Page 925 - Small Animal Clinical Nutrition 5th Edition

Feline Lower Urinary Tract Diseases 957

ble in most situations if the change is made gradually; for some
VetBooks.ir cats this many require a period of several weeks. Failure to make
a gradual transition may result in refusal to eat the moist food

been mentioned as useful. However, only one GAG has been criti- or increased stress, which may cause recurrence of clinical signs.
Therefore, moist food should be offered initially as a food
cally evaluated. In a randomized, double-blinded, controlled clinical option in a second dish next to the usual food (two-pan ap-
e
study, administration of glucosamine hydrochloride (125 mg oral- proach) (Westropp and Buffington, 2004; Buffington, 2007). If
ly once daily) was not associated with any difference in clinical
signs compared with cats that received placebo. If signs of FIC per- the cat consumes the moist food, the amount of moist food can
sist despite other treatments, GAGs (such as pentosan polysulfate f be increased gradually while decreasing the amount of dry food
[8 mg/kg body weight orally q12h] or a combination of glu- correspondingly. Table 46-23 lists tips for increasing water
g
cosamine and chondroitin sulfate [250 mg/200 mg orally q24h]) consumption.
may be attempted. Increasing frequency of feeding (i.e., dividing the daily
amount of food into several meals) may increase daily water
AMITRIPTYLINE intake in cats. In a study of healthy cats with free access to
h
Amitriptyline is a tricyclic antidepressant with anticholinergic, water, feeding two or three meals per day was associated with a
antihistaminic, sympatholytic, analgesic and antiinflammatory significant increase in total water intake compared with feeding
properties that has been used in treating people with interstitial a single meal (Kirschvink et al, 2005).
cystitis and cats with FIC. In an uncontrolled study of cats with
severe, recurrent FIC that failed to respond to other treatments, Reassessment
administration of amitriptyline for 12 months was associated with
decreased clinical signs in nine (60%) of 15 cats during the last six Clinicians should use their best judgment regarding the most
months of treatment. A randomized, controlled clinical trial of appropriate times for reevaluating patients with FIC. Because
amitriptyline treatment for seven days revealed no significant dif- of stress associated with hospital visits, it may be preferable to
ference in rate of recovery from pollakiuria or hematuria; overall, conduct evaluations by talking with owners more often than
clinical signs recurred significantly faster and more frequently in examining the patient. This allows for discussing effectiveness
cats that had been treated with amitriptyline compared with con- of current treatments and recommendations for changes if
trol cats. In a similar study, amitriptyline combined with amoxicillin needed. If there are changes in the cat’s clinical findings (e.g.,
was no more effective than placebo and amoxicillin when given to increased severity or frequency of episodes) despite appropriate
cats with FIC for seven days. Based on current information, treatment, additional patient evaluation including urinalysis,
amitriptyline does not appear to be beneficial for short-term man- urine culture and diagnostic imaging is indicated to detect
agement of cats with FIC. It is possible that longer use (i.e., sever-
al months) may be helpful; however, this has not yet been demon- other disorders (e.g., uroliths, UTI).
strated in a controlled, long-term clinical study.
Feeding Plan for Struvite Urolith Dissolution
Treatment options for cats with struvite uroliths include dis-
ENDNOTES solution by nutritional management and physical removal of
a. Buprenex. Reckitt Benckiser Pharmaceuticals, Inc., Richmond, uroliths (e.g., cystotomy, voiding urohydropropulsion, cath-
VA, USA. eter retrieval, laser lithotripsy). Treatment selection depends
b. Torbutrol and Torbugesic. Fort Dodge Animal Health, Fort Dodge,
IA, USA. on clinician experience, expertise and preference, availability
c. Metacam. Boehringer Ingelheim Vetmedica, Inc., Saint Joseph, of necessary equipment, patient factors and client preferences.
MO, USA. Considering all factors, it is generally preferred to select the
d. Feliway. Veterinary Product Laboratories, Phoenix, AZ, USA. least invasive treatment that has the most evidence for effec-
e. Cystease. Ceva Animal Health, Chesam, United Kingdom. tiveness.
f. Elmiron. Ortho McNeil Pharmaceutical, Inc., Raritan, NJ, USA. Two studies reported effects of feeding a dissolution food to
g. Cosequin for Cats. Nutramax Laboratories, Inc., Edgewood, MO, cats with struvite uroliths (Osborne et al, 1990; Houston et al,
USA. 2004). In one study, 25 cats (13 males, 12 females) with 28
h. Elavil. Astra-Zenaca, Wilmington, DE, USA. occurrences of struvite uroliths were fed a struvite dissolution
f
food (Osborne et al, 1990). Among cats in the study, there
The Bibliography for Box 46-5 can be found at were 20 occurrences of sterile uroliths and eight with UTI (five
www.markmorris.org.
urease-positive infections, three urease-negative infections).
Mean time for sterile struvite urolith dissolution was 36 days
(range, 14 to 141 days), while the average time for dissolution
Assess and Determine the Feeding Method of uroliths associated with UTI was 44 days (range, 14 to 92
Gradual transition to moist food and recommending other days). Clinical signs (gross hematuria and dysuria/pollakiuria)
strategies to increase water intake should be part of initial man- were present in 90% or more of urolith occurrences before
agement of patients with FIC. Cat owners may be hesitant to nutritional management and were absent by the time of first
switch from dry to moist food and some believe their cat will reevaluation in two weeks. None of the cats developed urethral
not eat moist food. However, switching to moist food is possi- obstruction but perineal urethrostomy had been performed