Judicious Use of Antibiotics in Canine Pyelonephritis

Pyelonephritis is a renal bacterial infection that can cause significant renal impairment, chronic kidney disease (CKD) and systemic complications (sepsis, shock, etc.) and, if not addressed properly in a timely manner, can lead to life-threatening infection. Due to the potential significant impact on health and kidney function, fluoroquinolones (an important antibiotic in human medicine) are recommended as first line therapy pending culture and sensitivity results. Previous recommendations lack scientific data to support a long term antimicrobial treatment. In cases of human pyelonephritis, a short course of antimicrobial (5-14 days) has proved efficient. This study will therefore investigate if short term antimicrobial therapy is as effective in our veterinary patients as it is in people. This will in turn impact the duration of a patient's exposure to antibiotics, preventing emergence of multi-resistant bacteria that could be detrimental to both global companion animal health and human health. It would also improve treatment observance and decrease overall costs of pyelonephritis treatment.

Hypothesis:
We hypothesize that a short course of fluoroquinolones (14 days) will be as efficient as a traditional course of fluoroquinolone therapy (42 days).

Specific Aims:
This is a prospective, multicentric, randomized controlled clinical trial. Client owned dogs presenting to one of the enrolled referral hospitals will be considered for inclusion following clinical diagnosis of pyelonephritis based on clinical signs, physical examination findings, clinicopathologic and imaging data and positive urine culture. They will then be randomly distributed in one of 2 treatment groups; short term (14 days) and long term (42 days) fluoroquinolone treatment (enrofloxacin 10mg/kg PO/IV q24h). Response to therapy will be ensured by follow-ups 7 days after initiation and 7 days after discontinuation of therapy. Phone follow ups will be performed one (1), two (2) and three (3) months after discontinuation of therapy.

Participation Requirements:

Diagnosed with uncomplicated canine pyelonephritis and willing to administer antibiotics for 2 or 6 weeks depending on the enrollment group and attend 2 recheck appointments during and following the end of antibiotic therapy.

Geographic location: Residing in the provinces of Quebec or Ontario or in the states of New York, Vermont and New Hampshire.  Patients must present to the following clinics: CHUV, St-Hyacinthe or DMV Center in Montreal in order to be eligible for participation in the study.

Owner's Responsibilities:

Administer antibiotics as recommended and attend regular recheck appointments 1 week and 3 or 7 weeks following initiation of therapy depending on the enrolled group.