I got home, and opened the vial it looked to me like an awful lot, even for a big dog. (Too late when I called back for anyone to still be there) I looked in Merck Vet manual. Looks to me like dose should be 11mg/kg bid for canines. OK Bodhi is 111pounds. A kg is about 2.2 pounds isn't it? So that means B is about 50 kilos. So he should get only about 550mg amoxicillin twice per day? Not 1200mg twice per day as the vet prescribed?

2) I doubt he has any infection right now. My hand was not totally clean, let alone sterile, but I cleaned him with watered down chlorhexidine after he stopped bleeding. And put on a new bandage. I'm not sure I should use any antibiotic at all given doubt about dose until I reach his reg vet who I hope will be there on Monday.
Perhaps a bigger issue for possible infection is the other leg where the original bandage that also got wet is still on. The wetness was from pretty much straight rainwater, quite fresh. But certainly not sterile. I think I got it pretty dry with the blower, but it is hard to tell how it is inside or especially at the gauze.

3) What I was hoping for when I took B in was something along the lines of steri strips to hold him together better. Both for the leg that just popped, and while at it, the castration site which opened up some on first day. The young vet seemed not to have heard of these. Are they not used in vet care? I know the young vet was afraid of him, but I am not. I can put on strips if they are used--and if I can find that Varitone stuff, that might keep him from trying to pull them off from the castration site which is not bandaged. Or I could stick an ecollar on him till things seem to gel back together...

4) Any thoughts / ideas?

I sure hope that eye specialist I saw doesn't turn out to be right after all...
Why do these sorts of things always happen on weekends?:( :(

PS If there IS a question about correct dosage of antibiotic, and my calculation is not flat out wrong as one of you may catch, any suggestions on how to bring this up to the reg vet on Monday? The regular vet is the main vet of this hospital. Bodhi is by chance the first of my pets that has seen him. Becky and Chuck had both seen another young vet there who we all liked but who moved on to another place, and then Becky saw another vet who was there for only a while who I didn't care for. So while I have been going there from time to time for 7 years, the main vet doesn't know me well.

[Judi W]

I doubt that steri strips would hold at all as they are not made for canine skin....... and they will hold a slice, but not a hole closed even on humans. You will probably have to let them granuloma over. It is next to impossible to get a place where the skin has been removed (like closing a circle) to hold stitches anyway and on the foot area I imagine really difficult.

[MARYDVM]

Although there may be no infection now, once a wound opens bacteria will enter and an infection can develop in 1 to 2 days. If you give 1 and 1/2 of the 400mg amoxicillin tablets twice a day that should be sufficient. The dosage level you were given is right for ampicillin, a similar antibiotic. There may have been some confusion.

The trouble with wet bandages is that they tend to chafe and create pressure sores. I would have all your bandaging material handy, and cut off the remaining bandage (even if it feels dry on the surface it usually is damp at skin level) then pat dry the skin and immediately rewrap. Wet bandages can cause a lot of problems it is important to get them off.

[Beckysmom]

I've never had to deal with dew claws before as my previous dogs didn't have any at the point that they arrived in my life. Is it like tails where if they are removed when the dog is just a few days old it all heals more easily? I don't recall any odd areas of scarring on other dog's legs. (incidentally, I found out that I didn't have to worry about B being a purebred tosa and someone showing up to claim him and suing me for altering him because it turns out that though he is otherwise very tosa looking in shape--tho' very rottie looking in coloring, that Tosas, according to a breeder, are born without rear dew claws.)

If he were yours, hypothetically, would you take off the other bandage that got wet and carefully clean and rebandage even if that might pop it open too, or would you leave it on? If relevant I should add that he is currently sleeping again and seems content as is.

[MARYDVM]

A wet bandage is worse than no bandage. If removing the bandage causes bleeding, then the incision was going to open anyway (dehisce) possibly from tension on the sutures or from a low grade infection at the surgical site. If there has been oozing from the incision, the bandage may be stuck to the skin. Wetting it again with warm water should help loosen it so it can be removed without pulling. Then everything has to be completely dried before rebandaging. A wet bandage fosters bacterial growth and is not healthy to keep in contact with the skin. Try walking around in wet socks and see what happens to your feet.

[Beckysmom]

Our post attempts must have crossed each other so that yours did not appear yet when I seemed to ask about bandages after you had just answered it! I thought I was replying to Judi W only. Thanks!

I wonder if the label could be wrong and maybe it is ampicillin rather than amoxicillin. I don't suppose there is an online veterinary PDR with pictures of the standard drugs? I know my human PDR tends only to have pictures and write ups for the newer drugs...the ones that have gone generic get short shrift.

I hate to give him too much--esp if it is possibly going to upset his stomach which seems to be part of how he partly ripped the castration area sutures out. But I also hate to find that the vet was right, but the woman at the check out counter mislabled my bottle, and end up with too little and antibiotic resistance.

Anyway, I'll go change his bandage and then check back just in case you have another reply.

[Beckysmom]

Update:

B now has dry legs. And I gave him 2 apparently Amoxicillin tablets. I couldn't cut them and so went probably high for first dose. unless they are actually ampicillin with a wrong label that is.

Did pop open like the other one. The big guy cried. But he got lots of cheese pieces and cream cheese to hide the med in and now he seems pretty happy and ready to go to sleep again.

Sure don't want to have to do this again. He doesn't try to bite me or growl, but he jumps around something awful. And he tucks his tail in and slinks about and gives me awful looks like as if to say, "couldn't you have just left me to be a street dog?" Or maybe, "why did you do this terrible thing to me? there was nothing wrong with anything but my eyes." or maybe, "was I such a bad dog that I deserved this? I only chewed up a few small items. Surely this punishment is beyond my crime." Yes! I am anthroporpomorphizing!!! More seriously, I don't think he understands that I am trying to help him. I am afraid that the surgery and all might put me in a line of people who have already hurt the poor guy.

[Beckysmom]

I keep thinking who would be more likely to make error: the young vet or the receptionist who put on the label, and as I slept on it, I think it is more likely to be the receptionist. All that would prob. take is reading the vet's writing wrong. And the young vets seem to use the rural vet hospital as stepping stone to something "better"--unless they want to do large animals, but this one doesn't--and so I would think would be more likely to be careful than a receptionist for whom this is probably just a job locally available, but not a vocational calling in life. Anyhow, I am leaning toward three sets of two tablets spread over 24 hour period--at which point the office will be open again and I can get the situation straightened out. If that seems like a bad idea, would you let me know?

My biggest priorities now with Bodhi are not to have an infection and to keep the eyes okay. The eyes are looking great. The rest of him will heal one way or another and if there is a little more or less scar, oh well. But if the eyes get messed up then there is a big problem And at present they look gorgeous. The vet not only fixed the entropion, but did it in a way that shaped the eyes beautifully.

The young vet had said that I could go with no bandage if I wanted or it was easier, given his personality and the weather wituation. And just keep cleaning and drying him if he gets wet again. I have him wrapped right now, but am considering that if he does get wet again, maybe I should go with none for several reasons. First and main one is that in throwing himself about to try to avoid my working on his legs he is more likely to do something to the sutures in his eyelids. I can clean and dry far faster than I can put on bandages. Second is that with big round wounds, if he has gauze on them I would think it likely that the gauze will adhere to the scabbing and so will be difficult to get off when needed without disturbing the healing process. In fact, I think the second leg was already apart under the bandages and gauze had already stuck so that a scab got pulled off when bandage came off and that that is why he cried. (He didn't cry on the first leg.)

All that extraordinary strength and agility he has which is such a Wow when watching him in normal circumstances is certainly difficult when trying to keep him quiet and calm for medical reasons.

[Beckysmom]

reason for the high amt. of antibiotic was to not have to deal with difficult dog having a problem. It has been split into 3 doses to avoid nausea.


He who was not sedated by sedative is sedated from the antibiotic. Go figure. Am being careful in case sedation in this dog equates with loss of bite inhibition.

Meanwhile the heavy rains have stopped and there was sunshine today. We got in a very good walk with all puddles successfully avoided.

One week of confinement over.