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Clinical Efficacy and Palatability of Pradofloxacin 2.5% Oral Suspension for the Treatment of Bacterial Lower Urinary Tract Infections in Cats

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Clinical Efficacy and Palatability of Pradofloxacin 2.5% Oral Suspension for the Treatment of Bacterial Lower Urinary Tract Infections in Cats J Vet Intern Med 2007;21:990–995 Clinical Efficacy and Palatability of Pradofloxacin 2.5% Oral Suspension for the Treatment of Bacterial Lower Urinary Tract Infections in Cats Annette Litster, Susan Moss, Mary Honnery, Bob Rees, Markus Edingloh, and Darren Trott Background: Pradofloxacin is a 3rd generation veterinary fluoroquinolone designed to restrict the emergence of antimicrobial resistance during therapy. Hypothesis: Pradofloxacin 2.5% oral suspension is a safe, efficacious, and palatable treatment for bacterial urinary tract infections (UTI) in cats. Animals: Seventy-eight cats presented with lower urinary tract signs and were positive on bacterial culture of urine. Methods: Cats were allocated into 3 treatment groups depending on bacterial susceptibility results: pradofloxacin (n 5 27), doxycycline (n 5 23), or amoxicillin-clavulanic acid (n 5 28). All antimicrobials were presented in palatable liquid form. Posttreatment urine specimens were collected after completion of the course of treatment and submitted for bacterial culture and sensitivity. Owners were questioned before and after treatment about their experiences with administering oral medication to their cats. Results: Posttreatment urine culture was negative in all cats in the pradofloxacin group, but there were 3 treatment failures in each of the other groups. Owners’ perceptions of the difficulty of administering oral medication to their cats was more positive posttreatment than pretreatment (P 5 .001; P , .001). There was no difference in palatability among the treatment groups (P . .05). Conclusions and clinical importance: We conclude that pradofloxacin 2.5% oral suspension is a highly effective and safe antimicrobial treatment for bacterial lower urinary tract infection in cats, and that the palatable formulation optimizes owner compliance. These findings make pradofloxacin a useful addition to the veterinary formulary. Key words: Bacterial cystitis; Cats; Fluoroquinolone. lthough clinical signs of lower urinary tract disease a range of canine and feline urinary tract pathogens, A (eg, dysuria, stranguria, pollakiuria, and hematu- including Escherichia coli and Staphylococcus spp.9 ria) are common in feline practice,1 bacterial urinary The aim of this controlled clinical trial was to assess tract infections (UTI) in cats are relatively rare.2 A the clinical efficacy and palatability of pradofloxacin variety of physical and mucosal defence mechanisms in 2.5% oral suspension compared to 2 other commonly the feline urinary tract, including highly concentrated prescribed antimicrobials (doxycycline and amoxicillin- urine, present a relatively hostile environment for clavulanic acid) for the treatment of feline bacterial bacterial growth.3,4 Studies consistently have shown that lower UTI. bacterial cystitis affects less than 3% of cats presenting with lower urinary signs.5–7 However, bacterial UTI are Materials and Methods important to recognize in feline practice because they can be cured with appropriate antimicrobial therapy. By Animals contrast, current treatments for idiopathic feline in- Approval for this study was granted by The University of terstitial cystitis, which has the same presenting signs as Queensland Animal Ethics Committee (Approval Number: SVS/ bacterial cystitis and is commonly diagnosed in practice, 131/05/BAYER). Urine specimens collected by cystocentesis were are only palliative.8 submitted from cats presenting at a number of participating Pradofloxacin is an 8-cyano-fluoroquinolone devel- veterinary clinics in the Brisbane, Queensland area. Only cats that oped to treat bacterial infections in dogs and cats.9 presented with clinical signs of urinary tract disease (eg, dysuria, stranguria, pollakiuria, and hematuria) and determined to have Molecular substitutions at positions C-7 and C-8 have positive bacterial urine cultures were included in the study. greatly enhanced the bactericidal activity of pradoflox- Signalment and clinical history were obtained for each cat, and acin compared to earlier fluoroquinolones, especially for a full urinalysis and bacterial culture were performed on all urine 9 pathogens with reduced fluoroquinolone susceptibility. specimens. After bacterial culture-positive status was confirmed, It has been shown in vitro to be highly active against cats were allocated into 1 of 3 antimicrobial treatment groups: pradofloxacin 2.5% oral suspension (recommended dosage 0.2 mL/ From the School of Veterinary Science, The University of kg q24h for a minimum course of 10 days); 100 mg/g doxycycline Queensland, Brisbane, Australia (Litster, Moss, Honnery, Trott); monohydrate paste (recommended dosage 5 mg/kg as a loading and the Bayer Health Care, Animal Health Division, Australia Ltd, dose, followed by 2.5 mg/kg q12h for 2 doses, and then a mainte- Brisbane, Australia (Rees); and the Bayer Animal Health, nance dosage of 2.5 mg/kg q24h for a minimum of 10 days); or Leverkusen, Germany (Edingloh). 62.5 mg/mL amoxicillin-clavulanic acid oral suspension (recom- Reprint requests: Annette Litster, School of Veterinary Science, mended dosage 62.5 mg/cat q12h for a minimum of 10 days), The University of Queensland, St. Lucia, Queensland, 4072 depending on results of antimicrobial susceptibility testing. If the Australia; e-mail: [email protected]. bacterial isolate was susceptible to more than 1 of the 3 Submitted February 12, 2007; Revised April 4, 2007; Accepted antimicrobials, the cat was allocated to the group with the fewest May 3, 2007. enrolees. Urine culture and urinalysis were repeated posttreatment, Copyright E 2007 by the American College of Veterinary Internal a minimum of 2 days after the antimicrobial course was completed. Medicine Urine was collected by cystocentesis if possible, otherwise a sterile 0891-6640/07/2105-0015/$3.00/0 urinary catheter was inserted after surgical preparation of the Pradofloxacin for Urinary Tract Infection in Cats 991 perineum. The pupillary-light-response reflex of all cats assigned to Comparisons between scored data were made by means of the pradofloxacin treatment group was examined twice during the the Kruskal-Wallis test for multiple independent groups. Compar- course of antimicrobial therapy. isons of multiple groups of independent data that fulfilled parametric assumptions were compared by means of ANOVA. Urine Culture and Urinalysis Chi-squared tests were used to compare binary data in contingency tables. On receipt, all urine specimens were cultured as described previously.10 Antimicrobial susceptibility patterns for all isolates were determined by the Kirby-Bauer disk diffusion method for Results a range of antimicrobials according to the guidelines of the Clinical Animals Laboratory Standards Institute.11,12 A minimum of 2 mL of urine was centrifuged at 3,000 3 g for Eighty-seven cats met the eligibility criteria (clinical 10 minutes and urinalysis was performed on the supernatant as signs of urinary tract disease and positive bacterial urine previously described.10 culture) and were allocated into a clinical trial antimi- crobial group. Seventy-eight of the 87 cats (pradoflox- Palatability Testing acin, n 5 27; doxycycline, n 5 23; amoxicillin-clavulanic Each owner was asked to complete a questionnaire (see below) acid, n 5 28) completed the entire trial procedure, concerning their previous experiences when medicating their cat, including provision of a posttreatment urinary tract before the cat commenced the clinical trial. This questionnaire was specimen. Course-length statistics for each of the administered by veterinarians or veterinary technicians at partici- antimicrobials were as follows: pradofloxacin, range pating veterinary clinics, who recorded responses on a scoresheet. 11–30 days (median, 18 days); doxycycline, range 14– Numerical scores were allocated to responses, as shown below. The 39 days (median, 28 days); amoxicillin-clavulanic acid, same questionnaire was completed by cat owners after the clinical range 11–46 days (median, 21 days). Course length for trial, concerning their experiences when administering the clinical- the pradofloxacin group was statistically shorter than trial medication to their cats. The questionnaire used after completion of the clinical trial was administered by staff from the for each of the other 2 groups (P , .05). Table 1 reports School of Veterinary Science, The University of Queensland, and the age, sex, and breed characteristics of all cats included responses were recorded on a scoresheet. in the clinical trial at the time the pretreatment urine specimen was obtained. There was not a statistically Questionnaire significant difference among treatment groups for any of Question 1 (before the clinical trial). When giving your cat these parameters. Urine was collected by cystocentesis medication that must be swallowed, which of the following best describes your previous experience: for 75 pretreatment urine specimens (pradofloxacin, n 5 Question 1 (after the clinical trial). When giving your cat the 25; doxycycline, n 5 22; amoxicillin-clavulanic acid, n 5 clinical-trial medication that must be swallowed, which of the 28), whereas urinary catheterization was used to obtain following best describes your experience: the remaining 3 specimens (pradofloxacin n 5 2 and doxycycline n 5 1). One of the 2 specimens obtained in a. Impossible: 22 the pradofloxacin group by catheterization produced b. Have difficulty but succeed: 21 a heavy ($100,000 colony forming units/mL) pure c. Use avoidance tactics (eg, hide in food): 0 growth of
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