Antibiotic for a UTI

Hi. I was wondering if anyone here had any opinions about what type of antibiotic usually works well for a diabetic cat? My cat has a UTI and I’m having problems finding an antibiotic that doesn’t have unpleasant side effects for her.

A little background… my cat Josie was diagnosed with diabetes about a month ago. Her blood glucose was pretty high when she was diagnosed (mid 400’s) and she started out with 3 units of ProZinc insulin twice daily. Upon switching her from a high carb to a lower carb dry food, along with some wet food, (have not fully transitioned her to wet food yet, although I plan to do so) I was able to cut her insulin down to 2 units at night and 1-1.5 units during the day. We were just starting to get her BG’s regulated, when she was diagnosed with a UTI last Thursday.

The vet prescribed Clavamox (1 cc twice daily) for this. After 3 doses she began having diarrhea. That was on Saturday morning and when I called the vet I was initially told to just keeping giving her the Clavamox and her diarrhea would go away when the medicine was finished. (WHAT???) I told them the diarrhea was bad and that I would not be able to continue giving her the meds. They then told me to go ahead and stop the Clavamox and bring her in on Monday.

Today I took her to a different vet in the same practice (NOT the vet who told me to keep giving her the antibiotic that was making her sick!) and he initially wanted to give her a Covenia shot. Since I had read negative things about it, I asked him to come up with an alternative. He said he’d never had issues with Covenia, but if I wasn’t comfortable with it we could try Albon liquid, which is a sulfa drug. He said it wasn’t his first choice for treating a UTI, but it was fine.

So I went home with instructions to give 3.5 cc’s of Albon liquid once daily. I gave her the meds about 1:15 this afternoon. I decided to do a little research on the medicine (after I gave it to her, I know, dumb!) and read that sulfa drugs can cause hypoglycemia even in non-diabetic patients.

Well, wouldn’t you know it, we narrowly missed a hypoglycemic episode this afternoon. At about 4+ hours she was at 104. Normally she doesn’t get that low until 6+. Tested again 30 minutes later and she was at 66. Gave her some high carb food and 15 minutes later 59. More high carb food and a tiny bit of Karo and she was at 89 and back on track again. (I know 59 may not sound like hypo, but because the insulin had not yet “peaked”, I was very afraid of where it was headed.)

I am willing to try to work with this medicine and cut back her insulin, but if she gets close to hypo or hypo again I am going to have to ask the vet for something else. And I don’t want to go the Convenia route.

So the point of this VERY long winded post (sorry!) is that I was wondering if someone on here had experience with an antibiotic (other than Clavamox) to treat a UTI? I need suggestions for my vet! Thanks!

 

I like Baytril. Zenquin is similar.

 

Thanks for your response, Larry and Kitties. I've heard of Baytril and I wonder why my vet didn't go with that instead of the Albon fluid.

If anyone else on here has had a diabetic cat with a Urinary Tract Infection, I'd love to hear which type of antibiotic helped your kitty!

 

The smart move on the vets part would have been to do a cystocentesis, straight needle draw from the bladder, and run a culture on the urine and find out what type of antibiotic would be the correct one. The vet could then have started an antibiotic till the culture came back to show what would be the best to use. Right now it is a guessing game so hopefully the UTI will clear up but.......if it comes back, have them run a culture first.

 

How do you even know that your cat has an infection? As Hope mentioned, was a culture done to prove that an infection even exists? Along with a sensitivity so that you can pick the best antibiotic?

This is a huge 'hot button' topic of mine......the rampant abuse/overuse of antibiotics - especially Convenia.

How was the "infection" diagnosed?

Please see my Urinary Tract Health page linked below.

 

Edit: Nevermind, every time I try to help on here I just feel like I'm treading on someone's toes. I should stop. I'm sorry. One of those designated "advice givers" will be able to help you better.

 

We are already having to face this life threatening problem every day in human and vet medicine.

keep in mind that these clinical signs are NOT necessarily indicative of an infection and are FAR more likely to be sterile cystitis.

I REALLY wish that everyone - including members of the medical profession - would stop using the abbreviation "UTI" which is worthless and misleading unless the I is defined, Infection? Or simply the MUCH more common Inflammation?

If we don't work harder at differentiating between the two and stop using "UTI" to describe urinary tract issues, the abuse of antibiotics will continue.

 

Hi everyone.

Thanks for your replies. When I took Josie to the vet last Thursday they took a urine sample and told me that she had no ketones (yay!), a fair amount of glucose in her urine (still trying to get her regulated) and a urninary tract infection.

The only symptom she really had was that she was urninating a lot. But that's typical for diabetics so I really didn't suspect that she had a UTI, although the vet did. I wanted them to take the urine sample to test for ketones, as much as anything.

It sounds as if this is different than what some of you are mentioning when you say a culture? I'm sorry, I don't know a lot about this, I just know that took a sample of her urine and the results indicated that she had a UTI. That's really all they told me. It sounds as if some of you are saying that there is additional testing that my vet should have done to confirm this diagnosis?

I don't think this test really told them what antibiotic they should be giving her. I think they just prescribed what they'd prescribe to anyone. When the Clavamox didn't work, they wanted to give her a Covenia shot. I wouldn't allow that, so they went with the Albon liquid.

Dr. Lisa, I'll go back and read your page again. Your page was actually one of two places where I read that Covenia shots were not a good idea. Do you know anything about this Albon liquid Josie is on?

Have any of you on here ever had a cat on Albon liquid? It just seems like an odd choice, but I think they felt they were running out of options, since the Clavamox made her sick and I said no to the Covenia.

 

Oh and as far as if she has an infection vs. inflammation... I really don't know. The vet just told me "UTI". I would have assumed that meant infection, but maybe not? I would imagine you'd treat an infection differently than an infection? Perhaps she wouldn't have needed antibiotics at all?

That's upsetting. I hate giving antibiotics unnecassarily. That, and I feel like we were just starting to get her BG's in somewhat of a good place, and now they are kind of all over the place again. She's been under so much stress lately with the upset stomach, diarrhea, extra vet trips, shoving medicine down her throat, etc. If this is all for nothing, if it was just a bit of inflammation that would have eventually gone away, I'm going to be very upset.

I asked the vet if this would just go away on it's own (because I hate overtreating!) and he said no. So I'm not sure if that indicates it is an infection, or if he was just saying that.

I really don't know what to do at this point.

 

One thing you can do, Holly, when there is diarrhea as a result of an antibiotic is to concurrently treat with a pro-biotic, like Forti Flora or acidophilis. The pro-biotic re-introduces good bacteria into the GI tract while the antibiotic kills all bacteria in the system.

Some vets (like mine) start their DX of a UT infection based on a urinalysis. That is a microscopic study of the fresh urine. My vet recently DX'd my Ennis with a UT infection based on blood and white blood cells in his urine. I didn't ask for a culture because I thought those finding were pretty hard core evidence. Ennis is 19YO and has never had cystitis. He was in and out of the litter box at least 50 times/day, so everything seemed to point to an infection.

When Ennis had an ultrasound the next week, the radiologist said that the blood and WBCs likely were from his then-DX kidney and bladder cancers. So even hard core "evidence" from a UA isn't always definitive of a UT infection.

A culture and sensitivity is different from a urinalysis. Sterile urine that is collected by cystocentesis (a needle into the bladder, not an uncomfortable procedure at all) is sent to an outside lab. It is spread on a culturing medium and left to grow for a couple days. If bacteria grows, the lab then determines what antibiotics the bacteria is sensitive to. This should be done before ABx are started because they ABX may kill some of the bacteria and skew the results.

BTW, Clavamox is the ABx that Ennis got for his "infection." My vet said it was the best for that situation, and it came in liquid form. (Ennis will NOT be pilled.) He did get horrible diarrhea (I was hoping and not using a probiotic). Once he got the Big D, I added Forti Flora to his food (which he considers a treat) and within a couple of days everything was straightened out.

 

This is what gets so many people into trouble since BLOOD and WBCs (white blood cells) are NOT necessarily indicative of an infection. People (including my colleagues) often forget that blood and WBCs are also present with inflammation.

Another HUGE mistake that people make since this is just as much of a sign (if not more so) of inflammation as it is infection. In fact, when I hear about this much discomfort, I vote inflammation over infection.

Correct. Nothing about blood or wbcs should be considered "hard core evidence" of an infection.

Now...if a very savvy tech picks up bacteria inside of a WBC, then that is a good indication of an infection but that is a rare scenario.

Yep.

I have great luck with clavamox tablets in Pill Pockets or just crushed in food which is how ferals are treated. Unfortunately, my colleagues rarely Rx the tabs crushed and put in food which is a huge shame since they then move to other (often inappropriate and more dangerous) drugs.

I want to stress again....BLOOD and WBCs are present with infections AND inflammation.

There is also the issue of contaminated stains in the vet clinic. Many "infections" have been misdiagnosed because bacteria is present in a stain. Stains should be made up fresh ~1x/week but I will bet you that most clinics don't come anywhere close to making up fresh stains that often.

Plus....it is not unusual for a tech to mistake debris for bacteria - resulting in a false Dx of an "infection".

Plus....and this is VERY important yet rarely discussed among my colleagues...CHECK THE USG!!! A cat with a high urine specific gravity (say...over 1.040 ish) has a VERY, VERY low chance of having an infection.

Bottom line? Culture the urine and stop drowning cats in unnecessary antibiotics.

And....let the sensitivity guide you so you don't have a cat that ends up being a 'dart board' with this AB and that AB thrown at them resulting in the following situation:

I am dealing with a case where the owner said he is spending ~$500/month on a very expensive antibiotic (although I think he recently found a cheaper source) for his 19 year old cat that now has a VERY resistant strain of e.coli in her urinary tract....secondary to his vet constantly putting her on ABs with no C and S. The university vet has put her on it "for life".

I know that C and S's are expensive but so are resistant bacteria and multiple rounds of ABs. Not to mention the stress on the owner - mentally and financially....and the cat - both mentally and THEIR ENTIRE BODY.

 

Dr Lisa,

Please explain this to me. I don't know what a "stain" is.

:shock: Ennis got wise to pill pockets and crushed pills in his food a LONNNGGG time ago. Liquid or injectibles are the only way I get any meds into him. I had to get the prednilosone for his cancers compounded into a flavored liquid.

 

Stains are liquid preparations that we add to slides with cells on them to add color to the cells to highlight them for better identification.

Scroll down and look at the multiple myeloma cells here:

http://trialx.com/curetalk/2011/06/mult ... e-gallery/

 

Holly

Just to add a few things to Dr. Lisa's posts because I think they are important. My Gracie had sterile interstitial cystitis for a few years; she presented clinically with all the signs of what people refer to as "UTI"....running to the litterbox, straining, blood in her urine, etc. The first time, she did get an antibiotic because I had never had a cat with these symptoms. The antibiotic was convenia which was brand new on the market at the time. She went into anaphylactic shock within minutes of me leaving the vet clinic and I got her right back there. They were able to quickly stabilize her.

I started looking more into it..... joined the FLUTD group on yahoo. Gracie never had bacteria in her urine and her c&s was always negative. I had ultrasounds done to make sure she did not have pyelonephritis because bacteria in a c&s does not always show itself with kidney infections. Very long story short...Gracie's was ALWAYS inflammation. My current vet does Nutrition Response Testing and found that Gracie had high levels of aluminum in her system which kicked off the cystitis when she was stressed (which was mostly when I travelled for work). As soon as she detoxed her, she has not had a cystitis event since. That's not to say that every cat with sterile cystitis has aluminum in their systems but they can have other issues which cause the inflammation NOT infection. So I am a HUGE proponent of what Dr. Lisa says.

Also....I'm not a vet but I have never heard of Albon being used for bladder issues. Typically it would be baytril. Albon is typically used for giardia. But again...I'm not a vet.

 

"There is also the issue of contaminated stains in the vet clinic. Many "infections" have been misdiagnosed because bacteria is present in a stain. Stains should be made up fresh ~1x/week but I will bet you that most clinics don't come anywhere close to making up fresh stains that often."

My experience is that this doe not usually apply to urine analysis. Most vets spin a urine sample, pour off the liquid and then add a drop of stain to the sediment left in the tube. The staine sediment is then placed on a slide and examined under a microscope. The stain does not get contaminated.

When examining ear, tissue and other sample, some of the sample is applied to a slide. The slide is dried and the slide is then dipped into different jars of stain. This is where you can have bacteria and other "things" in the stain and then get on the slide and appear as artifacts on the slide.

 

I was talking with a vet (not mine) yesterday about a cat that DCIN is vetting. He said the cat had a UTI, and I asked whether that was inflammation or infection. He said infection and that he was starting the cat on ABx. I asked how he knew it was an infection. He said from the urinalysis and the cat's lethargic and dehydrated condition.

I asked for a C&S. He said they were a waste of money, that half of them fail. I asked what he meant by fail. He said that in about 50% of the cases the cultures were spoiled and no bacteria grew. I asked him whether that meant there wasn't an infection. No, he insisted it was lab mis-handling. He was starting to get a little agitated and talking really fast like I was taking up his time.

I then asked him what in the UA made him think infection. He said he saw bacteria. I sighed and said OK.

My questions--

What do you think of this position that urine cultures that do not grow bacteria means lab mis-handling?

What might a client do when presented with this kind of position and attitude from a vet (especially one you don't know well)?

Can a vet "see" bacteria in a microscopic examination of urine?

Thanks!!

 

Yes. If there is a lot of bacteria in the urine one can easily see it on the microscope slide. I used to work at a vet and saw bacteria many time, include in my own cat's urine. However, sometimes there are things in the urine that can look like bacteria but not be bacteria.
Sometime a cat will have a UTI but the not have visual bacteria in the urine and it will not culture. Sometime not enough bacteria gets in the urine to be culturalable.
W

 

This is a subject that, in order to *thoroughly* cover would take fat too much typing but here are some quick comments:

Given that a lot of things can cause lethargy and dehydration, I certainly would not be automatically correlating those clinical signs with a UT infection.

It sure would be nice to ask him to document that off-handed remark. If the % of false negatives was actually that high, why do all of the VIN consultants and many knowledgeable vets recommend culturing the urine rather than shotgun treating every lethargic and dehydrated animal with ??? on the UA with ABs?

But...are there false negatives associated with cultures? Yes, of course there are. Nothing in life....including ANY and ALL lab tests are 100% accurate without the potential for false positive and false negatives. Contamination issues causing a false positive....sample handling problems (sample got too hot or too cold or the delay to plating was too long...etc...causing the bacteria to die) causing false negatives....etc...etc...etc...

But so what does that mean? Does that mean we just forego culturing urine and drown every cat in ABs that show a hint of a UT problem? If so, then that means a HUGE % of cats will be treated with ABs UNnecessarily.

Are cultures and their results 100% cut and dried? No, they are not but they are a lot more accurate if the sample is handled optimally....correct tube, possibly with preservatives used, temperature control, less time delay...etc...etc.

One practice that the VIN consultants are trying to get vets to do is to set up their own cultures in-house which helps mitigate the above problems and is MUCH cheaper. If no growth, less money out of the client's pocket. If growth? THEN send it to the lab for a sensitivity.

He has grossly exaggerated the situation by claiming a 50% false negative.

That's up to you.

That depends on the skill of the person looking at the urine. Artifacts are common that can be mistaken for bacteria such as stain precipitate. Stain precipitate has the potential for misleading the operator into thinking there is bacteria when there is not. This holds true if you add a drop of stain to the slide...vs...dipping the slide into the stain container. (See a post from Larry above.)

Thanks!![/quote]