It happens with animals, humans and crops. Sometimes treatment for certain illnesses fail to work as expected, even when the drugs are changed, leading to the patient succumbing to the illness.
This being my first article of 2019, I must share with you my experiences on this important subject because the information could save your animals from potential treatment failures and improve your prosperity this year.
I have many times encountered complaints of ineffective treatment. I have also personally given a course of treatment and have to modify it after realising I was not getting the desired results or the rate of healing was too slow.
When response is very slow from the onset, there is risk of the treatment failing altogether.
As a rule of thumb, the initial treatment should show great improvement in the first 24 hours because the infectious agent or the disease process has been strongly attacked and largely stopped.
Thereafter, the healing rate is normally slower because the damaged tissues take long to heal. I always advise my clients the recovery signs they need to monitor and report within 12 to 24 hours if no appreciable change is observed or if there is further deterioration.
Two week ago, I experienced a case of failed treatment. The farmer in Nairobi told me her dairy goats had been having diarrhoea for about a month. Despite treatment, three had died. The others kept worsening, had poor appetite and continued losing body condition. She feared they would all eventually die.
Upon examining the treatment records, I found the goats had been given Kaolin and sulphonamide-trimethoprim combination once.
Though I had not examined the goats, it was obvious they were unlikely to have recovered from the diarrhoea. I also noticed that the service provider had not given the probable cause of the diarrhoea but had just indicated diagnosis as “diarrhoea”.
Unfortunately, like headache, vomiting, sweating and fainting, among other observations, diarrhoea is only a sign of an underlying disease or disease process and it is not the real disease.
I always advise farmers that no veterinary service provider should ever give them an observation the farmer can make to be a diagnosis. After all, in the case of the goat farmer, she had called the service provider because she had seen the goats had diarrhoea.
I diagnosed coccidiosis with bacterial diarrhoea and treated the disease using anti-coccidia medicine and two types of antibiotics.
INCOMPETENCE OF THE SERVICE PROVIDER
I injected one antibiotic; then gave the other one by mouth. I also dewormed the goats since the last time they had been offered dewormers was six months. Goats should be dewormed at least every three months.
I instructed the farmer to give the antibiotic and anti-coccidia medicine for five days. I also asked her to inform me if the goats would have improved by afternoon of the following day.
That is, they should have increased appetite, be livelier and reduced the frequency of diarrhoea by producing thickening droppings.
The farmer happily called me at 4pm the following day to report the diarrhoea had actually stopped and the goats had eaten about half their normal ration.
I advised her to complete the treatment course. The goats have since fully recovered and the owner called me last week to ask why the initial treatment had failed.
Majority of treatments are successful. There are, however, a myriad of reasons why treatment fails. The most common cause is incompetence of the service provider.
To start with, in veterinary medicine, the number of animal species and number of diseases a student has to study in training at certificate, diploma and degree levels is so many that it is not possible for the graduate to have encountered all the disease possibilities by the time of graduation.
To complicate matters further, there are very many drugs that the practitioner must study their use in different species for different diseases and how they can adversely interact with each other.
To be a good animal health service provider, new graduates should always associate themselves with senior colleagues whom they can consult in case of difficulties.
As for veterinary paraprofessionals, called paravets, they must permanently associate with an experienced doctor to consult in case of difficult cases or those beyond their scope. The Veterinary Surgeons and Veterinary Paraprofessionals Act of Kenya actually requires them to do so.
Incompetence of a service provider may result in inaccurate diagnosis, poor choice of treatment plan or bad choice of drugs and drug administration. The bad choice of drugs could even mean using poor quality products.
In the goat case, the problem was inaccurate diagnosis, poor choice of drugs and inadequate knowledge of drug interactions.
Kaolin is an adsorbent that coats the intestines to prevent further damage and absorption of toxins. On the other hand, it absorbs the medicine given and reduces its availability to fight the germs causing diarrhoea. Kaolin should be administered at least two hours after other drugs. To make matters worse in this case, the antibiotic that was given does not kill coccidia in goats.
POOR POST-TREATMENT CARE
Resistance of infectious agents to drugs may also cause treatment failure. In Kenya, for instance, many mastitis-causing bacteria are resistant to penicillin and, therefore, such treatment is likely to fail. A good service provider must be well-updated on the state of antimicrobial resistance in their area of practice.
Sick animals in advanced stages of a disease may fail to respond favourably even with correct treatment because body tissues and systems may be too damaged to recover.
Early reporting of illnesses is very important. I have had five cases of milk fever reported to me a day after they had occurred. My treatment failed.
Another cause is poor post-treatment care. Animals under treatment should be fed a balanced, adequate diet and lots of water to enhance the healing process, unless restricted by the doctor.
A clean, warm and draft-free shelter with soft-bedding should also be provided to minimise stress.
The farmer and the animal health service provider must execute the full course of treatment as long as progressive recovery is observed.
Otherwise, the service provider should keep adjusting the plan of treatment until the desired response is obtained. If the treatment is prematurely stopped, some of the disease-causing agents may survive and restart the disease. They may even become resistant to the drugs.
Finally, treatment failure may result from disease recurrence due to environmental or biological factors.
If the disease-causative agent is in the environment and is not identified and removed, treatment may appear to have failed. In this case, the disease may recur as soon as the treatment course is completed.
Biological factors come into play when the disease agent is in the animal’s body or when the animal’s body produces chemicals that interfere with the drug action on the disease agent. A pus-filled cavity in the liver or lungs may protect the bacteria from the drug circulating in the blood.
Once the blood drug levels wane, the bacteria will emerge from the cavity and the disease being treated will recur.
Such cavities may also rapture and damage vital structures such as blood vessels and the treatment will be seen to have failed. I have had such cases with abscesses and tapeworm cysts in the liver and lungs of cattle.