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Urinary tract disease is a common clinical presentation in dogs and cats, and a common reason for antimicrobial prescription. This document is a revision and expansion on the 2011 Antimicrobial Use Guidelines for Treatment of Urinary Tract Disease in Dogs and Cats, providing recommendations for diagnosis and management of sporadic bacterial cystitis, recurrent bacterial cystitis, pyelonephritis, bacterial prostatitis, and subclinical bacteriuria. Issues pertaining to urinary catheters, medical dissolution of uroliths and prophylaxis for urological procedures are also addressed., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Respiratory tract disease can be associated with primary or secondary bacterial infections in dogs and cats and is a common reason for use and potential misuse, improper use, and overuse of antimicrobials. There is a lack of comprehensive treatment guidelines such as those that are available for human medicine. Accordingly, the International Society for Companion Animal Infectious Diseases convened a Working Group of clinical microbiologists, pharmacologists, and internists to share experiences, examine scientific data, review clinical trials, and develop these guidelines to assist veterinarians in making antimicrobial treatment choices for use in the management of bacterial respiratory diseases in dogs and cats., (Copyright © 2017 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.)

An internet-based survey was conducted to determine common strategies for control of feline upper respiratory infections (URI) in animal shelters. Two hundred and fifty-eight North American shelters responded, representing a spectrum of 57% private non-profit, 27% municipal and 16% combined private non-profit-municipal shelters. All but nine shelters reported having a regular relationship with a veterinarian, 53% had full-time veterinarians and 62% indicated full-time (non-veterinarian) medical staff. However, in 35% of facilities, non-medical shelter management staff determined what medication an individual cat could receive, with 5% of facilities making that decision without indicating the involvement of a veterinarian or technician. Ninety-one percent of shelters had an isolation area for clinically ill cats. The most commonly used antimicrobial was doxycycline (52%), followed by amoxicillin/clavulanic acid (33%). Shelters are using a wide range of prevention measures and therapeutics, leaving room for studying URI in different settings to improve understanding of optimal protocols.

Percent resistance and minimum inhibitory concentrations (MIC) were described for canine (n = 301) and feline (n = 75) pathogenic Escherichia coli (E. coli) isolates solicited during May 2005 to Sep 2005 from the Clinical Pharmacology Laboratory at Auburn University (n = 165) or commercial diagnostic laboratories ([CDL]; n = 211) from four regions in the USA. Drugs tested were amoxicillin (AMX), amoxicillin trihydrate/clavulanate potassium (AMXC), cefpodoxime (CFP), doxycycline (DXY), enrofloxacin (ENR), gentamicin (GM) and trimethoprim-sulfamethoxazole (TMS). Urinary isolates were most common (n = 174). Percent resistance was greatest for isolates from the respiratory tract, urine, and skin compared with the ear. Resistance was also greatest for samples sent from the south and central states compared with the western states (P ≤ 0.001). Percent resistance by drug was AMX (46 ± 2.6%) > AMXC (37 ± 2.5%) > CFP (21.8 ± 2%) = DXY (22 ± 2.1%) = ENR (20 ± 2.1%) = TMS (19 ± 2%) > GM (12 ± 1.7%). There was a significant difference in resistance between the different antibiotic drugs (P ≤ 0.001). Population MIC distributions were bimodal, and MICs were highest in samples from the southern states (P ≤ 0.001). E. coli resistance may limit its empirical treatment. For susceptible isolates, AMX and AMXC may be least effective and TMS most effective.

Background: Antimicrobial resistance is increasing among Escherichia coli isolates associated with spontaneous infection in dogs and cats., Objectives: To describe E. coli resistance phenotypes and clonal relatedness and their regional prevalence., Animals: Isolates of E. coli (n = 376) collected from dogs and cats in the United States between May and September 2005., Methods: Isolates submitted from the South, West, Northeast, and Midwest regions of the United States were prospectively studied. Phenotype was based on E-test susceptibility to 7 antimicrobials. Isolates were classified as no (NDR), single (SDR), or multidrug resistance (MDR). Clonal relatedness was determined by pulsed-field gel electrophoresis (PFGE)., Results: One hundred and ninety-three (51%) isolates expressed resistance to at least 1 drug, yielding 42 phenotypes. SDR isolates (n = 84; 44%, 8 phenotypes), expressed resistance most commonly to amoxicillin (30%, n = 25) and least commonly to cefpodoxime (1%, n = 1). MDR isolates (n = 109; 56%, 31 phenotypes) were resistant to amoxicillin (96%, n = 105), amoxicillin-clavulanate (85%, n = 93), and enrofloxacin (64%, n = 70); 18% (n = 20) were resistant to all drugs tested. The frequency of MDR did not differ regionally (P = .066). MDR minimum inhibitory concentrations (MICs) were 6-fold higher than SDR MICs (P < .0001). Dendrograms of 91 isolates representing 25 phenotypes revealed 62 different PFGE profiles., Conclusions and Clinical Importance: E. coli strains spontaneously infecting dogs and cats are genetically and phenotypically diverse. Given the current prevalence of MDR among clinical isolates of E. coli in United States, implementation of a robust surveillance program is warranted.

A 1-year-old castrated male cat was evaluated because of alopecia of approximately 4 to 5 months' duration as well as hyperactive behavior. It was later determined that the cat was ingesting valproic acid by eating food to which it had been added for daily administration to a child in the household who had cerebral palsy. The clinical signs slowly resolved after the source of valproic acid was removed. This emphasizes the sensitivity of cats to drugs that are commonly used in humans. It was not determined whether the clinical signs that developed in this cat were caused by an adverse reaction or from toxicosis as a result of prolonged hepatic elimination of valproic acid, which requires glucuronide metabolism for disposition. However, the cat recovered completely following removal of the drug and prevention of further exposure. This report emphasizes the importance of obtaining a careful and complete history from the owner regarding an animal and its environment. In the cat of this report, the owner had not considered the impact of the presence of the drug in the child's food.

Treatment of diseases affecting the gastrointestinal tract often focuses on resolution of clinical pharmacology of drugs used to treat the gastrointestinal tract, starting with appetite stimulants, followed by emetics and antiemetics, and antidiarrheals. Prokinetic agents and drugs used for the treatment of gastroduodenal ulceration are also discussed. Discussions include mechanisms of drug action, disposition of drugs as it relates to therapeutic use, drug interactions, adverse drug reactions, and clinical indications.

A 4-year-old cat was referred for treatment of a large, open wound. The wound had been lavaged twice, approximately 12 hours apart, with approximately 10 ml of 5% gentamicin solution prior to referral, because of infection caused by Pseudomonas spp. Results of initial serum biochemical analyses were within reference ranges, and the cat was anesthetized for surgical wound debridement and closure. Two days later, the cat was azotemic (SUN concentration, 113 mg/dl; serum creatinine, concentration, 9.8 mg/dl) and had a urine specific gravity of 1.008. Granular casts were seen in the urine. The azotemia became more severe over the next 2 1/4 hours, despite treatment for acute renal failure, and the cat was euthanatized. Severe acute proximal tubular necrosis, consistent with gentamicin-induced nephrotoxicosis, was diagnosed histologically. Retrospectively, serum samples obtained for biochemical analyses were assayed for gentamicin concentration. Serum concentration of gentamicin 8 hours after topical lavage was 58.07 micrograms/ml. This was approximately 6 times greater than the desired peak concentration for gentamicin and suggested that gentamicin had been absorbed systemically following topical application.

Treatment of small animal respiratory diseases tends to target bronchodilators. Although this is not inappropriate, recent advances in the understanding of respiratory diseases have underscored the importance of inflammatory mediators in the pathophysiology of respiratory diseases. Drug therapy of the respiratory tract in small animals is most successful when it is based on a knowledge of normal physiology and disease pathophysiology of respiratory tract diseases.

Twenty-five animals (21 dogs and 4 cats) in which hepatobiliary scintigraphy (HBS) was performed between 1982 and 1989 were included in a retrospective study to determine the utility of HBS for diagnosis of extrahepatic biliary obstruction. Final diagnoses, which were based on liver biopsy results and surgical findings in all animals, were hepatocellular disease alone (n = 17), hepatocellular disease and extrahepatic biliary obstruction (n = 7), and normal liver (n = 1). Hepatobiliary scintigraphy was performed by use of 99mTc-diisopropyl iminodiacetic acid in all cases. All 7 cases of extrahepatic biliary obstruction were confirmed at surgery. In animals with biliary obstruction, HBS failed to demonstrate radiolabel within either the gallbladder or intestine at any time. Using nonvisualization of the intestine by 180 minutes as the scintigraphic criterion for diagnosis of biliary obstruction, sensitivity was 83% and specificity was 94% in this series. Hepatobiliary scintigraphy was concluded to be an accurate indicator of extrahepatic biliary obstruction in this group of animals. High serum bilirubin concentration at the time HBS was performed did not appear to reduce the diagnostic usefulness of the scintigraphic findings.

The goal of this series of articles has been to provide a comprehensive review of the literature regarding recommended dosing regimens, therapeutic indications and contraindications, and potential side effects of drugs used in cats. In this fourth and last article, the available information regarding dosage regimens in cats has been consolidated in tabular form to facilitate an effective and rational approach to the pharmacologic prevention and treatment of a variety of feline medical disorders.

Successful antimicrobial therapy for anaerobic infections is often difficult because selection of the wrong antimicrobial drug, the presence of mixed infections, the effect of environmental conditions on antimicrobial activity, and the development of bacterial resistance contribute to therapeutic failure. Drugs that are used for the treatment of anaerobic infections include the beta-lactam antibiotics (ie, penicillins, the carbampenams, and the cephalosporins), chloramphenicol, clindamycin, metronidazole, and vancomycin. The clinical pharmacology and bacterial resistance patterns of each of these drugs determines which should be used in specific clinical situations. The penicillins remain the drug of choice for most anaerobic infections. Piperacillin, cefoxitin, chloramphenicol, clindamycin, and metronidazole are the most effective antimicrobials for the treatment of resistant Bacteroides spp. Drugs that are effective against both aerobic and anaerobic organisms, and thus are indicated as sole drugs for the treatment of mixed infections, include piperacillin, imipenem, cefoxitin and in selected instances, chloramphenicol. Drugs that may need to be combined with antimicrobials effective against gram-negative aerobes are clindamycin, narrow spectrum penicillins, and metronidazole.

The third article of this 4-part series discusses drug therapy in cats by therapeutic category. Specifically, the use of drugs to control infections, pain, fever, inflammation, cancer, and selected parasites is described. In addition, the use of hormonally related drugs and selected miscellaneous drugs in cats is addressed. Drugs emphasized are those for which use in cats is frequently associated with adverse reactions or drugs for which use is limited to illnesses that tend to be unique in cats.

In the second part of this 4-part series, drug therapy in cats is discussed by use of a systems approach. Specifically, drugs that can be used safely for treatment of disorders affecting the feline gastrointestinal, central nervous, respiratory, cardiovascular, and urogenital systems are described. Many drugs that are used in dogs can be safely used in cats according to the same or similar dosing regimens. Several drugs that have traditionally been considered inappropriate (eg, morphine derivatives, primidone) can probably also be used, if cautiously, in cats. In contrast, use of several drugs that are safely used in other species should be avoided in cats (eg, selected emetics and antiemetics, phosphate salt enemas, and selected urinary antiseptics). Cats are more sensitive than dogs to the adverse side effects of a variety of drugs (eg, aspirin, digoxin, selected antiarrhythmics), and extra precautions must be taken when these drugs are used in cats. Finally, several drugs are used for the treatment of illnesses that tend to be unique to cats (eg, taurine and calcium-channel blockers in selected feline cardiovascular disorders).

This is the first of a 4-part series concerning drug therapy in cats. In this article, factors that may increase the incidence of type-A adverse drug reactions in cats are discussed. Factors related to species and age differences, drug interactions, and the effects of disease are emphasized. Those that tend to be unique to cats, such as species-induced differences in drug disposition, are described in detail when sufficient information was available from the literature. General recommendations regarding drug administration are made, which will facilitate the implementation of rational drug therapy in cats, thus reducing the incidence of adverse reactions.