Has anyone had issues with Veraflox antibiotic or other fluoroquinolones?

[aldreams]

I got Veraflox prescribed for our 18 year old for a UTI and it seems to be very powerful at killing bacteria. But there are strong warnings that it can cause neurological problems and blindness for the cat: Veraflox® Oral Suspension | For Veterinary Professionals

There's also a group of people who have suffered huge nervous and muscle issues from fluoroquinolone antibiotics and basically became almost paralyzed: Floxed by Cipro at 22: ‘A Bomb Went Off in My Body’

So I'm worried about using this antibiotic for our super senior cat (especially since she has a history of seizures and vets believed she had a stroke a few years back). Does anyone have any input? Have you dealt with this before? What do you recommend we do? Is there any way of telling how she might react to the fluoroquinolone before trying it? Thanks!

 

[BlackCatOp]

The fluoroquinolone class of antibiotics have been know to cause retinopathy/blindness in cats. However, Veraflox is a cat only fluoroquinolone and blindness has not been shown with it’s use. I think the warning is there because it is in the same class as Baytril which has caused blindness.

Personally, I would and have used it my senior kitty (17yrs).

 

[aldreams]

The fluoroquinolone class of antibiotics have been know to cause retinopathy/blindness in cats. However, Veraflox is a cat only fluoroquinolone and blindness has not been shown with it’s use. I think the warning is there because it is in the same class as Baytril which has caused blindness.

Personally, I would and have used it my senior kitty (17yrs).

Thanks. Did you get any kind of issues from it, neurological or other? What dosage were you prescribed? Ours has a history of stroke and seizures so I don't want to end up as one of the rare exceptions that get lasting side effects from this drug.

 

[BlackCatOp]

Understand your concern. My kitty had CKD and the dose was lowered to compensate for decreased renal function. I don’t remember what the dose was but that it was lower than the normal amount. Have you talked to your vet about your concerns?

 

[aldreams]

Just came across this, pasting it here for reference.

Pradofloxacin - an overview | ScienceDirect Topics

Katrina R. Viviano, in August's Consultations in Feline Internal Medicine, Volume 7, 2016

Fluoroquinolones
Fluoroquinolones have evolved over time with the goal of improved oral bioavailability and a broader spectrum of activity. Veterinary-approved fluoroquinolones licensed for the cat include second-generation fluoroquinolones (e.g., enrofloxacin, marbofloxacin, and orbifloxacin) and the third-generation fluoroquinolone pradofloxacin. Retinal toxicity in cats has been reported for enrofloxacin and orbifloxacin (Table 4-1), but all fluoroquinolones have the potential to cause retinal toxicity and blindness in cats and should be used with caution.

Fluoroquinolone-associated retinal degeneration in cats is dose dependent and species specific. Cats are deficient in the ATP-binding cassette subfamily G member 2 (ABCG2) protein encoded by the ABCG2 gene. The ABCG2 protein functions as part of the blood-retinal barrier, preventing xenobiotics, including the photosensitive fluoroquinolones, from entering the retina.20 Cats treated with high doses or moderate overdoses of a fluoroquinolone are at risk for retinal degeneration and blindness. To minimize retinal toxicity in cats, clinicians may preferentially use marbofloxacin or pradofloxacin instead of enrofloxacin. In addition, when prescribing any fluoroquinolone for a cat the recommended label dose should not be exceeded, extra-label intravenous use or prolonged treatment durations should be avoided, and empirical dosage adjustments should be considered in cats with underlying kidney disease.21 For example, fluoroquinolones are primarily excreted in the urine and are considered concentration-dependent antibiotics; therefore extending the dosing interval to every other day versus once a day may be an empirical dosage adjustment in a cat with kidney disease and a serum creatinine concentration of 2 mg/dL (177 mmol/L).

 

[aldreams]

I did yes, haven't heard back yet. That clinic is not very thorough unfortunately. We already did a course of amoxicillin that didn't help the UTI, and they wanted to just give us a second course of the same. I had to push to get a stronger antibiotic and I actually specifically asked to get one of the *floxacins because I heard they were effective. That was before I knew about these bad side effects though.

I guess the options are to go with a reduced dose Veraflox and hope for the best. Or to try a third antibiotic that hopefully has fewer side effects but is more effective than amoxicillin.

BlackCatOp are you familiar with any other cat antibiotics? I have the bacterial culture report in my other thread. Do you have any recommendations based on that by any chance? From what I understand the ones with a <= are supposed to be effective (but I'm not too sure how that works).
Pls help! Cat has blood in urine and couldn't get up off the floor yesterday

 

[BlackCatOp]

So, choosing an antibiotic is complicated by the fact that the antibiotic needs to concentrated in urine. (Meaning that it needs to get to the site of infection which in this case is the bladder) Not all antibiotics are concentrated and excreted in the urine - So even when the sensitivity comes back “sensitive” that antibiotic may be ineffective as the testing is performed in vitro when assessing that antibiotic and may not reach the site of infection.

I know that didn’t answer your question but…

So labeled dose for Veraflox is 7.5mg/kg - just so you have a point of reference.

 

[aldreams]

Thanks, that helps a lot. The vet prescribed 1.5 ml per day, which works out to 37.5 mg per day. The cat is 2.6 kg so the appropriate dose should be just under 20 mg per day. All this to say I probably need to find a new vet

I'm thinking of trying a reduced dose to see how it goes, maybe 10 mg per day or less. I'm not too sure about this, but it seems like toxicity would be less of a risk with lower dosage.

 

[daftcat75]

Thanks, that helps a lot. The vet prescribed 1.5 ml per day, which works out to 37.5 mg per day. The cat is 2.6 kg so the appropriate dose should be just under 20 mg per day. All this to say I probably need to find a new vet

I'm thinking of trying a reduced dose to see how it goes, maybe 10 mg per day or less. I'm not too sure about this, but it seems like toxicity would be less of a risk with lower dosage.

I would not adjust the dosage without consulting with the vet. If you are concerned that they prescribed the wrong dose, please call back and discuss that with them. Do not make your own dosing decisions. You don't want to under-medicate and have it not be effective.

My senior kitty was on Veraflox a couple of times with no ill effects other than the usual antibiotic nonsense (some nausea and diarrhea.) On a separate occasion, she took marbofloxacin daily for a month for a severe ear infection. I think you should focus on the infection at hand rather than the rare side effect.

A bladder infection was what ultimately proved too much for my Krista. But she also had a stubborn case of GI lymphoma and was on steroids and chemotherapy for a number of months. Her immune system was probably shot. To be honest--I try not to blame my vet for her passing--but had she called back with the results and the prescription at the start of her Saturday instead of the end of the day when there's nothing I could do until Monday, Krista could have had two extra days to start the medication and maybe she wouldn't have been in such a bad state by Monday. She would pass that Wednesday (a year ago this Thursday.) Her case is different than yours. But the point is take the infection in an 18 year old cat more seriously than the possibility of a rare side effect.

 

[BlackCatOp]

I would contact your vet. But it does seem like she is receiving a high dose. Maybe your vet has a reason behind this??

 

[aldreams]

daftcat75 Thanks for the input! I'm sorry you had to go through that kind of trauma around the passing of your cat last year. I agree that talking with the vet is always a good suggestion. I did try to speak with her yesterday but only got the nurse and there was some resistance when I raised my concerns. They told me I could choose to give the Veraflox or not at my discretion and this is all they could do for us for now. Before this I actually had to ask pretty firmly for a stronger AB, because they just wanted to repeat the dose of Amoxicillin, which wasn't effective.

BlackCatOp I guess you may be right about there being a reason. I have some doubts though. I notice that they aren't very thorough at that vet office. They often don't follow up until I do and seem to be doing things pretty superficially.

I tried the Veraflox once at 1/3 the prescribed dose (0.5 ml) on the weekend. It's amazing how effective it was. The redness in the pee went down by about half and hasn't really gone up yet. Maya seems to be walking better now, and it just looks like the infection is less. I've been delaying giving her more until I get some input from other folks. I think I'll start her on the reduced dose so we can balance out the anti-microbial effect with possible side effects. If it's not working well, I might increase the dose gradually. We're also giving her D-Mannose, which I think will help clear up the bacteria. Will write an update in a few days. Thanks all for the input!

 

[daftcat75]

I still don’t think you should make your own dosing decisions. But if you do, I believe you should follow the manufacturer recommended dose of 7.5 mg/kg. That’s been tested safe and effective (safe even to 5X that dose if you read the insert notes.) There’s a real danger in under medicating with an infection: antibiotic resistance. Any bacteria that survives a course of antibiotics will be that much stronger for it. “What doesn’t kill us makes us stronger,” applies to the microbial world just the same. I also don’t recommend starting and stopping. You should finish a course that you start for the same reason. Give it for the full course even if she doesn’t seem to need it after a few days. Finish what you started so that you don’t leave the strongest bacteria to survive and thrive.

 

[daftcat75]

I did try to speak with her yesterday but only got the nurse and there was some resistance when I raised my concerns. They told me I could choose to give the Veraflox or not at my discretion and this is all they could do for us for now.

That was rude and somewhat callous of the nurse. But accurate. You needed to speak to the vet. Nurses can’t make dosing decisions. Only the doctors, the vets, can do that.

 

[aldreams]

I still don’t think you should make your own dosing decisions. But if you do, I believe you should follow the manufacturer recommended dose of 7.5 mg/kg. That’s been tested safe and effective (safe even to 5X that dose if you read the insert notes.) There’s a real danger in under medicating with an infection: antibiotic resistance. Any bacteria that survives a course of antibiotics will be that much stronger for it. “What doesn’t kill us makes us stronger,” applies to the microbial world just the same. I also don’t recommend starting and stopping. You should finish a course that you start for the same reason. Give it for the full course even if she doesn’t seem to need it after a few days. Finish what you started so that you don’t leave the strongest bacteria to survive and thrive.

Hmm that is a good point, I had not thought about how bacterial resistance could play into all of this.

The article I found earlier actually recommends giving a reduced dose to cats with kidney problems, which I suspect ours has. You can check it out above: Has anyone had issues with Veraflox antibiotic or other fluoroquinolones? It seems like it's a balancing act between effectiveness and side effects.

 

[daftcat75]

Hmm that is a good point, I had not thought about how bacterial resistance could play into all of this.

The article I found earlier actually recommends giving a reduced dose to cats with kidney problems, which I suspect ours has. You can check it out above: Has anyone had issues with Veraflox antibiotic or other fluoroquinolones? It seems like it's a balancing act between effectiveness and side effects.

Except that you're not a vet no matter how many veterinary articles you have read. Can you call back the clinic and insist on a call back from the vet?

Possible script for that call:

"I believe he prescribed the wrong dose and I am begging you for the health of my cat to have the doctor call back at his next break or before the end of his day so that we can discuss this. I am concerned about possibly over-medicating my cat. But I also do not want to delay treatment even one day longer."