In this era of One Health, responsible antibiotic stewardship is required of all providers in human and veterinary medicine. Development of multi-drug resistant bacterial strains, loss of antibiotic efficacy, and poor patient outcomes are among the possible consequences of antibiotic use in diseases that actually do not involve bacterial infections, or the use of antibiotics not targeted to the pathogens involved in bacterial infections. A number of working groups and professional organizations, including the American Veterinary Medical Association, American College of Veterinary Internal Medicine, American Animal Hospital Association and American Association of Feline Practitioners, and the International Society for Companion Animal Infectious Disease (ISCAID) Antimicrobial Working Group, have all published veterinary antimicrobial usage guidelines in the last several years.
This report is a retrospective analysis of thousands of medical records of cats who received a diagnosis of respiratory tract or urinary tract infection during a visit to any Banfield Pet Hospital in the USA between January and December 2016. The records of feline patients who received an in-hospital antimicrobial treatment, or a prescription for an antimicrobial from the hospital pharmacy within 14 days following their visit, were reviewed.
The focus of the current article is on the usage of antimicrobials in feline lower urinary tract disease (FLUTD) only. Most cats with clinical signs of FLUTD seen during the period of the study were treated with antimicrobials (19,153 of 22,667; 84.5%); less than half of these patients were treated with drugs recommended by the ISCAID guidelines. Almost 40% (7,656/19,153) of the FLUTD patients treated with antimicrobials had no urinalysis or urinalysis results that were negative for infection. The other 60% (11,497/19,153) received antibiotics in conjunction with a urinalysis positive for infection, but only 11% of these animals (1,299/11,497) also had a urine culture and antibiotic susceptibility testing. And 927/1,299 (71%) of those cats who had urine bacterial culture and susceptibility testing received antibiotics despite no growth on the urine bacterial culture.
When Banfield veterinarians in clinical practice were surveyed, they reported that some clients were unable to afford diagnostic testing for their cats, that it was difficult in some cases to communicate the value and rationale for diagnostic testing in FLUTD, and there were also concerns about the ability of patients and clients to comply with certain treatment regimens. Perceived ease of client and patient compliance based on drug format and ease of administration was a primary driver in selection of antimicrobial drugs for cats, not the ISCAID guidelines, which recommend either amoxicillin or trimethoprim-sulfonamide as first-line antimicrobials in the treatment of both non-recurrent and recurrent UTIs.
