Page 723 - Clinical Small Animal Internal Medicine

63 Feline Inflammatory Liver Disease 691

Table 63.1 Antibacterial agents used in the management of feline hepatobiliary disease
VetBooks.ir Drug Dose Comments

Amikacin 10–15 mg/kg IV, SC, IM Gram‐negative bacteria. Nephrotoxic (less so than gentamicin), therefore only
q24h used if resistance patterns merit its use
Amoxicillin‐clavulanate 12.5–25 mg/kg IV, PO Broad‐spectrum antibacterial but may not be effective against Pseudomonas or
q8–12h Klebsiella. Oral absorption reduced in systemically ill patients
Cephalexin 10–35 mg/kg PO q8–12h May not be effective against Pseudomonas or Proteus. Poor efficacy against
(first generation) anaerobes
Cefotaxime 20–40 mg/kg IV, SC More effective against gram‐negative but less effective against gram‐positive
(third generation) q8–12h organisms than cephalexin. Variable activity against anaerobes
Cefovecin 8 mg/kg SC q14 days More effective against gram‐negative but less effective against gram‐positive
(third generation) organisms than cephalexin. Possibly better activity against anaerobes than
cefotaxime
Cefuroxime 10–15 mg/kg IV q8–12 h More effective against gram negative but less effective against gram positive
rd
(second generation) organisms than cephalexin, but not as effective as 3 generation cephalosporins
Chloramphenicol 15–25 mg/kg PO, SC, Good efficacy against gram‐positive organisms and anaerobes. Moderate
IM, slow IV q12h activity against gram‐negative organisms. Not used routinely as cholestasis may
increase risk of toxicity
Clindamycin 5.5–12 mg/kg PO q12h Effective against gram‐positive organisms and anaerobes. Needs to be
10 mg/kg IV q12h combined with drug effective against gram‐negative organisms. Concentrated
in the bile, but care with reduced liver function as excretion is via hepatic
metabolism
Marbofloxacin 2 mg/kg PO, IV q24h Good efficacy against gram‐negative and some gram‐positive organisms, but
not effective against anaerobes. Preferred to enrofloxacin as decreased risk of
retinal damage
Metronidazole 8–10 mg PO, IV q12h Narrow spectrum against anaerobes. May cause nausea, vomiting, and
neurologic signs. Intravenous infusions given over 20–30 minutes
Pradofloxacin 3 mg/kg PO q24h Better efficacy against anaerobic organisms than marbofloxacin
Options pending culture results:
Amoxicillin‐clavulanate
Cephalosporin + metronidazole
Fluoroquinolone + clindamycin or metronidazole
IM, intramuscular; IV, intravenous; PO, by mouth (per os); SC, subcutaneous.

enzymes return to normal. In some patients antibacterial that may be administered as well as enabling some medi-
therapy may need to be continued for 2–3 months, and cations to be given via this route. In addition, the chance
repeat culture of bile may be warranted to assess response of removal is reduced, and owners often can manage
to therapy. these tubes at home. Gastrostomy tubes may be placed at
Surgery may be required to manage biliary obstruc- time of surgical intervention if required.
tion, if identified. The above treatments should be initi- “Critical care” diets are generally appropriate as they are
ated first to stabilize the patient as biliary surgery is highly digestible, can be administered via feeding tubes and
complex and may require prolonged general anesthesia. are supplemented with arginine, taurine, and antioxidants.
Surgical procedures such as stenting of the bile duct, Hepatic encephalopthy (HE) is usually a contraindication to
cholecystectomy, cholecystotomy or biliary bypass feeding a high‐protein diet but in this population of cats,
(cholecystoduodenostomy, cholecystojejunostomy) may signs of HE are generally attributable to arginine deficiency
be required. from anorexia and will correct with feeding protein. An
Nutritional support is very important as, if hepatic exception to this is if HE is present due to development of
lipidosis is not already present, these anorectic patients acquired portosystemic shunts subsequent to severe fibro-
are at risk of developing it. Placement of a feeding tube is sis, although significant hepatic fibrosis is uncommon in
recommended. A nasoesophageal tube may be placed in cats. Longer term dietary management should consider the
the first instance, especially if prolonged clotting times presence of concurrent diseases and be chosen accordingly.
are identified, but an esophagostomy tube is preferred. A diet for inflammatory bowel disease may be more appro-
The wider bore of these tubes increases the range of diets priate than a “hepatic” diet, for example.