Please Help! Cat with UTI & sick from all Antibiotics

jakigrrr

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My cat Espn (16) has a history of UTIs. Back in 2014, my vet said he had a type of bacteria that would "flair up" in stressful situations (likely due to his PU surgery back in 2012).

In September, we assume it flared up after a stressful vet visit- 2-3 times we found urine right outside of the litter box.
They didn't analyze the bacteria from the first Urinalysis, just gave him an antibiotic shot (Covinia maybe?). When he retested a few weeks later, they said it hadn't been effective. He was prescribed Doxycycline.

After 6 days on Doxycycline, he was vomiting up everything he ate. We managed to get him into a new vet on an emergency basis after 4 days of not eating and vomiting and they gave him probiotics and anti-nausea pills.

We got him back to eating full meals with a daily probiotic and Digestive prescription food. After a week, the new vet put him on Amoxicillin twice a day.
After 3 pills, he was vomiting again and stopped eating. We immediately stopped the antibiotics but over the last 2 days he is only eating about half of his daily food.

I just spoke with the vet who said, "Let's give him Covinia." I mentioned that the old vet had tried that and it didn't work. So she said, let's give him probiotics and digestive food, then start Amoxicillin again. I get the sense that they just don't know how to move forward.

2 Questions: I'm more concerned about his not eating at this point. We haven't had any more peeing accidents (we see him use the litter), and there's no blood in his urine. Is getting the infection taken care of more important than having him eating without vomiting at 16 years old? Before the antibiotics both vets said he was in great shape for his age...now he's got diarrhea (never had before) and not eating. It's frustrating.

2nd Question- what are talking points I should bring up with the vet? They seem frustrated that I pushed back on the usefulness of the 2nd Covinia shot.

Thank you for any help!!!
 

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stephanietx

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I would definitely advise against Convenia. Did they do a sensitivity test to see which antibiotic best treats the infection? Have you tried any supplements such as D-Mannose or Cornsilk to help?
 
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jakigrrr

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I would definitely advise against Convenia. Did they do a sensitivity test to see which antibiotic best treats the infection? Have you tried any supplements such as D-Mannose or Cornsilk to help?
They said that Amoxicillin would be the most effective. They also said the previous vet had notes that he had negative reactions to Amoxicillin, Penicillin, and Doxycycline. We have not tried any supplements, what do those help with? Infection, appetite, or nausea?
 

mrsgreenjeens

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In my opinion, it's best to get him eating without nausea first, then figure out if he still has a urinary issue. Many, many antibiotics tend to make cats sick, sometimes with diarrhea, sometimes with nausea. One of my former cats was so sensitive to almost all antibiotics that the treatment was worse that what ailed him so we withheld antibiotics unless absolutely a matter of life and death. Now I have a cat who gets diarrhea so easily on antibiotics that we are very careful about giving them to him, and always make sure we give a very good probiotics while he is on antibiotics, although we always space them out by a few hours.

One thing I can tell you is that Convenia usually doesn't fix UTIs, at least it hasn't really worked for any of our cats. One of ours ended up getting two injections and it stlll didn't work. NOW we automatically get a urine culture is there is a suspected UTI because even a antibiotic in pill or liquid form will not work if it's the wrong one for the bacteria in the urine. So why go through two weeks of pilling a cat only to have to do it all over again with a different one. Especially if they have bad side effects. BUT, we have also found that often giving them with food can be helpful to avoid nausea. Of course, if they aren't eating, this can be a challenge. When administering meds, it's best to use a new food. In our case, we use something like Fancy Feast broths, which aren't really just broth, but have pieces of chicken or fish and can hide the taste of the meds pretty well. Other people swear by the lickable squeeze up treats like Delectable Stews.
 
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jakigrrr

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In my opinion, it's best to get him eating without nausea first, then figure out if he still has a urinary issue. Many, many antibiotics tend to make cats sick, sometimes with diarrhea, sometimes with nausea. One of my former cats was so sensitive to almost all antibiotics that the treatment was worse that what ailed him so we withheld antibiotics unless absolutely a matter of life and death. Now I have a cat who gets diarrhea so easily on antibiotics that we are very careful about giving them to him, and always make sure we give a very good probiotics while he is on antibiotics, although we always space them out by a few hours.

One thing I can tell you is that Convenia usually doesn't fix UTIs, at least it hasn't really worked for any of our cats. One of ours ended up getting two injections and it stlll didn't work. NOW we automatically get a urine culture is there is a suspected UTI because even a antibiotic in pill or liquid form will not work if it's the wrong one for the bacteria in the urine. So why go through two weeks of pilling a cat only to have to do it all over again with a different one. Especially if they have bad side effects. BUT, we have also found that often giving them with food can be helpful to avoid nausea. Of course, if they aren't eating, this can be a challenge. When administering meds, it's best to use a new food. In our case, we use something like Fancy Feast broths, which aren't really just broth, but have pieces of chicken or fish and can hide the taste of the meds pretty well. Other people swear by the lickable squeeze up treats like Delectable Stews.
I feel like we're reaching the point of no antibiotics unless matter of life or death with him...after the disasters with both Doxycycline and Amoxicillin...but it's hard to gauge how painful the UTI actually is for him. We had been giving both meds with food and probiotics a few hours after. The Amoxicillin round we had switched to the Hills I/D food in hopes that that would make him less likely to vomit. No luck :( Now he just seems to have no appetite at all, which has never been the case for him.
 

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D-Mannose helps with e.coli infections, which is a common cause of UTIs. Cornsilk helps soothe the pain from UTIs. I would try Cerenia for nausea or Pepcid for nausea to get his tummy settled down enough to eat. You can try adding in some probiotics such as s. boulardii or even the human probiotic, Culturelle (no more than 1/2 capsule daily into wet food) to help with diarrhea.
 

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Urine culture is an absolute must to identify the bacteria involved. There are some 'harmless' forms of bacteria that don't need treated. However, looking for stones/crystals/sediment is also crucial to what might be behind a UTI. Urine PH, blood and/or protein also play a role in determining what might be causing a UTI. Pure D-Mannose works to rid the bladder of more than just e-coli, so while it won't resolve an actual infection, it can be used as a preventative measure. If stress is the cause, an anti-inflammatory might help.

Try baby food meat (Gerber Stage 2 or Beechnut) to see if you can get him eating again. Most cats, even those with limited appetite, like them enough to eat them - and, in many cases can jumpstart them to eating again. S. boulardii is good before, during, and after antibiotics, as its benefits are not diminished by antibiotics like so many other probiotics.
 
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jakigrrr

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D-Mannose helps with e.coli infections, which is a common cause of UTIs. Cornsilk helps soothe the pain from UTIs. I would try Cerenia for nausea or Pepcid for nausea to get his tummy settled down enough to eat. You can try adding in some probiotics such as s. boulardii or even the human probiotic, Culturelle (no more than 1/2 capsule daily into wet food) to help with diarrhea.
He's currently getting the Purina pre-biotic/probiotic combo. We did get him on Cerenia after he was vomiting on Doxycycline and had gotten him back up to a normal eating habit- though he was still having diarrhea by the time we gave him Amoxicillin.
 
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jakigrrr

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Urine culture is an absolute must to identify the bacteria involved. There are some 'harmless' forms of bacteria that don't need treated. However, looking for stones/crystals/sediment is also crucial to what might be behind a UTI. Urine PH, blood and/or protein also play a role in determining what might be causing a UTI. Pure D-Mannose works to rid the bladder of more than just e-coli, so while it won't resolve an actual infection, it can be used as a preventative measure. If stress is the cause, an anti-inflammatory might help.

Try baby food meat (Gerber Stage 2 or Beechnut) to see if you can get him eating again. Most cats, even those with limited appetite, like them enough to eat them - and, in many cases can jumpstart them to eating again. S. boulardii is good before, during, and after antibiotics, as its benefits are not diminished by antibiotics like so many other probiotics.

He's had 2 urine cultures at this point- one from each vet. It didn't sound like PH or protein were issues, but it's hard to tell from the lab results I attached. The original vet had said this specific bacteria is likely something he picked up because of his PU surgery. Definitely interested in seeing if the Pure D-Mannose can help.

We did try baby food after his vomiting on Doxycycline but it's not working this time, unfortunately, it feels like he's associating most of the food we have with being sick now. :(
 

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Try a completely different food...something he's never had before. Either that or you're going to need to force feed him because not eating is really not an option. Has he ever shown an interest in people food? I'm wondering if he'd eat a poached chicken breast if you cooked one up for him? Don't use any spices or herbs (or onions or garlic), just gently poach it and let it cool and shred it up for him to eat along with the broth it makes. That should be good for his tummy and intestines. This isn't a completely nutritious food for a cat, but can be fed for several days if he likes it. You could probably use thighs too as long as you trim them pretty well. No bones though.

I'm thinking if you can just jump start his appetite, maybe he'll start up eating again.
 
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jakigrrr

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Try a completely different food...something he's never had before. Either that or you're going to need to force feed him because not eating is really not an option. Has he ever shown an interest in people food? I'm wondering if he'd eat a poached chicken breast if you cooked one up for him? Don't use any spices or herbs (or onions or garlic), just gently poach it and let it cool and shred it up for him to eat along with the broth it makes. That should be good for his tummy and intestines. This isn't a completely nutritious food for a cat, but can be fed for several days if he likes it. You could probably use thighs too as long as you trim them pretty well. No bones though.

I'm thinking if you can just jump start his appetite, maybe he'll start up eating again.
He's been on a Urinary SO prescription for around 10 years so we've avoided giving him different food until recently. He was enjoying the Hills I/D prescription food until he started vomiting it up. He's eaten most of his 1st can today (went back to Urinary SO), we might give him some of our other cat's food tomorrow if he's still not eating at least 75% of what he should be!

The vet confirmed we can give him half of a Cerenia pill too to see if that helps his appetite at all.
 

stephanietx

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If he is still not eating, try the original pate Fancy Feast (no fish) or get Science Diet a/d from the vet. It's not a forever food, but one to get him eating.
 
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jakigrrr

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He did better yesterday, ate a full can, around 1/4-1/3 of another can, and a 1/8th cup of dry food.

The vet wants him to come back in, but I'm not sure if that's necessary at this point?
I know I don't want to give him the Covinia shot and I can't imagine we'll try Amoxicillin again...
That being said, we haven't seen him do anything other than pee in the litter since Sunday. I'm hoping he'll go today after having more food.
 

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Are you saying no pee or poop since Sunday, or just no poop since Sunday? You said earlier he was having diarrhea...I guess it's possible that completely emptied him out and now his slow eating is taking time to build up some stool, but would hope that by now something would be happening. Of course, with all his urinary issues, you know that no pee since Sunday would be a huge red flag, so guessing it must be just no poop since sunday.
 
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jakigrrr

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Are you saying no pee or poop since Sunday, or just no poop since Sunday? You said earlier he was having diarrhea...I guess it's possible that completely emptied him out and now his slow eating is taking time to build up some stool, but would hope that by now something would be happening. Of course, with all his urinary issues, you know that no pee since Sunday would be a huge red flag, so guessing it must be just no poop since sunday.
Yes, no poop that we've seen since Sunday. Of course, if he isn't having diarrhea anymore, it's harder to distinguish his from our other cat's.
Agreed, the last few days we wrote it off to not eating much, but I'm getting nervous not catching him going today yet.
 
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jakigrrr

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He's just about back to eating normally! Schedule is a little off but he's getting blood pressure meds, gabapentin, and a probiotic again :)

So prepping for next steps: Does anyone have experience with repeat UTIs and bad reactions to antibiotics?

If we can't go an antibiotic route, what can we do? If the vet pushes for trying Amoxicillin again, my gut says not to do it because both antibiotics sent him into a week of not eating normally, diarrhea, etc.
 

stephanietx

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Stand your ground on NO CONVENIA shot. I would ask the vet to find another antibiotic that might help, but if the vet isn't listening to you, I might go looking for a new vet.
 

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Hi.
As far as I know, Convenia is a third generation cepholosporin antibiotic and doesn't work on enterococcus. I could be wrong. I have posted a link to some information below.
On your cat's urinalysis, I noticed that the urine is very dilute. Had your cat been on fluids at the time the urine was collected? If not, I would worry about kidney disease or diabetes.
What is your cat eating and how is your cat's weight?
If it was my cat, and if things were doing ok, I wouldn't give antibiotics. I would feed only canned food and try to encourage him to drink by getting a water fountain (cat) and having a couple of places where he can have access to fresh clean water.
I would make sure to have a few clean litter boxes with unscented litter for him to use. I would also make sure his needs are met with a scratching post and places he can go up high if he choses to. I would also make sure there isn't any cat drama going on in the home.

Does he have any other medical issues going on besides the bladder ?
 
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jakigrrr

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Hi.
As far as I know, Convenia is a third generation cepholosporin antibiotic and doesn't work on enterococcus. I could be wrong. I have posted a link to some information below.
On your cat's urinalysis, I noticed that the urine is very dilute. Had your cat been on fluids at the time the urine was collected? If not, I would worry about kidney disease or diabetes.
What is your cat eating and how is your cat's weight?
If it was my cat, and if things were doing ok, I wouldn't give antibiotics. I would feed only canned food and try to encourage him to drink by getting a water fountain (cat) and having a couple of places where he can have access to fresh clean water.
I would make sure to have a few clean litter boxes with unscented litter for him to use. I would also make sure his needs are met with a scratching post and places he can go up high if he choses to. I would also make sure there isn't any cat drama going on in the home.

Does he have any other medical issues going on besides the bladder ?

For that urinalysis, he may have received fluids, but I'm not positive. They had kept him there for 2 hours because he didn't have enough urine. I had also been told his may be more diluted because he's been on a Urinary SO diet for around 10 years which causes him to drink more. He's always been a big water drinker anyway (have a fountain and bowls around the house) and so far all of his blood work hasn't indicated kidney disease (knock on wood). He's had 3 blood draws and 3 urine tests since end of September, most recent being about 2 weeks ago.

He's been primarily on Urinary SO but the last vet suggested Hills I/D because of the antibiotics causing vomiting and diarrhea.... as of yesterday I can finally confirm he has normal stools again, so I feel better about that! He's not eating the Hills I/D anymore and is back to scarfing down the Urinary SO (canned food). Normally his weight sits around 14.6 (he's a big-boned tuxedo cat) but after his 2 vomiting incidents, he went down to about 13.8-14 lbs.

Besides the bladder infection, he has high blood pressure and arthritis. He takes 1/4 pill of blood pressure meds every 12 hours and gabapentin twice daily.

Thank you for your thoughts on antibiotics! My gut is saying we shouldn't risk it but it doesn't feel natural to not try and beat an infection, so I've been struggling with that.
 
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