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When possible, in patients with kidney disease, avoid drugs that have a narrow margin of safety and undergo significant renal elimination (eg, fluoroquinolones in cats, aminoglycosides) and then choose alternative drugs (based on susceptibility results) that undergo hepatic elimination or those with a wide margin of safety. The International Society for Companion Animal Infectious Diseases (ISCAID) Antimicrobial Working Group Guidelines for Treatment of Urinary Tract Infections are available at iscaid.org/wp-content/uploads/2013/10/Urinary- guidelines.pdf . The lack of data and the limitations in well-designed studies prevent complete evidence-based guidelines from being described for treatment of urinary tract infection (UTI). This article presents an approachable and logical process for treating UTI; however, it too lacks clinical validation. The usefulness of urine drug concentrations has been debated, but several textbooks and peer-reviewed manuscripts suggest that these concentrations can play a role in creating a valid antimicrobial drug prescription. In addition, while the clinical success of drug therapy cannot be predicted on urine drug concentration alone, in the absence of individual patient drug therapeutic monitoring, glomerular filtration rate testing, and urine drug bactericidal assessment data, there are few hard facts on which to base therapy. This article focuses on relevant topics in drug pharmacokinetics/pharmacodynamics, urine susceptibility testing, and educated drug therapy, and numerous holes in our understanding prevent these topics from being without question or debate. However, I hope this article helps increase the understanding of drug pharmacology, where it pertains to UTI, to the best of our understanding. Uropathogenic E coli promote a paracellular urothelial barrier defect characterized by altered tight junction integrity, epithelial cell sloughing and cytokine release. Antimicrobial use guidelines for treatment of urinary tract disease in dogs and cats: Antimicrobial guidelines working group of the international society for companion animal infectious diseases. Antimicrobial susceptibility patterns in urinary tract infections in dogs (2010-2013). Vet Clin North Am Small Anim Pract 2006; 36(5):1003-1047-vi. Effects of processing delay, temperature, and transport tube type on results of quantitative bacterial culture of canine urine. UTIs in small animal patients: Part 2: Diagnosis, treatment, and complications. Therapeutic strategies involving antimicrobial treatment of the canine urinary tract. The pharmacokinetic-pharmacodynamic approach to a rational dosage regimen for antibiotics. Efficacy and tolerability of once-daily cephalexin in canine superficial pyoderma: An open controlled study. Correlation between pharmacokinetic/pharmacodynamic parameters and efficacy for antibiotics in the treatment of urinary tract infection. Pharmacokinetic and pharmacodynamic issues in the treatment of bacterial infectious diseases. Eur J Clin Microbiol Infect Dis 2004; 23(4):271-288. Mutant-prevention concentration and mechanism of resistance in clinical isolates and enrofloxacin/marbofloxacin-selected mutants of Escherichia coli of canine origin. Clinical pharmacology of the fluoroquinolones: Studies in human dynamic/kinetic models. Appropriate antibiotic treatment of genitourinary infections in hospitalized patients. Short- and long-term cure rates of short-duration trimethoprim-sulfamethoxazole treatment in female dogs with uncomplicated bacterial cystitis. Evaluation of the efficacy and safety of high dose short duration enrofloxacin treatment regimen for uncomplicated urinary tract infections in dogs. Effect of antibiotic treatment in canine and feline urinary tract infections: A systematic review. What are the best practices for antibiotic use in feline upper respiratory tract disease? Diagnosis and treatment can be simplified by assessing whether the disease is in the acute or chronic state. The following article is the first in a three-part series summarizing information fromthe new guidelines on the use of antimicrobials in dogs and cats with respiratory tract disease. These recommendations were developed by the Antimicrobial Guidelines Working Group of the International Society for Companion Animal Infectious Diseases. Feline upper respiratory tract disease (URTD) can present with clinical signs that include serous or mucopurulent nasal discharge, sneezing, epistaxis and conjunctivitis. The most common infectious causes of acute URTD in cats are feline herpesvirus 1 (FHV-1) or feline calicivirus (FCV), which can often be complicated by secondary bacterial infections caused by a variety of organisms. It is these secondary bacterial pathogens that are often the focus of treatment in cats with URTD. A thorough patient history should be obtained with particular attention paid to vaccination status; exposure to other cats; recent shelter, veterinary clinic or kennel exposure; recent environmental stressors; and contact with foreign bodies (such as house plants or grasses). Thoracic auscultation is performed to determine the presence of concurrent lower airway disease, and screening for feline leukemia and feline immunodeficiency viruses is recommended, given their detrimental impact on feline immunity. The diagnosis and treatment of URTD in cats can be further simplified by categorizing the disease into acute or chronic form. The clinical signs are considered acute if they have been present for 10 or fewer days. While nasal cytology and bacterial cultures are often performed, they are not recommended by the guideline authors because the results are difficult to interpret due to the presence of commensal organisms or false negative results. The use of polymerase chain reaction (PCR) assays for Mycoplasma species, Chlamydia species, FHV-1 and FCV can also prove problematic because the diseases can be isolated from both healthy and diseased cats. Furthermore, recent vaccination can confound interpretation. In cats with acute URTD, the working group recommends no antimicrobial treatment be initiated during a 10-day observation period, unless the patient is exhibiting fever, lethargy or anorexia along with mucopurulent nasal discharge. If antimicrobial therapy is indicated, the working group recommends empirical administration of doxycycline (5 mg/kg orally every 12 hours, or 10 mg/kg orally every 24 hours) for seven to 10 days. Doxycycline is recommended because of its broad spectrum of activity against common feline nasal pathogens and because it is well-tolerated by cats. To counteract the potential for esophageal stricture, tablets and capsules should be given coated with a lubricating substance, followed by water; administered in a pill treat, along with at least 2 ml of a liquid; or followed by a small amount of food. If Chlamydophila felis or Mycoplasma species are not highly suspected, amoxicillin can be an alternate choice (22 mg/kg orally every 12 hours). The guideline authors thought that there is not enough evidence to support the use of cefovecin in this setting. For cats with acute disease that does not respond to antimicrobial therapy within 10 days or cats with recurrent infections, a more extensive diagnostic workup is recommended. Administration of an alternate antibiotic with a different antibacterial spectrum should be considered only if owners decline further workup and a bacterial cause is still suspected. Cats with URTD that has been present for more than 10 days are considered to have chronic disease. For these patients, the guideline authors recommend a more extensive workup and referral to a specialist for advanced imaging or rhinoscopy and biopsy to look for possible nonbacterial issues (e.g. Antimicrobial selection and use in these patients should be guided by bacterial culture and antimicrobial sensitivity testing of nasal tissue samples. The empiric use of fluoroquinolones and third-generation cephalosporins should be avoided because of the emergence of bacterial resistance. The guideline authors caution, however, that nasal cultures can be difficult to interpret since many types of bacteria can be cultured from the nose of a healthy cat as well as an ill cat. Use of azithromycin should be reserved for patients in which chlamydiosis is not considered likely and when other drugs (e.g. doxycycline and amoxicillin) are not viable options. Although the optimal duration of therapy is unknown, the work group recommends continuing treatment for a minimum of seven days and for at least one week past clinical resolution or disease plateau. For cats with chronic, recurrent signs of upper respiratory tract disease, the guideline authors recommend use of the previously effective antimicrobial, but avoid repeated regular empirical treatment. If treatment is ineffective after 48 hours of therapy, a switch to an antimicrobial in a different drug class should be considered. If therapy is still ineffective, bacterial culture and antimicrobial sensitivity testing is recommended. Doxycycline: 5 mg/kg PO every 12 hours, or 10 mg/kg PO every 24 hours. Potential treatment for Lyme disease kills bacteria that may cause lingering symptoms, study finds. Screening thousands of drugs, Stanford scientists determined that in mice, azlocillin, an antibiotic approved by the Food and Drug Administration, eliminated the bacteria that causes Lyme disease. Deer ticks are vectors of Borrelia burgdorferi , the bacteria that causes Lyme disease. For decades, the routine treatment for Lyme disease has been standard antibiotics, which usually kill off the infection. But for up to 20% of people with the tick-borne illness, the antibiotics don’t work, and lingering symptoms of muscle pain, fatigue and cognitive impairment can continue for years — sometimes indefinitely. A new Stanford Medicine study in lab dishes and mice provides evidence that the drug azlocillin completely kills off the disease-causing bacteria Borrelia burgdorferi at the onset of the illness. The study suggests it could also be effective for treating patients infected with drug-tolerant bacteria that may cause lingering symptoms. “This compound is just amazing,” said Jayakumar Rajadas, PhD, assistant professor of medicine and director of the Biomaterials and Advanced Drug Delivery Laboratory at the Stanford School of Medicine. “It clears the infection without a lot of side effects.
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