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Continued from Animal Sheltering magazine, Jul-Aug 2009 The Best Medicine The lowdown on upper respiratory infections in cats By Brenda Griffin, D.V.M. Guidelines for Treating URI Treating cats can be rewarding for staff and a boost to morale—as well as a lifesaver for cats! The good news is that mild cases may limit themselves within a few days, and no treatment will be necessary besides supportive care and a little TLC. In other cases, clinical signs may last as long as two to three weeks and require substantially more treatment and monitoring. In a few cases, cats who are severely ill and/or fail to respond to appropriate medical therapy may have to be euthanized unless additional veterinary care can prevent them from suffering and succumbing to infection. Supportive Care All cats with URI will need supportive care, but they won’t necessarily need antibiotics. Remember, antibiotics are antibacterial, not antiviral, and most cats with URI have viral infections. When you have a cold, your physician does not routinely prescribe antibiotics for you unless you develop a secondary bacterial infection (such as a sinus infection). Instead, your doctor will tell you to rest and drink plenty of fluids. For cats, supportive care means keeping them warm, comfortable, and clean (by gently wiping their noses and eyes as needed), and encouraging them to eat and drink so that they do not get dehydrated. When cats get dehydrated, their respiratory secretions become thick, impairing proper drainage and compromising the normal protective function of the respiratory tract. Dehydration also makes sick cats feel even worse, leading to an even poorer appetite and ever-worsening dehydration. In turn, dehydration often leads to more severe disease, including the development of secondary bacterial infections. A cat’s appetite is closely related to her sense of smell, so the nasal congestion that occurs with URI (coupled with a sore throat) will often cause cats to lose their appetites. To encourage their appetite, all cats with any signs of URI should be offered canned foods—the smellier the better! Selecting food with a strong fishy smell and warming it slightly may help to stimulate the appetite of some cats. Canned foods are also easier than dry foods for cats with sore throats to swallow—and because they are composed of approximately 80 percent water, they help prevent dehydration. It is usually easier to get cats to eat canned food than it is to get them to drink water. Some cats can be tempted to drink by an offer of warm milk; however, many cats are lactose-intolerant, and more than a few laps of milk can result in diarrhea—the last thing a cat with a URI needs. If you do try to encourage drinking, stick with lactose-free milk or the watery juice from a can of tuna. Meat-based baby food can also be fed to cats to stimulate their appetites, but only use foods that do not contain onion powder—a common ingredient that can be highly toxic to cats. Because they are so small, cats can rapidly become dehydrated if they do not consume adequate volumes of fluid. They must be monitored daily to ensure proper hydration. Cats who are dehydrated, have a fever, and/or are not eating will need fluid supplementation. This can be accomplished by administering fluids under the skin (subcutaneously), but it’s important to give the correct volume. Cats should receive the fluid volume required to correct dehydration, meet their daily maintenance requirements, and replace any ongoing losses (such as those from nasal and ocular secretions). Relatively large volumes (300 to 400 ml) can be safely administered to most adult cats as a single subcutaneous dose at a single injection sight. Gently massage the injection area to help diffuse the fluid and prevent undue stretching that could cause tissue injury or pain. Staff must be trained to assess hydration and administer fluids as needed; under-dosing of fluids is a common reason that treatments fail. (Guidelines for assessing hydration and dosing fluids can be found at the end of this article.) Nutrition is extremely important for sick cats, and their appetites must be closely monitored. Cats who refuse to eat risk developing severe complications. Small kittens can become severely hypoglycemic, which can cause weakness and even death. Hand-feeding young kittens may save their lives, provided they swallow the food. But if hand-feeding for a day or two fails to jumpstart their appetite, you should seek veterinary care and, if additional resources are not available, consider humane euthanasia. Adult cats who do not eat for several days can develop hepatic lipidosis, a life-threatening condition that causes liver failure and other metabolic derangements that lead to death without aggressive veterinary care. Cats who refuse to eat for more than three to five days should be examined by a veterinarian. In some cases, force-feeding via a syringe can help, but most staff aren’t able to feed a sufficient amount to meet the cat’s caloric requirements. For example, an average 8-pound cat requires about 230 calories per day for maintenance. At a minimum, he should receive half of this amount to prevent rapid weight loss and the development of hepatic lipidosis. Hill’s Prescription Diet A/D is a specially designed, high-calorie diet that easily passes through a syringe and is meant to provide nutritional support to sick cats who refuse to eat. One can of A/D contains 5.5 ounces or 150 ml and 180 calories. To meet the nutritional needs of an average 8-pound cat, you would have to get him to swallow nearly 200 ml of A/D from a syringe in one day. To successfully feed him even half of that volume could be very difficult. By comparison, a 3-ounce can of Fancy Feast typically contains between 70 and 100 calories, so he would need to consume more than two cans per day to meet his needs, or a least one can per day to prevent rapid weight loss. Small kittens typically require two and a half times as many calories as adults. In fact, a 2-pound kitten requires approximately 175 calories per day. Given the difficulty of ensuring adequate nutrition for cats who will not eat well on their own, monitoring body weight, appetite, and dehydration is essential for proper welfare and treatment. To complicate matters, some cats (particularly adults) develop food aversion when they are ill. After continually being offered food, they associate its sight and smell with feeling sick or nauseous, and thus refuse to eat even when they are feeling better. For this reason, when cats refuse to eat on their own, it’s best to offer them enticing food two to three times during the day, but to remove it if the cat does not eat within a couple of hours. It’s important to allow shy cats who may not eat in front of you an opportunity to eat when you are away—but leaving food next to a sick cat all of the time can lead to food aversion and actually decrease your chance of success. Instead, you should tempt him with food periodically. Additional Treatments for Cats with URI A variety of treatments may be required, depending on the signs an individual cat is exhibiting and the severity of the illness. For cats with mild signs, such as sneezing or clear discharge from the nose or eyes, provide supportive care as needed and monitor them closely for several days to see if the signs resolve themselves or worsen; if they get worse, seek additional treatment. Be sure to monitor and record their attitude, appetite, the quantity and character of nasal and ocular discharge, hydration status, and litter box results daily. In addition, check body weight twice weekly and temperature as needed, based on the severity of the symptoms. Some cats will develop conjunctivitis (“pink eye”) and have red, runny eyes. If the discharge is watery or clear mucous (which can look brownish when it dries), keep the eyes clean by wiping them with a moist paper towel or cotton ball. If the eyes are squinty, and thick yellow or green ocular discharge is present, provide topical eye medication. Monitor the cat closely for several days to see if the signs are getting better or worse. If the cat continually holds the eye shut or the cornea looks cloudy, a painful ulcer could be present, and the eye is at risk of rupture. The cat should be examined by a veterinarian. When it’s necessary to provide topical treatment for conjunctivitis, the cat’s eyes should be treated with tetracycline or erythromycin containing eye ointments. (Use a one-quarter-inch strip in both eyes two to three times a day.) These are the best choices because they are broad-spectrum, non-irritating, and are effective against Chlamydophila, which is a bacterial cause of conjunctivitis sometimes seen in shelters. Triple antibiotic ointments (usually Neomycin, Polymyxin, or Bacitracin) can cause severe irritation in some cats. Ophthalmic ointments containing steroids (such as hydrocortisone or dexamethasone) should never be used in cats with conjunctivitis since they can exacerbate ulcers and prevent healing. Ocular discharge should be removed with a moist paper towel before you apply eye ointment. Diluted betadine solution (1 part betadine: 30 parts saline) can also be used to treat feline conjunctivitis (one drop in both eyes, two to four times a day). Betadine is inexpensive, readily available, and has both antibacterial and antiviral properties. Cats who develop thick purulent (pus-like) yellow or green nasal discharge probably have secondary bacterial infection. Such cats should be treated with supportive care plus antibiotics. Antibiotics are not effective for treating viral infections, but they are appropriate for cats who have thick, yellow-green nasal discharge because this is a sign of secondary bacterial infections. For feline URI in the shelter, doxycycline is often considered the drug of choice for treatment when antibiotics are needed. This drug: - Has a broad spectrum of activity and is highly effective against the common bacterial agents that are associated with URI in the shelter (e.g. Bordetella, Mycoplasma, Chlamydophila). Other antibiotics, including amoxicillin, clavamox, and cefadrops, are not effective against these bacteria - Penetrates the respiratory tract, reaching therapeutic concentrations where they are - Is safe for cats and kittens of all ages when used appropriately; generally does not cause discoloration of teeth, as other tetracyclines are known to do. - Should not be given to cats in tablet form, because it can cause serious ulcers of the esophagus if it “sticks” in the throat. Although a commercially available liquid suspension is available, it is very expensive. In contrast, both doxycycline tablets and capsules are very inexpensive and can be made into a liquid suspension and safely administered to cats. Tablets can be crushed in a coffee grinder. Use a compounding syrup, vitamin syrup, chicken broth, or other liquid (in small such small quantities, even milk is acceptable and should not cause significant reduced absorption) to make your own suspension. Ensure that the proper dosages and course of antibiotics are used. 1. Doxycycline: 5-10 mg/kg by mouth twice daily 2. Do not underdose 3. Treat for a minimum of 10 days, or for five to seven days beyond the resolution of the Antimicrobial resistance is a serious concern in animal shelters. When antibiotics are used too frequently, or at inadequate dosages or for inadequate periods of time, bacteria can develop resistance to them—causing the antibiotic to lose its effectiveness against the strains of bacteria in the shelter. This is extremely dangerous and is the reason why antibiotics should never automatically be administered to cats without a definite indication that they are needed (e.g. thick yellow-green nasal discharge). Likewise, constantly changing antibiotics can also spur resistance. If a cat fails to respond to supportive care and doxycycline after three to five days, consult your veterinarian for advice or consider euthanasia. (For a dosing chart for doxycycline, see the end of this supplement.) Lysine Lysine is an amino acid that inhibits replication of the herpes virus. It is widely available as an over-the-counter supplement at most drug stores. Some shelters routinely administer lysine to all cats in an effort to prevent URI, as well as to all sick cats as an adjunct to treatment. Unfortunately, lysine has not been shown to be effective for prevention or treatment of URI in recently published findings from field trials in shelters. Because of the lack of proven benefits, I don’t recommend the routine administration of lysine to cats with URI, especially considering the added expense and time associated with its use. Studies do, however, suggest that lysine may hasten recovery of cats with chronic conjunctivitis. If the shelter is treating a cat with chronic conjunctivitis (e.g. more than two weeks), lysine may be beneficial. The correct dosage is 250 to 500 mg by mouth twice daily. Cats with chronic disease should be examined by a veterinarian. Fever and pain Remember, just because a cat has a fever does not mean that a bacterial infection is present and that antibiotics are warranted. Sometimes, when you have a cold virus, you run a fever. In cats, fever spikes commonly occur with calicivirus infection. Painful oral ulcers may also be present. Cats with high fevers (more than 104.5 degrees) and/or pain may benefit from a single dose of a nonsteroidal anti-inflammatory agent such as meloxicam or carprofen (ask your veterinarian). However, these drugs are highly toxic and can cause fatal kidney damage when given to dehydrated animals. They should only be given as a single dose to well-hydrated patients. Repeated doses increase the risk of complications, and a single dose will often last for 48 hours, making additional doses unnecessary. Tylenol is fatally toxic to cats even in a single small dose and should never be given. Monitoring Sick animals should be examined daily by medical staff. This is required to ensure the adequate monitoring of recovery or progression of disease so that appropriate actions may be taken. Cats who are well on their way to recovery may be moved to transition isolation areas to allow room for cats with more severe disease to enter isolation. Many shelters offer cats for adoption despite mild signs of illness. Some shelters provide foster-to-adopt contracts, while others rely on free post-adoption pet insurance to help provide for aftercare if needed. Subcutaneous (SQ) Fluid Therapy for Kittens and Cats in the Shelter For subcutaneous fluids, use warm solutions of crystalloids such as LRS. It is essential to use warm fluids in small kittens to prevent chill and hypothermia. Adult cats with fevers may benefit from administration of room-temperature fluids; this will often serve to bring down their fever. Volume to administer is based on dehydration; maintenance; and ongoing losses. First, correct dehydration (use tables below to estimate percent dehydration and determine the volume needed for rehydration). Once the feline is hydrated and warm, he/she will hopefully eat and drink. Try hand feeding: canned food is 70-80 percent water, so 1 ounce of canned food contains approximately 20-25 ml. of fluid. Once the dehydration is corrected, 30 ml. of fluid per pound per day is needed for maintenance (for example, a 2-pound kitten needs 60 ml. of fluid per day). If the kitten is not taking in this volume orally, you will need to supplement the oral fluids with SQ fluid. If the kitten has ongoing losses (through diarrhea or nasal and ocular discharge, for example), maintenance needs will be higher: 45-60 ml per pound per day depending on the severity of the loss (and how much the kitten is taking in orally). In most cases, it is best to err on the side of too much fluid rather than too little. If you administer too large a volume of fluid, it will not be absorbed and you will be able to feel it persisting under the skin. This usually indicates that the kitten is well-hydrated and does not need additional SQ fluids. Fluids can be given once or twice daily (or more often if needed) to maintain hydration. Estimating Percent Dehydration - For URI, always treat for a full course of at least 10 days minimum, longer if needed Failure to follow these two rules can lead to resistant infections, which are extremely dangerous in the shelter environment. Doxycycline: oral liquid suspension Tablets should not be given orally because this drug can cause esophagitis/stricture so drug must be suspended. 100 mg tablet per 5 ml liquid* = 20 mg/ml suspension OR 48 tablets per 8 oz bottle liquid *use a compounding syrup, vitamin syrup, chicken broth, milk or other liquid (even milk is acceptable and should not cause significant reduced absorption) Crush tablets and pour into bottle. Add liquid to desired volume and shake well. Store in refrigerator or at room temperature. Discard unused portion after 30 days. Pink tablet coating may not fully dissolve, but is not cause for concern. Shake well before each use. *Remember: doxycycline tablets can be retained in the esophagus and cause esophagitis/stricture; never give doxycycline tablets or capsules to a cat!

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