Antibiotici per UTI sec. Working group of the International Society for Companion Animal Infectius Diseases

21 marzo 2017

Amoxicillin           11–15 mg/kg PO q8h       Good first-line option for UTIs.
Excreted in urine predominantly in active form if normal renal funnction is present. Ineffective against beta-lactamase-producing bacteria.

Amikacin           Dogs: 15–30 mg/kg IV/IM/SC q24h            Cats: 10–14 mg/kg IV/IM/SC q24h
Not recommended for routine use but may be useful for treatment of multidrug resistant organisms. Potentially nephrotoxic. Avoid in animals with renal insufficiency.

Amoxicillin/clavulanate           12.5–25 mg/kg PO q8h
Not established whether there is any advantage over amoxicillin alone.

Ampicillin           Not recommended because of poor oral bioavailability.  Amoxicillin is preferred.

Cephalexin, Cefadroxil           12–25 mg/kg PO q12h
Enterococci are resistant. Resistance may be common in  Enterobacteriaceae

Cefovecin           8 mg/kg single SC injection.
Can be  repeated once after 7–14 days.  Should only be used in situations where oral treatment is problematic. Enterococci are resistant. Pharmacokinetic data are available to support the use in dogs and cats, with a duration of 14 days (dogs) and 21 days (cats). The long duration of excretion in the urine makes it difficult to interpret posttreatment culture results.

Chloramphenicol           Dogs: 40–50 mg/kg PO q8h           Cats: 12.5–20 mg/kg PO q12h
Reserved for multidrug resistant infections with few other options. Myelosuppression can occur, particularly with long-term therapy. Avoid contact by humans because of rare  idiosyncratic aplastic anemia.

Ciprofloxacin           30 mg/kg PO q24h
Sometimes used because of lower cost than enrofloxacin. Lower and more variable oral bioavailability than enrofloxacin,  marbofloxacin,  Difficult to justify over  approved fluoroquinolones. Dosing recommendations are empirical.

Doxycycline            3–5mg/kg PO q12h
Highly metabolized and excreted through intestinal tract, so urine levels may be low. Not recommended for routine uses.

Enrofloxacin             Dogs: 10–20 mg/kg q24h           Cats: 5mg/kg PO q24h
Excreted in urine predominantly in active form. Reserve for documented resistant UTIs  but good First-line choice for pyelonephritis (20mg/kg PO q24h). Limited efficacy against Enterococci.  Associated with risk of retinopathy in cats. Do not exceed 5mg/kg/d  of enrofloxacin in cats.

Imipenem-cilastatin           5 mg/kg IV/IM q6-8h
Reserve for treatment of multidrug-resistant infections,  particularly those caused by Enterobacteriaceae or Pseudomonas aeruginosa. Recommend consultation with a urinary or infectious disease veterinary specialist or veterinary pharmacologist prior to use.

Marbofloxacin           2.7–5.5mg/kg PO q24h
Excreted in urine predominantly in active form. Reserve for documented resistant UTIs but good First-line choice for pyelonephritis.

Nitrofurantoin           4.4–5mg/kg PO q8h
Good second-line option for simple uncomplicated UTI,  particularly when multidrug-resistant pathogens are involved.

Trimethoprim-sulfadiazine           15 mg/kg PO q12h
Note: dosing is based on total trimethoprim + sulfadiazine concentration  Good first-line option. Concerns regarding idiosyncratic and immune-mediated adverse effects in some patients, especially with prolonged therapy. If prolonged (>7d) therapy is anticipated, baseline Schirmer’s tear testing is recommended, with periodic re-evaluation and owner monitoring for ocular discharge. Avoid in dogs that may be sensitive to potential adverse effects  such as KCS, hepatopathy, hypersensitivity, and skin eruptions.

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Categorie: Area Scientifica