Diagnosing And Treating Utis

[turbotaina]

The AMVA posted on their FB page that the International Society of Companion Animal Infectious diseases is in the process of setting forth guidelines for the diagnosis and treatment of urinary tract infections in cats and dogs. One of the studies on which the organization will be basing its guidelines has passed peer review and is awaiting publication. Here it is: Antimicrobial Use Guidelines for the Treatment of Urinary Tract Disease in Dogs and Cats

 

Here's the shorthand:

 

1. Urine should always be collected via cystocentesis (i.e., a needle inserted into the bladder) and not free catch

2. Sediment analyis alone is not sufficient for DX of UTI, but only for the need of further testing. A complete urinalysis and culture & susceptibility should be done in every case.

3. First line drug options:

a. for an uncomplicated UTI, amoxicillin or trimethoprim-sulfonamide

b. for a complicated UTI, guided by c&s, but the above drugs should be considered initially

c. for subclinical bacteria, antimicrobial therapy NOT RECOMMENDED unless there is a high risk of ascending infection. If so, treat per as complicated UTI

d. Pyelonephritis, start with fluoroquinolone, with re-assessment based on c&s testing

 

As someone who has often had to pay a lot of money for clavamox for treating my cat's UTIs, it is interesting to note that this study does not recommend its use as an initial treatment. According to this study, there is no evidence that that clavulanic acid helps: "Amoxicillin/clavulanic acid ...is an acceptable option but is not recommended initially because of the lack of evidence regarding the need for clavulanic acid and the desire to use the narrowest specturm that is possible while maintaining optimal efficiacy..."

Edited July 21, 2011 by turbotaina

[Batmom]

Really great info to have. Thanks for posting!

[MaryJane]

Great information - thanks for posting!

 

IMO, I would still do free catches with my dogs, at least at the beginning, because I have found (in my experience) that the "needle" has a great chance of introducing bacteria.

[Hubcitypam]

I have a girlie here with a UTI. She was put on Keflex for a month (we're almost there) was that not good?

[turbotaina]

It's apparenly not ideal, Pam, depending on which bacterium she has. If you print the PDF of the article, there's a list of different drugs commonly used to treat UTIs along with comments that include limitations. For cephalexin, "...enterococci are resistant. Resistance may be common in enterobacteriaceae in some regions." Assuming she doens't have enterococci, it should do the trick though

[Guest eaglflyt]

Thank you for this information.

[Hubcitypam]

It's apparenly not ideal, Pam, depending on which bacterium she has. If you print the PDF of the article, there's a list of different drugs commonly used to treat UTIs along with comments that include limitations. For cephalexin, "...enterococci are resistant. Resistance may be common in enterobacteriaceae in some regions." Assuming she doens't have enterococci, it should do the trick though

She's stopped peeing in her bed so I think that we're in the clear. Will advise Dr. Josh of the study tho....

[tbhounds]

Interesting about the fact that they recommend a cysto first vs a voided sample. So, how does your vet determine if blood is present in the urine if it is a true uti vs blood from the needle stick??? Hummm

[BootsyCollins]

Thanks for posting this information, Meredith! I will surely forget it completely and be texting you when i'm at the vet in need

[Batmom]

Interesting about the fact that they recommend a cysto first vs a voided sample. So, how does your vet determine if blood is present in the urine if it is a true uti vs blood from the needle stick??? Hummm

 

If it's a UTI you'll have organisms etc. You wouldn't use a cysto if you suspected kidney disease and were looking specifically for blood (or checking to make sure there wasn't any).

 

I suspect they're wanting a cysto because labs prefer it for culture, and because lots of people don't get clean samples. I'm not sure why veterinary labs want cysto while human labs do just fine with free midstream catch. Would assume that preference is based on experience but don't know.

[JJNg]

The AMVA is in the process of setting forth guidelines for the diagnosis and treatment of urinary tract infections in cats and dogs.

What is the source of this information? I didn't think that AVMA typically set guidelines for the treatment of specific conditions. Are the shorthand points listed from the article referenced, or 'inside info' on what is supposed to be included in the AVMA guidelines?

 

From a practical standpoint, I don't think these guidelines are very realistic, and I have a hard time believing that AVMA would set forth guidelines like this. While they may be ideal for an 'ivory tower' setting, they are not practical for the 'front lines' of general practice.

 

For a first time occurrence in a dog showing clinical signs that are classic for a UTI, it is quite typical to just start a course of amoxicillin, and in the majority of cases, this clears up the problem. I always prefer to at least do a urinalysis on a free catch sample, but sometimes this doesn't even happen if the dog has been straining so much that the bladder is completely empty when they come in for their appointment. How are we supposed to get a cystocentesis sample on a large dog with a tiny bladder? Not all clinics have the option to do an ultrasound-guided cysto.

 

There is also the issue of cost and time. Doing a complete urinalysis and culture/sensitivity in every case would easily bring the total cost of the initial visit to over $150-200. Many of my clients would not be able to afford this. Not to mention it taking a minimum of 3-5 days before results on the culture/sensitivity. Are we to delay treatment until results come in? Most clients would not be happy having to watch their dog strain to urinate and have accidents all over the house while we're waiting for results. The dogs that are just started on amoxi when they present (with or without a urinalysis), are often feeling better and back to normal by the time culture/sensitivity results would have come back.

 

I absolutely believe that the additional testing is essential with a recurrence or persistent infection, but I question whether doing it 'by the book' is necessary, or even in the patient's best interest, for a first time occurrence.

[turbotaina]

The AMVA is in the process of setting forth guidelines for the diagnosis and treatment of urinary tract infections in cats and dogs.

What is the source of this information? ....

 

They posted this information on their Facebook page.

 

And yes, the points are based on the article. I'm not a vet and have no "inside knowledge"

 

I think the general idea is to get as sterile a sample as possible, do full testing and use the narrowest spectrum a/b possible to avoid building up a/b resistant strains of bacteria. As stated above, I found it interesting that my vet(s) have prescribed clavamox for my cat's UTI (before any labs had come back) when it appears that amoxy would have done the trick just fine, and at a considerably smaller cost to me. It's worth noting, I'm not one of those people who think that my vet is money-grabbing and charging me a lot for prescriptions; I'm sure my vet prescribed what he thought was the correct option, but it appears that there is no clinical evidence that amoxy wouldn't have done the job just as well as clavamox - something he might not have known.

 

Edit: I went back and looked at the AMVA FB page, and it appears the guidelines are not coming from the AMVA, but from the International Society for Companion Animal Infectious Diseases. Sorry for the confusion there! I'll edit my OP

 

 

American Veterinary Medical Association (AVMA)Attention veterinarians: the International Society for Companion Animal Infectious Diseases has issued Antimicrobial Use Guidelines for Treatment of Urinary Tract Disease in Dogs and Cats. Dr. Weese's blog post provides some background and a link to the pdf of the guidelines.

Edited July 21, 2011 by turbotaina

[JJNg]

Edit: I went back and looked at the AMVA FB page, and it appears the guidelines are not coming from the AMVA, but from the International Society for Companion Animal Infectious Diseases.

Ah, that makes more sense. Is the post on the AVMA's FB Wall? What date was it from? For some reason, I can't seem to find it.

 

The more specialized groups tend to issue guidelines which represent what should be done in an ideal situation. But to make absolute statements with "always" and "should be done in every case" is not realistic and isn't going to happen in actual practice.

 

As stated above, I found it interesting that my vet(s) have prescribed clavamox for my cat's UTI (before any labs had come back) when it appears that amoxy would have done the trick just fine, and at a considerably smaller cost to me.

Cats are a completely different ballgame, regarding urinary tract disease (and many other things ). While most dogs showing signs consistent with a UTI really do have bacterial infections, the opposite is true of cats. The majority of cats showing the same signs don't actually have infections, just inflammation of the lining of the bladder. This condition is very similar to idiopathic cystitis in women, and is called by a number of names in cats - feline idiopathic cystitis (FIC), feline urologic syndrome (FUS), feline lower urinary tract disease (FLUTD).

 

I would actually agree with guidelines #1 and #2 that you listed above when referring to cats. I almost always cysto cats because it tends to be the easiest way to get a even a clean sample (not counting a patient I had that urinated in an empty bowl next to the litterbox where he pooped). And knowing that most cats don't have bacterial UTIs, I often don't even start antibiotics unless there's a positive culture. Most specialists are now recommending not using antibiotics at all with cats showing signs of FIC unless there is clear evidence of an infection on culture.

 

I actually find it interesting that the paper outlining the guidelines for UTI treatment didn't address dogs and cats completely separately. Given how different the condition and disease process is in the 2 species, I don't think 1 set of guidelines is adequate.

[turbotaina]

Jjing - it was like July 1 or something, so you need to go back a ways. They have a very active FB page!

 

And yeah, regarding my own cat's experience with UTIs, after the second round of clavamox which didn't seem to help, a separate vet at the practice suggested that it was ideopathic cysitis. The first time was definitely a UTI - she had blood in the urine and her girl parts were hurting - she was actually guarding them and keeping her tail tucked

Edited July 22, 2011 by turbotaina

[Guest LindsaySF]

Interesting info. Thanks for posting.