Help with antibiotics question please
- Thread starter Cinafina
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Oh really! What condition was it used for?
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Yes, well... it was my suggestion to the vet. The vet that has been most involved with Butchie's case sent me below link to an article, and she was saying that supported her opinion that only Doxy is appropriate. However, there were several other antibiotics listed suitable for Mycoplasma treatment, so I asked her about it. She said any antibiotics other than Doxy would/could have unacceptable side effects, the main one being retinal damage/blindness in cats from quinolones. But from what I've read it's a rare side effect, and studies seem inconclusive.... To her it would be an absolute last resort kind of treatment.
Antimicrobial use Guidelines for Treatment of Respiratory Tract Disease in Dogs and Cats: Antimicrobial Guidelines Working Group of the International Society for Companion Animal Infectious Diseases
But then I saw another vet for his check up on Saturday, and I asked her about it, and she was all for trying it saying the chances of eye damage is very rare and not a reason to not try it. I don't know if Butchie is intolerant to Doxy type antibiotics or if it just doesn't work for him, but what I do know is that he ended up being really sick while he was on them, so I have NOT been in a hurry to try them again!
My thoughts are that next time he has a flare up, I would be (maybe, probably...) willing to try one of these other types of antibiotics!
This all does my head in, and feels like a gamble with his health to some extent! So hard to know what to do,...
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Did it work well? Any side effects..?
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We have had great success with erythromycin ointment for any eye issues.
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It was a long course of 6 weeks but yes, it worked well.
No side effects that I could tell. Appetites still good.
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Thanks for the advice! Are they just to treat eye issues or are they oral antibiotics too?
Funnily enough I have noticed Butchie's eyes being a bit gunky the last couple of days, which is not something normal for him
Hoping it's nothing, but am uneasy about it....
Cinderstar95
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@Cinafina Hi! I’m a year away from my pharmD and going into vet pharmacy. What would you like to know specifically about these drugs? I’ve used both cipro and oflox in the past so I have anechdotal experience as well as (almost!) a degree in it! I’ll answer any questions I can
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Oh thanks!! I did think of you but couldn't recall your username
Well, I'd really appreciate your opinion on these antibiotics and the risk of retinal damage. I read this article last night, and it makes Enrofloxacin sound pretty bad!? Pradofloxacin and Marbofloxacin sound better, but still some risk??
Enrofloxacin-associated retinal degeneration in cats. - PubMed - NCBI
Aarrrgh dunno what to think!
Cinderstar95
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So, just as a follow up, Im assuming your using this right now. What is it for? Like what type of infection and what dose is he getting? I read the article and a few others and I’m at work right now so I can’t write up to much until tonight. What’s up with your little guy and what have you tried already?
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No, he's not on anything at the moment but just finished a week course of Clavaseptin a week ago. He has chronic symptoms of cat flu, and PCR tested positive for Mycoplasma in Sept/Oct 2018, but none of the other 'usual suspects' came up positive. One vet we've seen quite a few times and that got quite involved in his condition, said that only Doxy is suitable because the quinolones (and/or flouroquinolones?) and any other antibiotics have "unacceptable" side effects, with blindness being the main concern I think.
Another vet we saw last week said that we could try these, and that any side effects like eye damage is very rare! So I don't know what to think with everything I'm reading about it and 2 vets with completely differing opinions!
Butchie was first given Doxy after he was diagnosed last year and got a 2 week course. One week in to that course he got really ill with conjunctivits, really congested and struggled to breathe and then a really high temperature, and he was hospitalised for 2 days. This has really put me off trying Doxy again, but I still want to treat his symptoms. I know it might only be a temporary "cure", and that we'd need to do pulse therapy of maybe 4-6 weeks twice a year, but I'd just love for him to be normal for a few weeks or months!
I'm doing all this research so that next time it comes to making a decision about his treatment (which could be soon or weeks or months!) I can tell the vet that I would like to try this or that...
Any help and information is greatly appreciated! Thank you.
Cinderstar95
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Sorry it took me so long to get back to you. I didn't get home until past midnight yesterday so I didn't have time to think about what to say.
So first off, I don't know for certain if the Doxy is what gave him that reaction. That doesn't sound like a hypersensitivity reaction to the medicine, especially after a week of being on it. Now, I don't know that for certain and I would listen to your vet about what they think, but tht could have just been something that happened in conjunction. Now if it didn't work then thats an indication to not try it again as it didn't kick the infection!
Its a pretty safe drug all in all so giving it to him if it comes down to it under close supervision could still be a possibility.
As for the quinolones. - if I say anything you don't understand just let me know. I've forgotten to use patient friendly language in the past and sometimes just go with straight medical terminology and If you don't have a medical background, it just sounds like gibberish lol.
so I read the study you linked. To break it down, it was a retrospective study meaning they looked at all the cats that received enrofloxacin and identified those who DID develop eye issues. I can't get access to the full version of the study so I can't determine for certain how many cats received the drug, only that 17 developed the retinal degeneration. The study does provide enough evidence that I would beleive that it is an associated risk. i looked on one of my vet pharmacy resources and enrofloxacin does have a noted risk of blindness. Now, that is seen at high doses, at 5 mg per kilogram (2.2 lbs). So if he's 10 lbs, he would be 4.5 kg and should have a dose above 22.5 mg (logically round that to 20 mg dose at the most)
If it stays below that dose, the risks are minimal. the most common side effect is simply GI issues like nausea, vomiting and drug associated diarrhea. Most antibiotics will have that side effects however, so you wont get away from it.
Its difficult to say what antibiotic I would recommend because it really depends o what he's infected with, and those decisions are made based on regional trends. If a ton of cats in your area have staph infections, they will typically treat for staph first, just how therapy goes.
you said that mycoplasma came up last year. I dont' know if they treated that successfully or not, but even if they did, its a possibility that he didn't clear it completely and it returned. If it did and he has a mycoplasma infection treatment does depend on which strand of mycoplasma he has, but typically it IS susceptible to the floroquinolones (FQ for now on). However in people we typically treat Mycoplasma with either a macrolide or doxycycline. Doxy is a no go at this point, so Macrolides would be the next option. those are the -mycin antibiotics, azithromycin, erythromycin, and clarithromycin are the common human brands. vet brands may come under different names. FQ's are usually given if they can't give doxy or a macrolide for some reason. That doesn't mean they are bad drugs, they just tend to have more side effects than other drugs. If there is a high rate of antibiotic resistance in your area, that may influence the decision to go straight to a FQ. Its just hard for me to say because I don't know susceptibility trends in your area.
In my experience, When Shazam was a kitten, he came to us very sick. baby didn't play until he was 6 months old, and we got him at 4 mo. He had serious respiratory issues and I assume it was a pneumonia of some sort. He failed two trials of clav-amox (Augmentin) and my vet was really hesitant to try anything stronger because of his age. But he was dying. So she gave him Ciprofloxacin and it knocked the infection out in a matter of days. He had no side effects from it and it saved his life. Her concern was cartilage damage and tendinitis which is the common issues with FQ's, and why they don't recommend giving it to children under 12. Its used in serious situations however.
The fact of the matter is that all antibiotics have side effects, and some of them can be really severe. But what my infections disease professor always said was that some kidney damage doesn't matter if your dead. If your baby is that sick that he's going to be at risk for dying, its a matter of weighing the risks. Would you rather have a blind cat or no cat? That sounds harsh and it is - I don't mean to sound insensitive or anything like that. I've struggled with my cats health issues also, its really difficult to make those decisions, knowing that they depend on you to take care of them. But you have to take into account that antibiotic aren't magic and sometimes sacrifices have to be made for life.
A question you could ask is why enrofloxacin over any other FQ? Ciprofloxacin, Moxifloxacin, pradofloxacin, none of them have the risk of retinal toxicity. have they done blood cultures or other cultures to see if they can figure out what he's infected with? That would help guide treatment decisions. If the only option is enrofloxacin, I personally would still give it to my pair as long as it was under the 5 mg/kg dose.
I hope that this helps, and if you have any more questions, Ill try to answer them. Ill be rotating through a vet teachig hospital for school purposes starting in june. So I can ask experienced vet pharmacists starting then if anything else comes up!
Best wishes!
So first off, I don't know for certain if the Doxy is what gave him that reaction. That doesn't sound like a hypersensitivity reaction to the medicine, especially after a week of being on it. Now, I don't know that for certain and I would listen to your vet about what they think, but tht could have just been something that happened in conjunction. Now if it didn't work then thats an indication to not try it again as it didn't kick the infection!
Its a pretty safe drug all in all so giving it to him if it comes down to it under close supervision could still be a possibility.
As for the quinolones. - if I say anything you don't understand just let me know. I've forgotten to use patient friendly language in the past and sometimes just go with straight medical terminology and If you don't have a medical background, it just sounds like gibberish lol.
so I read the study you linked. To break it down, it was a retrospective study meaning they looked at all the cats that received enrofloxacin and identified those who DID develop eye issues. I can't get access to the full version of the study so I can't determine for certain how many cats received the drug, only that 17 developed the retinal degeneration. The study does provide enough evidence that I would beleive that it is an associated risk. i looked on one of my vet pharmacy resources and enrofloxacin does have a noted risk of blindness. Now, that is seen at high doses, at 5 mg per kilogram (2.2 lbs). So if he's 10 lbs, he would be 4.5 kg and should have a dose above 22.5 mg (logically round that to 20 mg dose at the most)
If it stays below that dose, the risks are minimal. the most common side effect is simply GI issues like nausea, vomiting and drug associated diarrhea. Most antibiotics will have that side effects however, so you wont get away from it.
Its difficult to say what antibiotic I would recommend because it really depends o what he's infected with, and those decisions are made based on regional trends. If a ton of cats in your area have staph infections, they will typically treat for staph first, just how therapy goes.
you said that mycoplasma came up last year. I dont' know if they treated that successfully or not, but even if they did, its a possibility that he didn't clear it completely and it returned. If it did and he has a mycoplasma infection treatment does depend on which strand of mycoplasma he has, but typically it IS susceptible to the floroquinolones (FQ for now on). However in people we typically treat Mycoplasma with either a macrolide or doxycycline. Doxy is a no go at this point, so Macrolides would be the next option. those are the -mycin antibiotics, azithromycin, erythromycin, and clarithromycin are the common human brands. vet brands may come under different names. FQ's are usually given if they can't give doxy or a macrolide for some reason. That doesn't mean they are bad drugs, they just tend to have more side effects than other drugs. If there is a high rate of antibiotic resistance in your area, that may influence the decision to go straight to a FQ. Its just hard for me to say because I don't know susceptibility trends in your area.
In my experience, When Shazam was a kitten, he came to us very sick. baby didn't play until he was 6 months old, and we got him at 4 mo. He had serious respiratory issues and I assume it was a pneumonia of some sort. He failed two trials of clav-amox (Augmentin) and my vet was really hesitant to try anything stronger because of his age. But he was dying. So she gave him Ciprofloxacin and it knocked the infection out in a matter of days. He had no side effects from it and it saved his life. Her concern was cartilage damage and tendinitis which is the common issues with FQ's, and why they don't recommend giving it to children under 12. Its used in serious situations however.
The fact of the matter is that all antibiotics have side effects, and some of them can be really severe. But what my infections disease professor always said was that some kidney damage doesn't matter if your dead. If your baby is that sick that he's going to be at risk for dying, its a matter of weighing the risks. Would you rather have a blind cat or no cat? That sounds harsh and it is - I don't mean to sound insensitive or anything like that. I've struggled with my cats health issues also, its really difficult to make those decisions, knowing that they depend on you to take care of them. But you have to take into account that antibiotic aren't magic and sometimes sacrifices have to be made for life.
A question you could ask is why enrofloxacin over any other FQ? Ciprofloxacin, Moxifloxacin, pradofloxacin, none of them have the risk of retinal toxicity. have they done blood cultures or other cultures to see if they can figure out what he's infected with? That would help guide treatment decisions. If the only option is enrofloxacin, I personally would still give it to my pair as long as it was under the 5 mg/kg dose.
I hope that this helps, and if you have any more questions, Ill try to answer them. Ill be rotating through a vet teachig hospital for school purposes starting in june. So I can ask experienced vet pharmacists starting then if anything else comes up!
Best wishes!
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@Cinderstar95 First of all thank you for the very lengthy reply and for taking the time to get involved! I will reply later when I have some more time
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@Cinderstar95 I agree with you that I don't think he's got an intolerance to Doxy, but based on the fact that he got really ill whilst on it, I don't think it works!
To the best of the vet's knowledge after the PCR test done last year, he has Mycoplasma, and that makes him susceptible to secondary bacterial infections. But we're working from the assumption that his main condition is bacterial as well. He had swabs taken in February, which confirmed he had no secondary infections going on at that time and that he'd not developed a resistance to Clavaseptin, which has been our go-to-antibiotic for intermittent flare-ups.
Personally I don't have a preference for Enrofloxacin - it was just one of the various 'floxacins'. It was just while investigating these antibiotics that it seemed to be the worst in terms of retinal damage... From what I've read there was still some risk with Pradofloxacin and Marbofloxacin, but less so..?
I was ignorant about the 'mycin' type of antiobiotics until mentioned on this thread, but having looked them up, it seems they are effective against atypical bacteria like Mycoplasma - did I understand that correctly? Azithromycin was one that came up, which I think it said is derived from Erythromycin..? It seems to me it's worth trying this type of antibiotic!
What I don't get though, is WHY my vet just keeps insisting Doxy is the only option!? Not one of the alternatives I have found myself have been mentioned even in passing. I'm gonna have to make an effort to not be annoyed next time I see her, which is probably going to be Friday.
Once again I'd appreciate your input and thank you!
To the best of the vet's knowledge after the PCR test done last year, he has Mycoplasma, and that makes him susceptible to secondary bacterial infections. But we're working from the assumption that his main condition is bacterial as well. He had swabs taken in February, which confirmed he had no secondary infections going on at that time and that he'd not developed a resistance to Clavaseptin, which has been our go-to-antibiotic for intermittent flare-ups.
Personally I don't have a preference for Enrofloxacin - it was just one of the various 'floxacins'. It was just while investigating these antibiotics that it seemed to be the worst in terms of retinal damage... From what I've read there was still some risk with Pradofloxacin and Marbofloxacin, but less so..?
I was ignorant about the 'mycin' type of antiobiotics until mentioned on this thread, but having looked them up, it seems they are effective against atypical bacteria like Mycoplasma - did I understand that correctly? Azithromycin was one that came up, which I think it said is derived from Erythromycin..? It seems to me it's worth trying this type of antibiotic!
What I don't get though, is WHY my vet just keeps insisting Doxy is the only option!? Not one of the alternatives I have found myself have been mentioned even in passing. I'm gonna have to make an effort to not be annoyed next time I see her, which is probably going to be Friday.
Once again I'd appreciate your input and thank you!
Cinderstar95
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Azithromycin is a decent one that does have atypically coverage. It depends da on the species of mycoplasma but it’s worth a conversation with the vet. One thing of note in people sometimes resistance develops quickly to azithromycin as in like a week or two of treatment. But t may be an option. Erythromycin and clindamycin are also good drugs.@Cinderstar95 I agree with you that I don't think he's got an intolerance to Doxy, but based on the fact that he got really ill whilst on it, I don't think it works!
To the best of the vet's knowledge after the PCR test done last year, he has Mycoplasma, and that makes him susceptible to secondary bacterial infections. But we're working from the assumption that his main condition is bacterial as well. He had swabs taken in February, which confirmed he had no secondary infections going on at that time and that he'd not developed a resistance to Clavaseptin, which has been our go-to-antibiotic for intermittent flare-ups.
Personally I don't have a preference for Enrofloxacin - it was just one of the various 'floxacins'. It was just while investigating these antibiotics that it seemed to be the worst in terms of retinal damage... From what I've read there was still some risk with Pradofloxacin and Marbofloxacin, but less so..?
I was ignorant about the 'mycin' type of antiobiotics until mentioned on this thread, but having looked them up, it seems they are effective against atypical bacteria like Mycoplasma - did I understand that correctly? Azithromycin was one that came up, which I think it said is derived from Erythromycin..? It seems to me it's worth trying this type of antibiotic!
What I don't get though, is WHY my vet just keeps insisting Doxy is the only option!? Not one of the alternatives I have found myself have been mentioned even in passing. I'm gonna have to make an effort to not be annoyed next time I see her, which is probably going to be Friday.
Once again I'd appreciate your input and thank you!
FQs are typically more resistant at least in humans but it is always a chance it could help. They are strong antibiotics. I would just try to get the vet to explain her reasoning as to why doxy is the only option. And if it’s side effects, which ones are she really worried about? We don’t want him to be in pain but also if the side effect is slightly disabling but doesn’t cause chronic pain. It may be worth it so that he’s not always sick.
It’s a conversation that needs to be had.
Keep us updated!
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@Cinderstar95 Hmm, what do you mean with FQ's being more resistant? Do you mean we or animals get resistant to them quickly, or that the bacteria get resistant to them?
But yes, with quinolones (and probably FQ's too) she only seemed worried about side effects, and the way she talks about them it'd make you think 2 out 5 cats went blind or something!
Do you mean we or animals get resistant to them quickly, or that the bacteria get resistant to them?But yes, with quinolones (and probably FQ's too) she only seemed worried about side effects, and the way she talks about them it'd make you think 2 out 5 cats went blind or something!
Cinderstar95
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Sorry! Autocorrect got me there. I meant that bacteria will become resistant to the flouroquinolones (floxacins) quickly sometimes. Not always. But it’ happens in the human side.
And my boy was on Ciprofloxacin when he was a kitten. He did just fine. It’s certainly not an every cat thing. Just need some clarification from the vet I think. And some grounding on how serious his condition is on both sides. Doxy certainly is a good drug and may still be a viable option but there are other agents out there that might help him. And a good vet will take the time to explain it to you and have that sort of conversation
And my boy was on Ciprofloxacin when he was a kitten. He did just fine. It’s certainly not an every cat thing. Just need some clarification from the vet I think. And some grounding on how serious his condition is on both sides. Doxy certainly is a good drug and may still be a viable option but there are other agents out there that might help him. And a good vet will take the time to explain it to you and have that sort of conversation