Staphylococcus, Antibiotics, Weight Loss

[irinasak]

Sophie (5 years, spayed) was recently diagnosed with staphylococcus spp, which manifests like a claw infection. Because the topical ointment wasn't doing much, the vet prescribed antibiotics - Kesium (amoxicillin and calvulanic acid) 62.5 mg, twice daily for 14 days. We are in day 5. She also takes saccharomyces boulardii and RXNutriGest, which has probiotics in it.

She threw up twice, in the first day and 3rd day, 4-6 hours AFTER the morning dose of antibiotic. She vomited a small quantity of white foam. She also has diarrhea but not severe, once or twice/day in small quantity. Her overall condition is bad. I am sure she has stomach pain, it starts about an hour after the antibiotic and lasts for 3-4 hours after.

She is also losing weight, started before the antibiotic but now is accelerating. She has always been a finicky eater, I opened several threads about her in the past. However, at 3.2 kg/ 7 pounds, she is just bones and skin. There are many things to say - in November 2015 she was in acute renal failure, but recovered. We are testing her kidneys and draw blood every 3 months - last blood work was done on the 20th June, before starting the antibiotic, to see if her kidneys could take it. Blood work fine, all in normal limits (kidney, liver, pancreas, protein levels). CBS also normal. Peeing normal, drinking water as usual, appetite as always (on the poor side, she never ate much, not even as a kitten). But she is so so thin.

Vet says to continue the antibiotics and go see him on Friday, I talked with him today. But Sophie is in pain and is so thin and I am scared.

So, am I crazy? If not, how can I help her?

 

[foxxycat]

Did the vet give any alternatives for treatments? What about adding Pepcid AC? Maybe the meds are giving her an upset stomach. I am sorry to hear your baby has come down with this. Sounds like the meds are hard on her stomach..the vomiting you said is 4 to 6 hours later-is it when she's sleeping and pukes in the middle of the night or is she active then vomits? I would definitely raise this concern to the vet-I see you do bloodwork-wondering if the meds affect the kidneys? Even though you had this done a few days ago-just wonder if it's affecting appetite even more.

Do you give sub fluids at home for treatment of kidney issues?

you can try feeding other foods. Tuna, Chicken-plain cooked, other cooked fish, eggs, baby food meats- there's I think 4 or 5 flavors-these are easy to digest and already pureed-maybe easier on stomach.

I would ask about nausea control-the not eating sounds like nausea=I understand you not wanting to add anymore meds but I would def ask about Cerenia or Zofran-at least for 3 days=see if it helps the vomiting.

What about constipation? That too can cause vomiting=some meds have side effect of constipation. Plain canned pumpkin/plain yogurt can help restore the guts fiber and probiotics to help with this.

 

[irinasak]

Thank you for your reply.
The vet said that if Kesium doesn't work, he wants to try Convenia. I know the discussions about Convenia, but I don't have first hand experience with it. But he is not addressing the side effects, this is why I made an appointment for Friday. I am sure the antibiotics are hard on her stomach, pain and hyper acidity, I can hear her stomach gurgling and she has diarrhea. However, she vomited twice in 5 days but doesn't seem nauseated most of the time (when she is, she licks and smacks her lips, holds head low, tail between legs - but she doesn't do this most of the time. She is sitting, however, in meatloaf position a lot and I can see that she is in pain because her eyes are not so clear). She vomited when she was awake and active, in the evening. I will ask for medications. In the mean time, I am thinking of upping the probiotics and adding some slippery elm bark.

We are monitoring the kidneys, but not treating them. We have decided in December 2015, after ultrasound and numerous blood work, to not treat them because they started working fine again (she was in acute, not chronic renal failure). Her values are within limits (will test again to see if the antibiotics affected them). This is why we go back every three months or sooner if she seems off, because, at this point, she in not on diet, fluids, Azodyl, Ipakitine, binders or anything. But, because the ultrasound showed modifications in both kidneys, we test a lot and are hypervigilent.

I have more cat food than a pet store. It's been five years since I specialized in all available cat food, raw food, dry vs wet debate and my knowledge is useless. She loves one food one day, eats like a champ, than can't stand to see that food anymore. I would feed her angel wings dipped in gold if she would eat them (I have two other cats who are on the chubby side because they enjoy Sophie's leftovers so much).

 

[foxxycat]

I tthink the slippery elm would be fine to try. I have heard many good things about it. I also think adding Cerenia will help the digestive issues you are noticing. Pepcid AC as well. Once the upset stomach gets dealt with-eating will be easier.

I remember my elder girl being fussy about food=I never knew what she would eat from day to day. KMR is also an alternative...either in a can or the powder mixed in water might help.

 

[foxxycat]

Convenia is a good one for skin issues and also treats E Coli. My pumpkin face has had 2 of these-not in same year. She got a kidney infection and we used that-with the help of fluids and pain meds-she was feeling much better in 3 days. I didn't notice any side effects.

I know the internet is full of scary stories-but for me-she was very hard to medicate any liquid meds and the vomiting I worried about so my vet picked this particular medication=it worked for us=all you can do is try. I think if one tries to up the fluid intact=it will help offset side effects=these cats-I wish I could make them drink water like you and I do.

One thing you can ask about is sub fluids when they give the injection of Convenia=not in the same spot=don't want to dilute it-but maybe the fluids will help perk up and help with appetite.

Did you try canned pumpkin for the diarrhea?

I would definitely ask about Cerenia and Pepcid AC for the stomach side effects=both are available as injections- they work for 24 hours. If you feel confident to give at home they can set you up for a few take homes of this medication=3 to 5 days may be all that's needed to get through this hump.

They can also prescribe Cyproheptadine- it's an antihistime BUT also appetite stimulant-this one is 12-24 hours. the other is Mirtazapine. This one is given every 2-3 days=this one has more side effects than the other one. This is also an option=but me personally I would have vet give Cerenia/Pepcid then wait an hour-then give appetite stimulant=otherwise the upset tummy may not go away. Sometimes they just need a short course of these meds to get over the illness hump.

You can always ask the vet about this-I wish more vets would treat nausea without having us to beg them to. Luckily the younger vets are on board with this-it's the older vets I have more of an issue with this kind of treatment-then I remind them our goal is to get the cat eating/drinking without assistance=if they need a few days to get this goal-then what's the harm? I am sorry your vet is not making you feel confident. Sub Fluids afterwards will help give more liquids in their bodies to help flush out said infection is how I understand it. I know it's a lot to take in=this is just my experience with my cats when they have been sick. My vet seems to be right on top of treatments-wish others were too.

Hope this helps.

 

[PushPurrCatPaws]

... , the vet prescribed antibiotics - Kesium (amoxicillin and calvulanic acid) 62.5 mg, twice daily for 14 days. We are in day 5. She also takes saccharomyces boulardii and RXNutriGest, which has probiotics in it.

She threw up twice, in the first day and 3rd day, 4-6 hours AFTER the morning dose of antibiotic. She vomited a small quantity of white foam. She also has diarrhea but not severe, once or twice/day in small quantity. Her overall condition is bad. I am sure she has stomach pain, it starts about an hour after the antibiotic and lasts for 3-4 hours after.

She is also losing weight, started before the antibiotic but now is accelerating. She has always been a finicky eater, I opened several threads about her in the past. ... But Sophie is in pain and is so thin and I am scared.

So, am I crazy? If not, how can I help her?

Thank you for your reply.
The vet said that if Kesium doesn't work, he wants to try Convenia. ... I am sure the antibiotics are hard on her stomach, pain and hyper acidity, I can hear her stomach gurgling and she has diarrhea. However, she vomited twice in 5 days but doesn't seem nauseated most of the time (when she is, she licks and smacks her lips, holds head low, tail between legs - but she doesn't do this most of the time. She is sitting, however, in meatloaf position a lot and I can see that she is in pain because her eyes are not so clear). She vomited when she was awake and active, in the evening. ...
I have more cat food than a pet store. ... She loves one food one day, eats like a champ, than can't stand to see that food anymore. ...

Did your vet tell you to give the antibiotic along with food?

A lot of times, having food with an antibiotic is very helpful for decreasing any nausea or stomach upset that the antibiotic can cause. If she is not eating a lot of food regularly, then an anti-nausea medicine and/or pain medicine would likely help -- has your vet suggested that approach? Even if she isn't always licking her lips (as a sign of nausea), there seem to be plenty of other signs of nausea and discomfort she is showing at other times.

If you are in day 5 of this antibiotic and her symptoms seem to be worsening, is there a way to move up the vet appointment sooner than Friday? Things seem to not be going well and before she "sets up a pattern" of getting worse on this particular antibiotic, I think the vet needs to see her again and you two can talk about what to do.

 

[irinasak]

Thank you very much for your replies. She is on a roller coaster - she feels fine - has the antibiotic - feels bad - feels fine - has the antibiotic and so on. I will take into consideration all of this ASAP - anti nausea, anti acidic, appetite stimulant, food with the antibiotic.

But her weight is what scares me most and she was already a very thin cat. She started eating less before the antibiotic and I suspected the heat wave and the staphylococcus for the lack of appetite (I read that some strains can affect the GI tract). I feel the need to say again that her blood work and cbs are normal. She is also a highly sensitive cat - if the pills alone don't hurt her, than it's the handling and the humans who constantly disappoint her.

I have a dog who is on ivermectin, high blood pressure treatment, liver medicines, was on antibiotics also for 10 days. She is perfectly fine, no side effects, happy, full of energy. Wish Sophie was as strong as Vader.

 

[irinasak]

Just came back from the vet. Sophie vomited twice last night, once at 23.30 and once at 3 am. She also had diarrhea and seemed in a poor condition, so I took her to the vet in the morning.

We have stopped the antibiotic. She was given fluids (Ringer) and anti nausea and anti acidic shots (Cerenia, Arnetin - ranitidine and NoSpa). Her glucose levels were normal, that was tested in house, but the rest of the blood results will come back from the lab tomorrow.

The vet is working with two theories:
1. Those were antibiotic side-effects
2. The antibiotics made an underlying condition worse. As for the underlying condition, we have no idea. As I said before, nothing wrong showed up in the blood work, not even on the 20th of June.

 

[foxxycat]

I am so sorry they don't know what's going on. I would agree that side effects of meds were making things worse. I am glad you got Cerenia and fluids going. That should help. I too have had cats with good blood work results still show symptoms of being sick. The only thing I can think of is some kind of GI involvement. Did they want to try a few days of Pepcid AC to see if it helps with nausea issues going on?

What about Convenia? I think that would be a better option at this point-they can send you home with Cerenia pills to take for the next 3-4 days incase she gets side effect of nausea with the antibiotic.

 

[PushPurrCatPaws]

Take it slow for a few days.

Have you tried putting her food in a slightly different place in the house? Sometimes when my kitty is feeling nauseated, I put her food in a higher (vertical) place than where she normally eats (she normally eats on the floor). Putting the dish up on a flat stool, up off of the floor, or on top of a table or cabinet, gives the cat more of a sense of control and view of their surroundings. When they are feeling ill, this might help them feel less nervous at the food dish. (It's sort of like a power position... which is why cats like cat trees.) I find that my cat when nauseated will eat a bit more than usual if I set her dish on top of a table.

 

[irinasak]

Shophie's blood work is back. Kidney, liver, pancreas ok, protein levels below limit. That was to be expected, given the poor appetite, diarrhea and vomiting she's had this week. Any idea what is the protocol for low protein?

As of yesterday evening (after we came back from the vet and the treatment there), Sophie eats (it is truly wonderful, but I do not want to give you the impression that she eats like a normal cat, but something is better than nothing), drinks water and pees. She still has diarrhea, so that's another thing to address later today when we go back to the vet.

The big question is, what do we do about the stapyloccocus? After this bad reaction, I am so reluctant to try a different antibiotic.

 

[irinasak]

VERY IMPORTANT: Anyone out there knows an online pharmacy that delivers Cerenia tablets in Europe, Romania?

After an extensive visit to the vet, we know this much: in Ro we only have injectable Cerenia. I could really use the tablets. Sophie is fine according to the blood work and she tested negative for FIV, FELV and heartworm, all tested by the vet today because he does not really believe that an antibiotic can cause diarrhea and vomiting (please, don't get me started).

At this point, I have come to the conclusion that the best course of action would be for Sophie to try a different antibiotic, with Cerenia and an anti acid as preventive measures (hence my need for Cerenia tablets, as traveling once a day 50 km - +30 miles to the vet and back for the Cerrenia shot is not really an option).

 

[irinasak]

UPDATE: After the bad reaction to Kesium (amoxicillin and clavulanic acid), which put her on IV fluids and 4 days of Cerenia and Arnetin shots, we gave her something called Enteroguard (metronidazole, furazolidone and oxytethraciclyn) which did NOTHING for her diarrhea, but at least it didn't make her feel worse.

However, the fecal exam came with some very puzzling information: giardia infestation (mild/small infestation, says the lab), e.coli and enterococcus. At this point we do not know what is causing the diarrhea, but, as far as I read, if the e.coli or enterococcus were a problem (they are normal bacteria that live in the digestive tract but can go haywire and infect the host - cat, human, dog), they would manifest more aggressive: bloody diarrhea, fever, bruising, vomiting, pale skin. Her diarrhea is not bloody, she does not have a fever (never did during this period), the vomiting stopped right after we stopped the Kesium, no bruising, no pale skin.

She eats as always and is getting better every day, if it were not for the diarrhea I would say she is 90% her old self.

So we decided to treat for giardia, as the enterococcus is hardest to treat (if anyone is interested in additional information, I will gladly provide) and we really do not know, at this point, what is causing the diarrhea.

So I hope that panacur will do the trick and save us from antibiotics, as I strongly oppose Convenia and Vancomicyn, which the vet recommended if the diarrhea will not stop in 10 days (of course I will choose to treat, if no other option). So we keep our fingers crossed and ask for some vibes, as I feel confident I can fight giardia, but the nosocomial bacteria scare me to death.

Oh, and the staphylococcus infection seems to be improving only with topical treatment yeei.