Antimicrobial use guidelines are currently used in human medicine to provide guidance to doctors when selecting drugs to treat a variety of conditions. These guidelines have been instituted to help counteract the rise in antibacterial resistance as well as lessen the overall impact of misuse on patient health. In 2010, the Antimicrobial Guidelines Working Group of the International Society for Companion Animal Infectious Diseases began developing guidelines that may be used to treat dogs and cats with urinary tract diseases. These guidelines are given as general recommendations to aid in the decision-making process. An overview is provided here; to read the complete guidelines, visit http://hindawi.com/journals/vmi/2011/263768.
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SIMPLE, UNCOMPLICATED UTIs
By definition, these urinary tract infections (UTIs) occur in patients that are otherwise in good health and that have had fewer than three previous UTIs in a 12-month period.
Clinical signs (dysuria, pollakiuria, increased urgency) as well as bacteriuria and pyuria should be present. A complete urinalysis along with sediment evaluation is recommended in all cases, along with aerobic bacterial culture and susceptibility testing. The urine sample should be kept refrigerated, and the culture should be performed within 24 hours of collection. Interpretation of the urine culture results will vary based on the sample collection method (Table 1).
Table 1: Urine Bacterial Culture Result Interpretation Based on Sample Collection Method
Initial therapy in most of these patients should consist of amoxicillin or trimethoprim-sulfonamide while you await culture results (Table 2). Clinicians should monitor changes in local resistance patterns in patients with uncomplicated UTIs that may necessitate a change in first-line drug choices.
Table 2: General Recommendations for First-line Antimicrobial Therapy
If a patient demonstrates clinical improvement while receiving the initial therapy despite in vitro resistance based on sensitivity testing, the current treatment should be continued, and a follow-up urinalysis and culture should be performed after the treatment is completed.
If there is no response to treatment and the isolate is resistant to the initial drug choice, an alternative drug should be selected.
Treatment for seven days with appropriate antimicrobials is reasonable for these patients, and monitoring only requires resolution of clinical signs.