URI and extended antibiotics treatments?

[2Abyssinians]

We have an 11 months old kitten that has been on antibiotics for the better part of 9 months now. We are trying to treat a chronic URI, or, at least, a heavily clogged nose with accompanying coughing and sneezing and some eye discharge, when symptoms are at their worst.

Over those months, she's had two courses of Azithromycin (minimal improvement), one course of Baytril (no effect at all), and then many courses now of Doxycycline. The Doxy has so far had the best improvement -- pretty quick improvement over first few days but never seems to fully get rid of symptoms entirely. Between most of these courses there has been a gap, perhaps a week or two at most, where symptoms pretty quickly return over 4-10 days. The Doxy has been able to keep her symptoms controlled and with that, she's able to do pretty well, but now, in the middle of that, she has developed patchy fur from constant scratching and grooming, which has made the poor girl look like a mangy mess on top of it all.

The vet indicated she didn't want to try antihistamines for the skin to avoid complicating / confusing the treatment or interpretation of results for the URI symptoms. In the meantime, we have been experimenting with different food types to see if a food allergy could be the culprit for the skin problems. For that, we will probably try a flea and tick treatment to rule that out. I guess it could still be ringworm, but apparently the odds of that are low since it's considered highly contagious, and neither ourselves, nor our other cat have it.

From what I've read, it's not impossible for cats to be allergic to the antibiotic itself, so she could conceivably be having a reaction to the long-term use of the Doxy itself, it seems. (the skin issues have only cropped-up in the last 2-3 months).

One thing confusing me in all this is the general facts that antibiotics are said not to work on viral infections, only secondary, bacterial, infections. However, the fact that she improves on the antibioics at first, might seem to indicate she therefore does have some bacterial infection still(?) (otherwise the antibiotic wouldn't do anything(?)). But either way, why would it be that an antiobitic seems to successfuly "control" an infection but be unable to fully kill it off completely?

Do antibiotics in any way interfere with an animal's natural immune response? Would there ever be an argument that we should let her try to fight it off on her own and that doxy is actually impairing her ability to do that, or does it actually "boost" her immune response?

We also wonder, naturally, whether we might be creating a more resistant infection (if that's what it is) by having these gaps between courses and failing to fully kill it off each time, but the Doxy does such a good job of controlling things, that we convince ourselves that she's cured, only for symptoms to flare up again. The vet doesn't seem concerned about the gaps between courses. Don't get me wrong, on a couple of the courses (the most recent one, for example) we did go through two bottles of liquid Doxy with no break between, so she was continuously on it for approx 5 weeks, I think.

The other general worry, of course, is about keeping her on antibiotics for so long, since that must wreak havoc with her natural biome, etc, but I guess it's the better of the evils.

Anyway, we're at the point now where I think we definitely need to pay for some additional testing to see if they can determine what bug she has, if anything.

We have wondered if it could just be allergies, but I don't think allergies would ever cause those thick green nasal discharge globs that she sneezes out!

Thanks for reading. Any ideas, similar stories, or feedback on any of my thoughts and questions above, appreciated.

cheers.

 

[Jem]

Hi, I'm so sorry you are having to deal with this. It's is very frustrating and disheartening to see our little kitties suffer.
My first question for you is did the vet do a PRC panel on a sample of her discharge? This could also be a fungal infection, but I also wonder about a pseudomonas aeruginosa infection, which can be very stubborn to treat. A proper cultur and PCR panel to determine the exact pathogen you're dealing with is necessary.
I would also highly recommend getting an x-ray, to check the state of the nasal cavity itself, including the possibility of polyps.

Antibiotics don't "boost" the immune system, and in fact sometimes, an active infection can become resistant to an antibiotic if used too much. She could also, due to the length of time she's been having symptoms, now have Chronic Upper Respiratory Disease.

My boy, when we adopted him, had a URI, and like you just didn't want to go away. It would get a bit better for a short time and resurface. Unfortunately my boy has Chronic Upper Respiratory Tract Disease. It was confirmed with an X-ray. His previous/initial infection, that was not take care of properly (he was a rescue) caused permanent damage to the turbinates in the nasal cavity. I don't have a copy, but when looking at the x-rays, his entire nasal cavity is a big giant cave, all the tissu/mucus membranes have been destroyed on one side, making re-infection and irritation from allergens highly likely. We no longer give him any antibiotics, and just try to lessen any type of allergen that can get up into his nasal cavity. He sneezes everyday, sometimes just a bit of clear snot will come out, and sometimes it's a bit more colorful, but we will not medicate unless it shows that an actual infection is present. The x-ray also showed a small tumor that has caused a slight deviated septum. Thankfully, it was just a mass of scarred inflamed tissue, we had it biopsied...no cancer.

So for us, how we treat is...
Eliminate as many allergens from his environment as possible. More dusting and cleaning, less dusty litter, air purifiers, etc...
We also help keep his nasal cavity "cleaned out" by using basic pure saline nose drops up his nose every once in a while...sort of like how a netty pot keeps human noses cleared of debris.
So far since doing this, we have not had to give him any antibiotics. Sometimes, his discharge will look a little on the "infected side", but a few days of nose drops and it clears itself.

As for your girls skin, where is the fur loss?

 

[Jem]

The Doxy has so far had the best improvement -- pretty quick improvement over first few days but never seems to fully get rid of symptoms entirely. Between most of these courses there has been a gap, perhaps a week or two at most, where symptoms pretty quickly return over 4-10 days

One more thing.
When we were trying to get the initial infections under control, as a last ditch effort, our vet gave us an UNinterrupted course of Doxy (was the one that worked best for us as well) It was (I think) once (or twice) a day for 10 days, followed by one dose every three days for 6 weeks...non stop. It's the starting and stopping of antibiotic use that causes resistance. So perhaps talk to your vet about this as well. That is what finally got the infections under control, but as I said, he will always be a snotty, eye runny kitty, but our efforts have really helped tremendously.
Also....try to stay away from Baytril if you can. It can cause blindness in cats, it's not an antibiotic that my vet will ever prescribe for a cat, although many do unfortunately.

 

[BlackCatOp]

I would suggest seeing an internal medicine specialist. I agree that you have some valid concerns.

1) There are antivirals that are quite effective for upper respiratory infections. This may be helpful for your kitty.
2) Stopping and starting antibiotics does lead to antibiotic resistance

For reference:
After several frustrating years of many vet visits, my kitty has been diagnosed with chronic lymphocytic rhinosinusitis. He was treated for several months empirically with azithromycin + pred and then transitioned to inhaled steroid. He is doing really well after suffering for years. He had adult developed onset of sneezing and snot slinging - he was healthy until ~5 years. I will note that the inhaled steroids aren't cheap but it beats the constant vet visits.

Also, there are some risk using steroids in a sneezing/snotty cat if the infection is fungal. (Depending on your location fungal infections may or may not be common) Steroids can cause fungal infections to become worse.

https://www.michvma.org/resources/Documents/MVC/2018 Proceedings/carey_03.pdf

http://www.delawarevalleyacademyvm.org/pdfs/sep13/4ChronicSneezingCats_2013.pdf