Fluoroquinolones in cats

RE: Fluoroquinolones in cats

Clive Ansell — Fri, 01 Dec 2017 17:21:20 GMT

[quote user="Lucy Fleming"]

[quote user="Beats"]I'd give Betamox LA and repeat (at home - owners presumably not needle-shy...)[/quote][quote user="David Mills"]Shot of AmoxLA.[/quote] Not a bad call, actually, though I'd potentially be cagey about sending a bottle home in case of unathorised 'as-and-when' use by the owners! A handful of pre-filled syringes might work.

[/quote]

Or just revisit for 3 or 4 injections q48 hours to complete the course.

can Amox LA be dispensed and stored in plastic syringes?

RE: Fluoroquinolones in cats

Lucy Fleming — Fri, 01 Dec 2017 16:12:03 GMT

[quote user="Clive Ansell"]I can't see anything wrong with the careful, responsible and occasional use of fluoroquinolones when based on laboratory evidence and where there are no other viable options available[/quote]

Neither can I, though as it happened we didn't have anything in stock that would be an appropriate size tablet to treat this cat with!

[quote user="Michael Woodhouse"]taking the opportunity to explain we need to get on top of this glycosuria[/quote][quote user="Michael Woodhouse"]I have to wonder whether it would self resolve with a few days of IVFT and careful blood glucose management[/quote] Both true - though this case is not poorly controlled due to lack of owner will to control it (if anything the opposite is the problem) - he's proving to be very difficult to regulate![quote user="Michael Woodhouse"]Does this cat even NEED antibiotics[/quote]Another very good question! I do tend to treat my diabetic patients with antibiotics earlier than I might a non-diabetic. In this case, nsaids weren't making much difference, his signs did seem to resolve with an antibiotic course.

[quote user="Beats"]

[quote user="Lucy Fleming"]Cat has previously been on amox-clav[/quote]

For what, how recently?

[/quote] For another urinary infection! I can't recall when, but it wasn't recently - last year some time I think.

[quote user="Beats"]

Plain or boric?

Were the enterococci visible microscopically on sediment?

How many cfu's?

MIC's?

[/quote]

Boric, yes, 10⁵cfus (so not loads, especially for a free catch sample), MIC of >/= 16 for tetracycline, doxy not given.

[quote user="Beats"]

can you expand on collection method? (I would invariably do cysto in this situation by choice, but appreciate urinating on way to vet can be a logistic problem - still in a diabetic cat I'd think cysto usually achievable)

[/quote] This one was collected by the owner at home with non-absorbent litter, making it even harder to be sure it's significant/ even less likely to be significant! We don't generally do a lot of cystos, and when I saw this chap he had a tiny bladder from frequent voiding.

I hope that's answered all the questions (as it happened he had a course of amox-clav and a probiotic, and all seems resolved) - just thought it was an interesting one to discuss.

RE: Fluoroquinolones in cats

Edward Jones — Fri, 01 Dec 2017 09:58:01 GMT

[quote user="Michael Woodhouse"]

[quote user="Martin Atkinson"]I have seen one. Best avoided I'd say.[/quote]

Based on 1 case, really?

[/quote]

Does EBVM entirely dispose of anecdotal experience as useless? If so it should not. 1) Many discoveries start from a pattern being noticed and the following attempts to statistically prove it. Without the anecdotal evidence the investigation would not start. 2) Much of veterinary medicine does not have evidence of sufficient standard. This fluoroquinolone case is a good example: What is the distribution volume of enrofloxacin? What is the lipid solubility of enrofloxacin? The manufacturer doesn't appear to know or care, so we are left to extrapolate based upon anecdote and experience. Are there any studies of enrofloxacin's therapeutic index that take body fat percentage into account?

[quote user="Michael Woodhouse"]I once put a cat on meloxicam and it got run over a few days later. Should I report that to the drug company and stop using it?[/quote]

The attempt at reductio ad absurdum fails, because yes I would reassess my actions in this scenario. Not in the way you mean because there's no theoretical way that I can imagine that dosing meloxicam could directly cause an accident (unlike Martin's example where it's very possible to imagine how dosing a fat cat for its actual weight might lead to a relative overdose). A cat in pain probably shouldn't be let outside in the first place and in your example clearly this wasn't made sufficiently clear to the owner.

The blind worshipping of EBVM is a little tiresome - unfortunately it has a small alter.

I agree that we don't need fluoroquinolones.

[quote user="robloxley"]

[quote user="Charlotte Marshall"]It is going out of date on the shelf, why can't they supply it in smaller boxes! Boxes of 100 is really too much for something that we should be using only rarely.[/quote]

Speak to your rep, we have done deals on replacing OOD stock

[/quote]

Ceva will do this.

RE: Fluoroquinolones in cats

Beats — Thu, 30 Nov 2017 21:04:44 GMT

[quote user="Lucy Fleming"]Urine sample (free catch)[/quote]

Plain or boric?

Were the enterococci visible microscopically on sediment?

How many cfu's?

MIC's?

[quote user="Lucy Fleming"]Cat has previously been on amox-clav[/quote]

For what, how recently?

Based on info given, I'd give Betamox LA and repeat (at home - owners presumably not needle-shy...) every 2 days for a week or more, assuming obvious improvement in clinical signs after first injection. I'm not an expert, so this is purely what I would do based on my current level of ignorance, not what I recommend you should necessarily be doing!

RE: Fluoroquinolones in cats

David Mills — Thu, 30 Nov 2017 20:02:53 GMT

[quote user="Lucy Fleming"]

Just to stir the pot....

Saw a diabetic cat recently, stranguria and pollakiuria. Urine sample (free catch) grew Enterococcus faecalis. Diabetes is poorly controlled so there is usually glucosuria.

Lab comment: intrinsically resistant to cefovecin, cephalexin, clindamycin, gentamycin and potentiated sulphonamides.

Resistant to tetracycline and doxycycline.

Sensitive to: amox-clav, enrofloxacin, marbofloxacin, nitrofurantouin, chloramphenicol, amoxicillin

Cat has previously been on amox-clav and had horrendous diarrhoea associated with it.

What would you do?

[/quote]

Shot of AmoxLA.

Or course amoxicillin.

Urine c and s are somewhat esoteric given the massive concentrations reached in the urine for many tetracyclines and penicillins.

RE: Fluoroquinolones in cats

Michael Woodhouse — Thu, 30 Nov 2017 19:02:14 GMT

[quote user="Lucy Fleming"]

Just to stir the pot....

Saw a diabetic cat recently, stranguria and pollakiuria. Urine sample (free catch) grew Enterococcus faecalis. Diabetes is poorly controlled so there is usually glucosuria.

What would you do?

[/quote]

It's a poisoned chalice and I'd also give fluoroquinolone, whilst taking the opportunity to explain we need to get on top of this glycosuria because this cannot continue. In a way our hands are tied because the products exist, are licensed and sensitivities reported. This doesn't have to be the case.

Do I think the cat is guaranteed certain death if we couldn't use fluoroquinolones in vet patients? No. What if the lab was ONLY allowed to report fluoroquinolone sensitivity if resistant to everything else?

This is clearly an opportunistic infection, I have to wonder whether it would self resolve with a few days of IVFT and careful blood glucose management. Does this cat even NEED antibiotics or are we reaching for the easy option?

RE: Fluoroquinolones in cats

Clive Ansell — Thu, 30 Nov 2017 17:49:11 GMT

[quote user="Lucy Fleming"]

Just to stir the pot....

What would you do?

[/quote]

I can't see anything wrong with the careful, responsible and occasional use of fluoroquinolones when based on laboratory evidence and where there are no other viable options available. I don't think anyone advocates that they should never be used, just kept in the armoury for use when absolutely necessary, and ideally based on a laboratory report.

I've had a similar case recently; young otherwise healthy neutered female cat with haematuria. no response to Metacam and Cystaid initially, no response to Amoxyclav. Urine obtained by cystocentesis was cultured and an organism (can't remember which one) sensitive to only fluoroquinolnes was found. No tumours, uroliths or crystals found. 2 weeks Veraflox, got better.

RE: Fluoroquinolones in cats

Lucy Fleming — Thu, 30 Nov 2017 16:59:41 GMT

Just to stir the pot....

Saw a diabetic cat recently, stranguria and pollakiuria. Urine sample (free catch) grew Enterococcus faecalis. Diabetes is poorly controlled so there is usually glucosuria.

Lab comment: intrinsically resistant to cefovecin, cephalexin, clindamycin, gentamycin and potentiated sulphonamides.

Resistant to tetracycline and doxycycline.

Sensitive to: amox-clav, enrofloxacin, marbofloxacin, nitrofurantouin, chloramphenicol, amoxicillin

Cat has previously been on amox-clav and had horrendous diarrhoea associated with it.

What would you do?

RE: Fluoroquinolones in cats

Anthony Dennison — Mon, 27 Nov 2017 09:40:32 GMT

[quote user="Martin Atkinson"]

[quote user="Robin Grimmer"]

Never believe anything a rep tells you.

[/quote]Unless its, 'I'm bringing a big box of doughnuts'.

[/quote]

Nope, I've been done by that before. They arrived with sandwiches from the local Spar.

Raging.

RE: Fluoroquinolones in cats

Rob Loxley — Sun, 26 Nov 2017 16:46:22 GMT

Speak to your rep, we have done deals on replacing OOD stock

RE: Fluoroquinolones in cats

Charlotte Marshall — Sun, 26 Nov 2017 16:34:17 GMT

I would use marbofloxacin but have no experience of using pradofloxacin. Mind in a practice of 5 vets we don't use much. It is going out of date on the shelf, why can't they supply it in smaller boxes! Boxes of 100 is really too much for something that we should be using only rarely.

RE: Fluoroquinolones in cats

Martin Atkinson — Sat, 25 Nov 2017 10:21:58 GMT

[quote user="Robin Grimmer"]

Never believe anything a rep tells you.

[/quote]Unless its, 'I'm bringing a big box of doughnuts'.

RE: Fluoroquinolones in cats

Robin Grimmer — Sat, 25 Nov 2017 10:10:39 GMT

Never believe anything a rep tells you.

RE: Fluoroquinolones in cats

Martin Atkinson — Sat, 25 Nov 2017 09:58:23 GMT

[quote user="Emily Rainbow"]The rep gave a good argument about how it’s less likely to induce resistance vs the others but I can’t remember the exact wording but it seemed reliable at the time![/quote]Ditto the Zoetis rep regarding Convenia. There are few C&S results that show Cefovecin to be superior to something else in our arsenal but her argument is that it should be considered the same as a first generation cephalosporin even though its 2nd (or 3rd?) and should thus not need to be held in reserve and should be used routinely - I was not convinced.

One can't help but feel they are be being guided by commercial interest and after all few reps are qualified enough to form their own scientifically unbiased opinion.

RE: Fluoroquinolones in cats

Emily Rainbow — Fri, 24 Nov 2017 20:03:18 GMT

I prefer pradoflox (veraflox). The rep gave a good argument about how it’s less likely to induce resistance vs the others but I can’t remember the exact wording but it seemed reliable at the time!

RE: Fluoroquinolones in cats

Robin Grimmer — Fri, 24 Nov 2017 15:17:10 GMT

Gram negatives are much more common pathogens in exotics so fluoroquins would be more justified in this group.

RE: Fluoroquinolones in cats

Gillian Mostyn — Fri, 24 Nov 2017 15:00:06 GMT

[quote user="Martin Atkinson"]This is me being a bit of a Devil's Advocate but that is a somewhat hypocritical statement - are these exotics suffering from fluoroquinolone deficiency? If not, why not apply the same due diligence used only on the basis of culture/sensitivity?[/quote]

You're absolutely right. I guess the increased knowledge about the use of enro vs others in exotic species, the lack of products sold in a format to allow accurate dosing, alongside following the cascade, has meant that we reach for it more frequently than ever we would in other species. This certainly isn't ideal, and I increasingly use other antibiotics these days, especially with more becoming licensed. Unfortunately there just aren't as many products available to use, like there are in other domestic animals.

Incidentally, I offer C&S in exotics far more frequently, and at a much earlier stage in an infection, than I do in cats and dogs. Unfortunately the cost implications are often more of a problem though....

RE: Fluoroquinolones in cats

David Mills — Fri, 24 Nov 2017 14:35:28 GMT

[quote user="Martin Atkinson"]Read '100s' as a throwaway figure used to illustrate 'quite a few more' but maybe a few dozen. Don't forget I've been around a bit longer than you.[/quote]

Why not just say that rather than trying to show off and mislead?

What were the indications for using fluoroquinolone and was it based on C/S?

Can we trust any answer you give?

RE: Fluoroquinolones in cats

Martin Atkinson — Fri, 24 Nov 2017 14:23:53 GMT

[quote user="David Mills"]I struggle to understand why someone would treat "100s" of cats with this antibiotic.[/quote]Read '100s' as a throwaway figure used to illustrate 'quite a few more' but maybe a few dozen. Don't forget I've been around a bit longer than you.

[quote user="David Mills"]there is only one cat reported to have gone blind after using the data sheet dose.[/quote]Maybe that was my case then?

[quote user="Gillian Mostyn"]

I very rarely use systemic fluoroquinolones in anything except exotics, so would only really use them if strongly indicated by a sensitivity profile. I also struggle to see a reason to use marboflox in hundreds of cats???

[/quote]This is me being a bit of a Devil's Advocate but that is a somewhat hypocritical statement - are these exotics suffering from fluoroquinolone deficiency? If not, why not apply the same due diligence used only on the basis of culture/sensitivity?

[quote user="Michael Woodhouse"]Based on 1 case, really?[/quote]Given the cat was visual before and blind 7 days later I'd say yes given the known risk !

[quote user="Michael Woodhouse"]I once put a cat on meloxicam and it got run over a few days later. Should I report that to the drug company and stop using it?[/quote]No because you are now being sarcastic as well as facetious but if it had developed ARF I might have looked a bit closer!

RE: Fluoroquinolones in cats

Rob Loxley — Fri, 24 Nov 2017 13:45:42 GMT

[quote user="Robin Grimmer"]If you needed to use a Fluoroquinolone in a cat, what would you use?[/quote]

We stock Marbofloxacin (and enroflox liquid for 'exotics') but use little.

[quote user="Robin Grimmer"]

With enrofloxacin, there is a stated risk of causing retinal problems/blindness.

Just wondered what the evidence was for this and has anyone ever seen it?

[/quote]

My understanding was most were dispensing errors - giving out the 150mg tablet rather than 15mg? Is there still the Baytril oral liquid for cats?

RE: Fluoroquinolones in cats

David Mills — Fri, 24 Nov 2017 13:20:12 GMT

[quote user="Michael Woodhouse"]but I've come to the conclusion we really don't need them. I'm starting to think the best thing would be to remove them from veterinary sale altogether.[/quote]

I agree with this, meant to say the same thing

RE: Fluoroquinolones in cats

Michael Woodhouse — Fri, 24 Nov 2017 13:15:03 GMT

[quote user="Martin Atkinson"]I have seen one. Best avoided I'd say.[/quote]

Based on 1 case, really?

I once put a cat on meloxicam and it got run over a few days later. Should I report that to the drug company and stop using it?

I started off being quite defensive when it was looking like we may have our use of fluoroquinolones restricted, but I've come to the conclusion we really don't need them. I'm starting to think the best thing would be to remove them from veterinary sale altogether.

Been at a few vet meetings and there are some vets positively in love with them and unless they can't get them, will continue to use them in reasonable quantities. Some kind of map who's buying them could be fun.....

RE: Fluoroquinolones in cats

David Mills — Fri, 24 Nov 2017 12:26:24 GMT

[quote user="Richard Carter"]have an activity against pulmonary mycoplasmas and some of the protozoa and as cultures are typically false negative is worth treating your asthmatic cat before consigning it to a lifetime of steroid.[/quote]

As is doxycycline. Doxycycline also shows better penetration of lung tissue, bronchial secretions, is anti-inflammatory and active against a wide range of respiratory bacteria.

If they're false negative, how do you know they're present, and if they are, clinically significant?

Assume you also treat for feline lungworm?

The above in no way justifies the use of fluoroquinolones in cats.

RE: Fluoroquinolones in cats

Richard Carter — Fri, 24 Nov 2017 12:14:48 GMT

have an activity against pulmonary mycoplasmas and some of the protozoa and as cultures are typically false negative is worth treating your asthmatic cat before consigning it to a lifetime of steroid.

RE: Fluoroquinolones in cats

Robin Grimmer — Fri, 24 Nov 2017 11:31:58 GMT

I agree. I think there is rarely an indication for using them in cats, I can't remember the last time I used them. I'm doing a locum at the moment and there is a cat on a course of enrofloxacin. I'd probably use pradofloxacin (Veraflox).