Can we compare veterinarian medicine to human medicine?

As I’ve progressed through pharmacy school I have also progressed as a mother of a ferocious little golden retriever puppy. Many of you know he’s all I talk about. As a part of raising him, has come many veterinary visits, medications, and learning the “dog lingo” of treatment. Let’s start from the beginning, we had the Heartgard, Nextgard, and treatment for explosive diarrhea as just a 12 week old pup. Ironically, I had to do my research on these before we learned them in MC610. Before getting a test back for giardia, which costs at least $45 and takes 2-3 business days, they are sending me home with metronidazole, Proviable (dog probiotic), and pro-pectalin (giant horse sized pills that even a 20 lb dog has to take at least 4 of daily. I thought it was very interesting that they were so dead set on sending me home with an antibiotic for my pup before they even knew what he had. It also seemed like a common routine for them to do that, although I trust their judgement as veterinary doctors, it seems opposite of what we preach in antimicrobial stewardship.

The next time we had to go in due to diarrhea and vomiting we had a new on-call vet take care of us. This time she was convinced that he had a fungal infection in his ears (common for golden retrievers because they are sensitive and have a lot of allergies). It was not our primary reason for coming, but she seemed to focus on it. There was no immediate test to see why he had diarrhea, maybe it was a food insensitivity, maybe he picked up something outside, maybe he has giardia again? If he does we won’t know for a few days and then treatment will take almost four months. So we push 400 mL of IV fluid through his back fat along his spin (that is a big needle for a dog) to rehydrate him and wait. This time I walk out with baggy full of metronidazole again, antidiarrheal, antifungal ear cleaner, antifungal ear ointment, anti-nausea, and a probiotic with no specific diagnosis. For that trip we learned that dog health care is expensive and if you could put dogs on your people insurance, it would be such a convenience.

Flash forward to the pup being 10 months and now we have to pull a telemedicine call to the vet to take care of this random skin irritation that popped up. She offers hydralazine for systemic anti itch, prophylactic antibiotic (cefpodoxime), new skin spray, and proviable (dog probiotic since he has a sensitive stomach). So although I was hesitant to take a prophylactic antibiotic she recommended given the pandemic and accessibility to care, “the last thing you need right now is to pay an ER vet visit for an intense skin infection.” I agreed. She’s the one that takes care of hundreds of dogs, right?

So what’s up with all this prescribing? When it isn’t antibiotics for Remy, it is gabapentin at the community pharmacy for seemingly every dog, Ativan for animals, and so on. Should there be more limitations on veterinary medicine? How do we know if humans are abusing the system at sake of their pets?

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