Assistance please - reoccurring uti in a diabetic dog

RE: Assistance please - reoccurring uti in a diabetic dog

Sarah Keir — Fri, 16 Nov 2018 09:50:05 GMT

[quote user="Robert FalconerTaylor"]

[quote user="Sarah Keir"]

SulphaTrim - licensed and handy bottle sizes so no subdividing required

[/quote]

Off label then.

[/quote]

On cascade

RE: Assistance please - reoccurring uti in a diabetic dog

Robert FalconerTaylor — Thu, 15 Nov 2018 06:32:20 GMT

[quote user="Sarah Keir"]

SulphaTrim - licensed and handy bottle sizes so no subdividing required

[/quote]

Off label then.

RE: Assistance please - reoccurring uti in a diabetic dog

Sarah Keir — Wed, 14 Nov 2018 17:31:39 GMT

[quote user="Robert FalconerTaylor"]

[quote user="David Mills"]

[quote user="Michael Woodhouse"]. I find that a concerning choice.[/quote]

Same. But it is surprisingly common.

We have been a fluoroquinolone free hospital for the last 6 months. No issues. I'd happily support a ban on vets using them, or at least some special licensing.

[/quote]

What do you do for rabbits?

[/quote]

SulphaTrim - licensed and handy bottle sizes so no subdividing required

RE: Assistance please - reoccurring uti in a diabetic dog

Robert FalconerTaylor — Wed, 14 Nov 2018 16:22:24 GMT

[quote user="David Mills"]

[quote user="Michael Woodhouse"]. I find that a concerning choice.[/quote]

Same. But it is surprisingly common.

We have been a fluoroquinolone free hospital for the last 6 months. No issues. I'd happily support a ban on vets using them, or at least some special licensing.

[/quote]

What do you do for rabbits?

RE: Assistance please - reoccurring uti in a diabetic dog

Sarah Keir — Tue, 16 Oct 2018 20:53:49 GMT

[quote user="Robert FalconerTaylor"]

Just curious - did the Ceva GRAM book ever become widely distributed and used in SA practice? Perhaps this question should be a tangent!

[/quote]

Could only get the book if purchased large amounts of an antibiotic we didn't want. Pharma!

RE: Assistance please - reoccurring uti in a diabetic dog

Lucy Fleming — Mon, 15 Oct 2018 14:29:37 GMT

[quote user="Robert FalconerTaylor"]Wisdom or witchcraft?[/quote]

My understanding is that the source of most of the bacteria involved in these ascending infections was the faecal flora originally, so trying to out-compete the E. coli isn't a bad idea. Whether it is borne out by real-world experience I am not sure but I would definitely consider some type of probiotic use in this sort of case. Even if it simply reduced the frequency of infection it would be useful.

RE: Assistance please - reoccurring uti in a diabetic dog

Robert FalconerTaylor — Sat, 13 Oct 2018 15:50:29 GMT

[quote user="Beats"]

There was a good podcast from Joe Bartges I think it was at BSAVA this year (or maybe last year) on recurrent UTI's with some suggestions, but financially it can become a bit tricky I find.

[/quote]

One of the things he recommends are pre and probiotics - ones with high number of bacteria and more bacteria types 'the best' - visbiome mix 450m fits the bill. He claims it increases overall systemic immune response and so helps UTI remission. This is a shot of the slide

Wisdom or witchcraft?

PS: he also recommends D-mannose in the food.

RE: Assistance please - reoccurring uti in a diabetic dog

Beats — Sat, 13 Oct 2018 13:47:17 GMT

[quote user="David Mills"]

[quote user="janine redman"]

Is trimethoprim sulphonamide worth considering?

[/quote]

Ah, if only they made it anymore.

What a sad, sad loss.

[/quote]

Should I be stock-piling? Wasn't aware of supply issue.

RE: Assistance please - reoccurring uti in a diabetic dog

Thomas Johnson — Sat, 13 Oct 2018 09:33:34 GMT

[quote user="shanley barber"]

She certainly doesnt look Cushingoid in any way, and is one of the easiest dogs to stabilise that I’ve had, so I assume not Cushingoid. She’s on 0.25 Iu/kg of Caninsulin, so no suggestion of insulin resistance.

Yes, she is symptomatic- becomes pupd when she has a uti, but otherwise not, urinates on the floor at home.

Re: ongoing glycosuria, I've looked back at the urine samples post antibiotics; most of them are glucose negative but one or two are positive.

She has had a six week course of antibiotics- follwed by a normal urine sediment- followed by a uti two months later!

[/quote]

I used to treat an elderly labrador that got recurrent UTIs, it was also under the care of the RVC for mast cell tumours and was on Palladia, as well as Metacam and gabapentin for arthritis. It had several bladder scans and urine cultures which found E. coli sensitive to all antibiotics. The plan we eventually came up with in conjunction with the RVC was that whenever it developed a UTI we would give it a 4 week course of amoxycillin, and only do any testing if it didn't respond to treatment.

RE: Assistance please - reoccurring uti in a diabetic dog

Rob Loxley — Sat, 13 Oct 2018 08:37:20 GMT

[quote user="David Mills"]

[quote user="janine redman"]

Is trimethoprim sulphonamide worth considering?

[/quote]

Ah, if only they made it anymore.

[/quote]

We have some human 80/400mg TMPS for use under the cascade.

[quote user="Robert FalconerTaylor"]did the Ceva GRAM book ever become widely distributed and used in SA practice?[/quote]

We weren't prepared to buy the antibiotics that would have got us a free copy...

RE: Assistance please - reoccurring uti in a diabetic dog

Robert FalconerTaylor — Sat, 13 Oct 2018 07:35:56 GMT

Just curious - did the Ceva GRAM book ever become widely distributed and used in SA practice? Perhaps this question should be a tangent!

RE: Assistance please - reoccurring uti in a diabetic dog

Michael Woodhouse — Sat, 13 Oct 2018 00:26:37 GMT

Think outside the box, Norodine 24 available and you'd get a month's treatment for a 25kg dog from 1 bottle costing well under £1/day. I often get farmers to inject their own dogs. No way I'd prat about with tablets with my own dogs if available as an injection.

RE: Assistance please - reoccurring uti in a diabetic dog

David Mills — Sat, 13 Oct 2018 00:14:26 GMT

[quote user="janine redman"]

Is trimethoprim sulphonamide worth considering?

[/quote]

Ah, if only they made it anymore.

What a sad, sad loss.

RE: Assistance please - reoccurring uti in a diabetic dog

David Mills — Sat, 13 Oct 2018 00:13:54 GMT

[quote user="Michael Woodhouse"]. I find that a concerning choice.[/quote]

Same. But it is surprisingly common.

We have been a fluoroquinolone free hospital for the last 6 months. No issues. I'd happily support a ban on vets using them, or at least some special licensing.

RE: Assistance please - reoccurring uti in a diabetic dog

Beats — Fri, 12 Oct 2018 23:30:33 GMT

I culture most of my recurrent/ persistent UTI's and could thoroughly recommend the Idexx service for this.

Rarely, I'm pragmatic and admit defeat in older dogs with persistent or recurrent UTI's.

If so, and antibacterials are required to control clinical signs, I restrict myself to amoxicillin, TMPS and oxytet and give a 4 to 6 week course of one (maybe nitrofurantoin, but I've had bad experience with gut upsets in past). Then at next infection pick a different one. Clinical signs resolving within 3 days is a reasonable indicator that the empirical choice is being effective, and urine checked under microscope as you do tells you if in any doubt re choice.

Alternatively, a week of antibiotics (same options) every month.

There was a good podcast from Joe Bartges I think it was at BSAVA this year (or maybe last year) on recurrent UTI's with some suggestions, but financially it can become a bit tricky I find.

RE: Assistance please - reoccurring uti in a diabetic dog

janine redman — Fri, 12 Oct 2018 21:40:44 GMT

Is trimethoprim sulphonamide worth considering?

RE: Assistance please - reoccurring uti in a diabetic dog

Michael Woodhouse — Fri, 12 Oct 2018 20:18:27 GMT

[quote user="shanley barber"] flouroquinolones or a Labrador,[/quote]

Don't think I've ever used a flouroquinolone to treat a UTI in my career. Don't think I've used one at all for a number of months. I find that a concerning choice.

RE: Assistance please - reoccurring uti in a diabetic dog

shanley barber — Fri, 12 Oct 2018 19:42:05 GMT

Hello,

To answer a few of the queries:

Yes, she is symptomatic- becomes pupd when she has a uti, but otherwise not, urinates on the floor at home.

Re: ongoing glycosuria, I've looked back at the urine samples post antibiotics; most of them are glucose negative but one or two are positive.

She has had a six week course of antibiotics- follwed by a normal urine sediment- followed by a uti two months later!

RE: Assistance please - reoccurring uti in a diabetic dog

Jenny Harris — Fri, 12 Oct 2018 13:57:23 GMT

Just re-reading your initial post it sounds like the dog is symptomatic and that is why you are checking the urine? My comments were more in the case of a dog in which you are just including urine culture/cytology as part of diabetic management, but there are no symptoms of a uti.

RE: Assistance please - reoccurring uti in a diabetic dog

Jenny Harris — Fri, 12 Oct 2018 13:54:16 GMT

I would ask if the dog is symptomatic or not. If asymptomatic and the DM is stable then possibly may not need to be treated , which I think is the case in people

RE: Assistance please - reoccurring uti in a diabetic dog

Rob Loxley — Fri, 12 Oct 2018 13:54:05 GMT

[quote user="Martin Atkinson"]I would be inclined to give antibiotics according to C&S for at least 6 weeks then culture and if -ve continue for another 2 weeks. [/quote]

And in difficult cases like this probably also re-culture a week? after final cessation of antibiotics. Have had grumbling pyelonephritis cases that have taken months to clear. Have you imaged the upper urinary tract?
Also look for other underlying factors

RE: Assistance please - reoccurring uti in a diabetic dog

Kate Richardson — Fri, 12 Oct 2018 10:55:26 GMT

Any chance concurrent Cushings?

RE: Assistance please - reoccurring uti in a diabetic dog

Martin Atkinson — Fri, 12 Oct 2018 10:03:16 GMT

[quote user="shanley barber"]Any suggestions as to why it is reoccurring and how to manage it?[/quote]How long do you give the antibiotic for? Do you obtain a free flow sample of urine or catheterise/cysto? Why use flouroquinolones if this infection is sensitive to all antibiotics as suggested? - as you've said they are expensive, and should not be used as first line choice.

I would be inclined to give antibiotics according to C&S for at least 6 weeks then culture and if -ve continue for another 2 weeks.

The point about persistent glycosuria is worth consideration.

RE: Assistance please - reoccurring uti in a diabetic dog

Kara Gibson — Fri, 12 Oct 2018 08:54:13 GMT

Few thoughts: really is worth culturing this one as E.Coli very easy to get multiple antibiotic resistance so may be that you are only clearing the susceptible population (even though not seeing any bacteria on microscopy at the end of the course).

Does the dog have any other predisposition to ascending infection - e.g. a recessed vulva or perivulval dermatitis? Dilute chlorhexidine cleaning daily may aid if so.

How often is this dog able to go to the toilet? The more opportunities she has to void her urine the better.

I know you have said she is a stable diabetic but has she had any ongoing glucosuria?