UTI Guidelines

Question 1

How common is sporadic cystitis in intact male dogs? What differentials should be considered?

Answer 1

not common
should consider prostatitis

Question 1

How is sporadic bacterial systitis defined?

Answer 1

less than 3 episodes within last 12 months

Question 2

What methods of obtaining urine for culture are not recommended?

Answer 2

urinary catheter
free catch

Question 3

How should a culture be adjusted if voided urine is used?

Answer 3

voided urine –> start culture within hours
and perform quantitative culture

Question 4

What is the treatment recommendation for sporadic cystitis (type of medications and duration)

Answer 4

• consider giving NSAIDS for 3-4 days and see if self-resolving
• consider waiting for culture results before starting Abx
• if indicative clinical signs, bacteria on sediment, and dog, can give without culture: amoxicillin for 3-5 days
• TMS can be considered but more side effects

Question 5

Why is clavulanic acid unlikely necessary in sporadic cystitis treated with amoxicillin?

Answer 5

because amoxicillin reaches such high cc, that even beta-lactamase-producing bacteria will be sufficiently inhibited

Question 6

What is the recommendation for using fluoroquinolones, nitrofurantoin, or 3rd generation cephalosporins in sporadic cystitis?

Answer 6

not recommended unless, culture shows resistance to amoxicillin and TMS and clinical signs have not resolved

Question 6

When should antibiotics be changed for treatment of sporadic cystitis?

Answer 6

if culture shows resistance AND clinical signs have not resolved

do not need to switch if culture shows resistance but CS are resolving sufficiently

Question 7

When should you obtain a post-treatment urinalysis or sporadic cystitis?

Answer 7

not needed as long as CS resolve

Question 8

How does the treatment recommendation for sporadic cystitis differ between dogs and cats?

Answer 8

no empirical abx given to cats due to very low occurence of UTIs

Question 9

How is recurrent bacterial cystitis defined?

Answer 9

3 or more UTIs within last 12 months
2 or more UTIs within last 6 months

Question 10

What workup is recommended for patients with recurrent bacterial cystitis?

Answer 10

urinalysis
culture
full workup for complicating factors (i.e., blood work, ultrasound, radiographs)
consider cystoscopy +/- bladder mucosa biopsy for histopath and culture

Question 11

How should treatment be changed if bacterial cultures shows resistance to the abx tx in recurrent bacterial cystitis patients?

Answer 11

only change treatment if CS are not resolving
if clinical failure documented –> change abx

Question 12

How should the treatment duration differ between reinfections and persistent/relapsing infections of recurrent bacteria cystitis?

Answer 12

• long term treatment not automatically warranted
• 3-5 days

consider longer treatment if factors like bladder wall invasion present

Question 13

What is the recommendation for recheck cultures in dogs treated for recurrent bacterial cystitis?

Answer 13

• consider after 5-7 days of treatment
• consider culture after 5-7 days of cessation of abx treatment

Question 14

What group of bacteria are most pyelonephritis cases caused by?

Answer 14

Enterobacteriacea

Question 15

Describe the full diagnostic workup recommended for cases of suspected pyelonephritis.

Answer 15

• urine culture (cysto) use MIC for serum not urine!
• cbc/chem
• ultrasound
• consider pyelocentesis - especially if urine culture from cysto negative
• blood culture if febrile
• Lepto PCR and MAT (serology)

Question 16

What is the recommended empirical treatment for pyelonephritis?

Answer 16

Fluoroquinolones or Cefpodoxime

IV 3rd generation options: Cefotaxime, Ceftazidime

Question 17

When should IV Abx therapy be considered in pyelonephritis?

Answer 17

if animal does not appear systemically well or in anorexic

IV recommended if dehydrated/lethargy/anorexic or hyporexic

Question 18

Explain how culture results should be evaluated and how treatment should be adjusted in dogs with pyelonephritis

Answer 18

combination therapy - both susceptible - stop one

combination therapy - one resisitant - stop that one
if not clinical response - add another susceptible abx

both resistant and no clinical response - change abx treatment
if clinical response dont change - unless other reason for improvement (e.g., IV therapy)

Question 19

What length of abx is recommended for pyelonephritis?

Answer 19

10-14 days

Question 20

What all should be rechecked 1-2 weeks after cessation of abx tx in pyelonephritis

Answer 20

serum creatinine, physical exam, UA, culture

Question 21

What drug properties make an antibiotic most likely to penetrate the blood-prostate-barrier?

Answer 21

lipid soluble, weakly alkaline, high pKa

Question 22

Explain the indication or usefulness of the following drugs for bacterial prostatitis:
* Enrofloxacin
* TMS
* Clindamycin and macrolides
* Ciprofloxacin
* penicillins/cephalosporins/aminoglycosides /tetracyclines

Answer 22

Enrofloxacin - recommended, good penetration, covers suspected common pathogens

TMS - Only trimethoprim (not sulfonamide) has good penetration, but evidence of good clinical response - can be considered

Clindamycin/Macrolides - can penetrate barrier, but lack of efficacy against gram-negative bacteria

Ciprofloxacin - not recommended, unpredictable bioavailability

penicillin/cephalosporins/aminoglycosides/tetracycline - not recommended, not good penetration

Question 23

What is the recommended antibiotic treatment duration for bacterial prostatitis?

Answer 23

4 weeks for acute
4-6 weeks for chronic

Question 24

How should a patient be monitored on follow-up for bacterial prostatitis?

Answer 24

prostatic size, rectal palpation, ultrasound
culture not recommended

Question 25

In dogs with struvites, what is the most common bacteria inducing this?
What is the full chemical name of struvite crystals and how do bacteria cause their formation?

Answer 25

Staphylococcus pseudointermedius

Magnesium ammonium phosphate

urease-forming bacteria - hydrolyze urea to ammonia - used for crystals + increase pH

Question 26

For bacterial cystitis induced uroliths, how long should abx tx last?

Answer 26

7 days

Question 27

What is the recommendation for abx tx in uroliths without evidence of bacterial cystitis?

Answer 27

abx rarely indicated
treat as subclinical cystitis