A multicenter study of antimicrobial prescriptions for cats diagnosed with bacterial urinary tract disease

Abstract

Objectives The aim of this study was to evaluate initial antimicrobial therapy in cats diagnosed with upper or lower bacterial urinary tract infections at veterinary practices in the USA and Canada. Methods Electronic medical records from a veterinary practice corporation with clinics in the USA and Canada were queried between 2 January 2016 and 3 December 2018. Feline patient visits with a diagnosis field entry of urinary tract infection, cystitis and pyelonephritis, as well as variation of those names and more colloquial diagnoses such as kidney and bladder infection, and where an antimicrobial was prescribed, were retrieved. Results Prescription data for 5724 visits were identified. Sporadic cystitis was the most common diagnosis (n = 5051 [88%]), with 491 (8.6%) cats diagnosed with pyelonephritis and 182 (3.2%) with chronic or recurrent cystitis. Cefovecin was the most commonly prescribed antimicrobial for all conditions, followed by amoxicillin–clavulanic acid. Significant differences in antimicrobial drug class prescribing were noted between practice types and countries, and over the 3-year study period. For sporadic cystitis, prescription of amoxicillin–clavulanic acid increased significantly and cefovecin decreased between 2016 and 2018, and 2017 and 2018, while fluoroquinolone use increased between 2017 and 2018. Conclusions and relevance The results indicate targets for intervention and some encouraging trends. Understanding how antimicrobials are used is a key component of antimicrobial stewardship and is required to establish benchmarks, identify areas for improvement, aid in the development of interventions and evaluate the impact of interventions or other changes.

Prevalence and Antimicrobial Resistance of Bacterial Uropathogens Isolated from Dogs and Cats

“…Our data, although limited to a small study population, suggest that empiric UTI therapy was often performed with ENR, MAR, or CFV. This was particularly the case in cats, which was previously also noted by Weese et al (2021) [ 84 , 85 ]. FQs and 3GC are classified by the European Medicines Agency (EMA) for “restrict use” in animals to mitigate public health risk, and the WHO classifies them as HPCIA [ 12 , 86 ].…”

Bacteriuria in Cystocentesis Samples from Cats in the United Kingdom: Prevalence, Bacterial Isolates, and Antimicrobial Susceptibilities

“…It has indeed been reported that a large proportion of the total use of cefovecin in the UK (13.7%) is for treatment of lower urinary tract diseases, and in most cases (56%) this drug is prescribed due to an inability to orally medicate the cat [ 28 ]. Furthermore, a recent multicentre study of antimicrobial prescriptions for cats diagnosed with bacterial urinary tract disease in the USA and Canada concluded that cefovecin was the most commonly prescribed antibiotic, with a percentage of use varying between 27 and 61% depending on the type of urinary tract disease diagnosed [ 13 ]. This inappropriate use could not only be ineffective but promote further antimicrobial resistance.…”

“…This inappropriate use could not only be ineffective but promote further antimicrobial resistance. However, Weese and others (2021) also identified an increased consistency with the International Society for Companion Animals Infectious Diseases (ISCAID) guidelines over the 3-year study period, with less use of third generation cephalosporins and fluoroquinolones by study completion [ 13 ]. Although these changes were of relatively low magnitude, they are encouraging indicators.…”

“…Subclinical bacteriuria (SB) has also been reported in cats with a highly variable prevalence (1–29%) [ 7 , 9 , 10 , 11 , 12 ]. However, FLUTD is one of the most common reasons for the use of antimicrobial drugs in veterinary medicine [ 13 , 14 , 15 ]. To prevent further development of antimicrobial resistance, selection of antimicrobial agents should be based on urine culture results and in vitro susceptibility testing in cats, and antimicrobial agents with an appropriate but narrow spectrum of activity should be used.…”

Online survey of owners’ experiences of medicating their cats at home

“…9 Attempts to medicate unwilling cats can result in human injury, 2 but failure to complete a course of medication has wider human health implications if antibiotic courses are not completed, potentially promoting antibiotic resistance, which is a major concern in veterinary and human medicine. 10 Perceptions that cats are challenging to medicate may promote the use of highest priority, critically important antimicrobial drugs, such as cefovecin 11 in a long-acting subcutaneous injection formulation, or other antibiotics such as fluoroquinolones, led by formulation rather than spectrum, which may not comply with the International Society for Companion Animal Infectious Diseases guidelines 12 and raises antibiotic stewardship concerns. Additionally, incomplete antibiotic courses may lead to subtherapeutic antibiotic serum levels, impacting efficacy and the development of resistance.…”