NY Vet: How to Avoid Recurrent UTI

When dealing with companion animals with recurrent urinary tract infections (UTIs), it is important to identify and correct the underlying issues to avoid repeated antibiotic treatment, according to a speaker at the New York Vet 2018 Conference.

In a session supported by PRN Pharmacal, Gary Oswald, DVM, MS, DACVIM, told the audience that there is a “significant percentage of antibiotic use in veterinary medicine for urinary tract treatment,” and he added, while some of it is appropriate use, there is “misuse.” The goal, he said, is to “discourage ineffective and excessive antibiotic use.”

Typical clinical signs of a lower UTI, particularly in cats, can include periuria, pollakiuria, dysuria and stranguria and hematuria.

Bacteria that are typically associated with UTI in animals include Escherichia coli, Enterococcus, and Staphylococcus. Dr. Oswald noted that those patients with subclinical bacteriuria who have no virulence factors, such as typically occurs following previous antibiotic therapy, should not be given antibiotics. He cited a 2014 study in the Journal of the American Veterinary Medical Association that noted in canine patients with subclinical bacteriuria that were not treated with antibiotics, there was no increase in ascension into pyeloneophritis compared with nontreated patients.

“Monitor and consider nonantibiotic treatments [for patients with subclinical bacteriuria] but consider antibiotic treatment if the patient is at risk. If the urine culture becomes symptomatic, treat appropriately,” he said.

Discussing prevention of recurrent UTIs, Dr. Oswald noted that the keys are to correct the underlying issues, improve the general immunocompetence of the patient, improve lower urinary tract defense mechanisms, and to make an inhospitable environment for the colonizing bacteria.

He said resolving metabolic issues, including weight issues that can lead to diabetes mellitus, hyperadrenocorticism, and hypothyroidism, is a good place to start in addressing recurrent UTIs.

Dr. Oswald also encouraged a thorough dermatologic examination for signs that may lead to infections, including checking areas that may be covered in damp or chronically wet hair.

He also described some “underappreciated causes of UTI, including subclinical urethral incontinence, incomplete micturition, and chronic antibiotic use,” as potential contributors to chronic illness. Counseling owners about these issues can prevent repeat trips to the vet office, leading to happier owners and happier pets, he said.