# Two antibiotics at once?



## Chewysmom (Mar 31, 2009)

I have a kitten with a decently severe URI with mostly nose and eye involvement (sneezing, lots of clear snot, both eyes watering, one has inflamed membranes, looks terrible!)
His appetite is good but he is definitely feeling 'down and has had a fluctuating fever for the past few days.

The vet gave me Clavamox several days ago and Tobramycin eye drops. I have seen no improvement whatsoever, in fact his eye actually looks more inflamed now than when I first took him in four days ago, and his general state seemed no better. In my experience with these infections and these particular medicines I typically see some improvement (more than this for sure) within the first 2-3 days.

I had another cat who required Azithromycin to clear up a severe URI but my regular vet does not carry it. Took him to another vet and asked for the prescription and got it, but my question is this: is it harmful to continue both medicines to 'cover all the bases' of does one take the place of the other? I know they both work for specific purposes, and I do not want to put him in any danger.

I'm nervous, I want him to get better, I hate seeing him suffer. Nothing is opaque or pus-ish, meaning all dsicharges are clear, and he generall seems to be getting better...very slowly. 

Has anyone ever been prescribed these two antibiotics together?
My one cat that required it before went from Clavamox to Doxycycline to Azithromycin and there was surely some overlap within her body...
I just want to make sure he's getting all the chances at getting better.


----------



## librarychick (May 25, 2008)

I would not give both antibiotics at the same time unless your vet directly suggested it.

I WOULD start him on l-lysine, since it's possible feline herpes is that cause of the URI. The lysine will help your kitties body fight off the virus and help get the infection under control.

I'd also get a probiotic to give your cat while it's on the antibios to help keep the good gut bacteria healthy.


----------



## laurief (Jun 22, 2008)

Firstly, there's a strong probability that what your kitten has is viral (as are most of the common URI's), not bacterial, in which case no amount of antibiotic will have any effect on it whatsoever. 

Secondly, I second the recommendation for L-lysine. I'm guessing that your kitten has herpesvirus (almost all domestic felines are infection with herpesvirus), since there is both upper respiratory and eye involvement, and both can occur with herpes. L-lysine inhibits the replication of the herpesvirus, making it easier for the kitten's own immune system to beat it back into remission. If the kit is under 6 mos of age, mix 250 mg of L-lysine into a canned food meal once daily, every day, until all symptoms are gone. If the kit is over 6 mos, give 500 mg daily. You can buy L-lysine anywhere human vitamins are sold.

Thirdly, this is what the Plumb's Veterinary Drug Reference (the drug reference that almost all vets use) says about potential drug interactions between Clavamox and azithromycin (this comes from the section on Clavamox):

"Drug Interactions ...


----------



## laurief (Jun 22, 2008)

Sorry, I clicked the wrong thing before I was finished with that last post. Here's the rest ...

Thirdly, this is what the Plumb's Veterinary Drug Reference (the drug reference that almost all vets use) says about potential drug interactions between Clavamox and azithromycin (this comes from the section on Clavamox):

"Drug Interactions ...
BACTERIOSTATIC ANTIMICROBIALS (_e.g., ... _ macrolides [of which azithromycin is one] ... ): Because there is evidence of _in vitro_ antagonism between beta-lactam antibiotics [of which Clavamox is one] and bacteriostatic antibiotics, use together has been generally not recommended in the past, but actual clinical importance is not clear and currently in doubt."

Bottom line, if this were my kitten, I probably wouldn't be giving any antibiotic at all, but I most certainly would not be giving these two antibiotics together.

Laurie


----------



## Chewysmom (Mar 31, 2009)

I have some Viralys powder, but it expired 11/2013
I know many drugs are ok past their expiration date...
Opinions?


----------



## Chewysmom (Mar 31, 2009)

laurief said:


> Bottom line, if this were my kitten, I probably wouldn't be giving any antibiotic at all, but I most certainly would not be giving these two antibiotics together.
> 
> Laurie


I really appreciate this info, I looked and looked and could not find the interactions. So...clinical importance not clear is also vague to me. Does this simply mean there is not enough data for them to say either way?


----------



## laurief (Jun 22, 2008)

Chewysmom said:


> I really appreciate this info, I looked and looked and could not find the interactions. So...clinical importance not clear is also vague to me. Does this simply mean there is not enough data for them to say either way?


That would be my assumption.

Laurie


----------



## laurief (Jun 22, 2008)

Chewysmom said:


> I have some Viralys powder, but it expired 11/2013
> I know many drugs are ok past their expiration date...
> Opinions?


Combining drugs, using drugs past their expiration dates, using drugs in the absence of a definitive diagnosis - these are all issues that should be discussed with your vet.

Laurie


----------



## laurief (Jun 22, 2008)

Oh, Viralys is just L-lysine. Rather than using outdated L-lysine, why not just go to Walmart or similar and pick up a fresh bottle of lysine powder or tablets? They're cheap enough.

Laurie


----------



## Chewysmom (Mar 31, 2009)

*Photo for reference...*

It's kind of a dark picture, but here is Shredder and his poor eye. His eyeball looks ok but the mucous membranes inside are quite inflamed as you can see.
Also all discharges have been clear so far, but a little sticky.

I've decided to go with the original vet recommendation and meds, hold off on the Azyithromycin, and go get some Lysine.


----------



## laurief (Jun 22, 2008)

That sounds like a reasonable strategy. Even if the URI is viral, Clavamox should discourage any secondary bacterial infection from taking hold while his immune system is busy fighting off the virus.

Laurie


----------



## Venusworld21 (Oct 23, 2012)

I had a cat who needed azythromycin after she was already on clavamox and the vet specifically told me to discontinue the clavamox when she started the azythromycin.


----------



## Chewysmom (Mar 31, 2009)

laurief said:


> Oh, Viralys is just L-lysine. Rather than using outdated L-lysine, why not just go to Walmart or similar and pick up a fresh bottle of lysine powder or tablets? They're cheap enough.
> 
> Laurie


Ok, got the 500mg pills, cut one in half, crushed it to a powder and mixed it into some wet food. It went in without an issue. I will repeat again daily until his symptoms subside.

I really hope this helps. I am going to continue the Clavamox in case there is any bacterial issues working here. I do not know. Whether to continue the Tobramycin drops though. Very frustrating as they were more expensive than the Clavamox but they don't seem to be doing anything at all.
I'm hoping he is not allergic to either of these medications.
I just want him to feel better.

Thank you for your advice....


----------



## Chewysmom (Mar 31, 2009)

Venusworld21 said:


> I had a cat who needed azythromycin after she was already on clavamox and the vet specifically told me to discontinue the clavamox when she started the azythromycin.


He got a total of one dose of the Azithromycin, about 5mg, while on the Clavamox, but he will get no more.

I don't think that one dose will do any harm (hoping anyway!) since an overlap in situations like one of mine I mentioned previously and the one you describe most likely occur pretty frequently...

Thanks for your experienced info, it means a lot.


----------



## laurief (Jun 22, 2008)

Here is what Plumb's says about Tobramycin drops, "The commercially available solutions and ointments are sometimes not concentrated enough to achieve therapeutic effect and fortified concentrations of greater than 14.5 mg/mL are compounded for use." So, if you are using a commercial concentration of the drops (less than 14.5 mg/mL), that may explain the lack of positive response. I don't know why your vet would have prescribed Tobramycin instead of a triple eye antibiotic. 

Laurie


----------



## Chewysmom (Mar 31, 2009)

laurief said:


> Here is what Plumb's says about Tobramycin drops, "The commercially available solutions and ointments are sometimes not concentrated enough to achieve therapeutic effect and fortified concentrations of greater than 14.5 mg/mL are compounded for use." So, if you are using a commercial concentration of the drops (less than 14.5 mg/mL), that may explain the lack of positive response. I don't know why your vet would have prescribed Tobramycin instead of a triple eye antibiotic.
> 
> Laurie


Thats frustrating, because I asked about ointment and he said they usually only prescribe it for dogs (I didn't get a good explanation on that one).
I find it frustrating that there is no real recourse when a treatment plan isn't effective, like getting the next prescription at a discount, or returning the ineffective medicine. I've had *so*many unnecessary medications prescribed in the past just because I was worried and took the bait, meds I read about later saying how they were only mariginally, if at all, effective.


----------



## laurief (Jun 22, 2008)

Sounds like a heck of a good reason to research meds online BEFORE purchasing them ... unless, of course, your animal is critically ill and needs the meds immediately to preserve life. Or you could do what I've been known to do, which is to ask the vet if I can read his drug reference about the prescribed drug so that I understand exactly what I'm giving my animal and what the side effects may be.

Laurie


----------



## Chewysmom (Mar 31, 2009)

laurief said:


> Or you could do what I've been known to do, which is to ask the vet if I can read his drug reference about the prescribed drug so that I understand exactly what I'm giving my animal and what the side effects may be.
> 
> Laurie


Ok, now that is a damned good idea... One I will surely be using!


----------



## Chewysmom (Mar 31, 2009)

Just curious for those who've used it successfully... How long does it take for the Lysine to show improvement?
His fever has been down all evening, close to normal temp.
His eye of course still looks terrible.
He's still very nasally congested.
I could do steam in the bathroom for him but I've heard mixed info on whether it is good for humans to due the added moisture in the lungs possibly making the chance of bacterial infection there a bit more favorable than without.... Any opinions on that out there?


----------



## laurief (Jun 22, 2008)

Chewysmom said:


> Just curious for those who've used it successfully... How long does it take for the Lysine to show improvement?


That depends on whether or not the source of the illness is herpesvirus and on the strength of the kitten's own immune system.



> I could do steam in the bathroom for him but I've heard mixed info on whether it is good for humans to due the added moisture in the lungs possibly making the chance of bacterial infection there a bit more favorable than without.... Any opinions on that out there?


Personally, I would use steam treatments only if the kitten is having difficulty breathing OR if he's not eating adequately. If he's eating and breathing OK, I wouldn't bother with steam treatments.

Laurie


----------



## Chewysmom (Mar 31, 2009)

Well, his nose is very congested, but he is eating, with a good appetite, and hydration is good.
I am freaking out a little however...it might not be a big deal, but on the side he is having the eye issue, I can feel his lymph node under his jaw. I can feel the other one on the other side but it's tiny while the other one is easily felt, a little bigger than a pea.
I felt around under his arms, etc, can't feel any inflammation of nodes there...

I'm taking him to the vet tomorrow to get virus tested, hoping like crazy he tests negative.


----------



## laurief (Jun 22, 2008)

I have read that more than 95% of all domestic cats are infected with the herpesvirus, so if your kitten isn't infected with herpes yet, he almost certainly will be when he comes into contact with another infected feline.

Laurie


----------



## Chewysmom (Mar 31, 2009)

laurief said:


> I have read that more than 95% of all domestic cats are infected with the herpesvirus, so if your kitten isn't infected with herpes yet, he almost certainly will be when he comes into contact with another infected feline.
> 
> Laurie


I'm not worried about herpes or calicivirus...
More worried about the possibility of feline leukemia


----------



## Chewysmom (Mar 31, 2009)

Up to 170$ with this episode of URI with his poor over- swollen conjunctiva.

Vet did an eye stain to check for corneal ulcers, there were none so he was able to prescribe an anbiotic eye drop with a steroid to bring down the inflammation, and told me to up the Clavamox to 1 ml (62 mg) twice a day up from .5 ml twice a day (this baby is 2.7 lbs and about 10 weeks old). That seems like an awfully high dose to me. Anyone wish to chime in?
Government info sheet on Clavamox dosage says 5-12mg/lb. This worries me...

Very frustrating to ask questions to the vet and be met with "I don't know" for nearly every answer.
It's discouraging to have the vet say "sure, it could be viral" when I ask if this could be Chlamydia (bacterial)


----------



## Chewysmom (Mar 31, 2009)

Ok...for anyone who's interested...he tested negative for feline leukemia and feline AIDS
So relieved, but he's still progressing so slowly


----------



## 10cats2dogs (Jun 16, 2013)

Chewysmom, 
That is Great News, that he tested negative! 
I know how scary that can be...
Hopefully he'll get better soon!
The L-lysine is really good to add to his food, it may take a while to see results, so be consistent with it!
I actually give my cats l-lysine every day...
Some people only give it when it seems it's needed...
ALL Paws Crossed for him!
Sharon


----------



## TabbCatt (Mar 26, 2014)

Chewysmom,
I'm happy he's turned out negative as well, for both FIV and FeLV. Thank goodness for that. Hope he keeps recovering!:smile:


----------



## Chewysmom (Mar 31, 2009)

Yes, but his eye looks worse.
The red lining is so swllow it almost obscures his entire eyeball...
170$ and might have to go to yet another vet to find a solution.
Very frustrating, especially when my other pets are showing signs of sickness.


----------



## laurief (Jun 22, 2008)

If I were you, I would NOT be using a steroidal eye antibiotic in the eye of a kitten who is likely experiencing a current herpes flareup. I would insist on a non-steroidal, triple eye antibiotic ointment. In fact, I am currently using exactly that in the eyes of two of my horses and three of my cats (injuries with the horses, herpes with the cats). It can take a while for even triple eye antibiotic to get an eye infection under control - sometimes several weeks.

Laurie


----------



## Chewysmom (Mar 31, 2009)

I have stopped the steroid drops...knowing the damage that might be done and that it willmake things worse freaks me out. What is the name of the stuff you are using? Terramycin seems to be all out of stock and for some reason CA requires a prescription or it.


----------



## laurief (Jun 22, 2008)

I use triple eye antibiotic ointment by prescription from my vet. Every vet knows what triple eye antibiotic is (neomycin, polymyxin B, bacitracin). It's made by several different pharmaceutical manufacturers.

Terramycin is known to cause eye irritation in some cats, so it's not ideal.

Laurie


----------



## Chewysmom (Mar 31, 2009)

Also his eye, as of today, looks no better and when he cries it seems like he is saying it hurts him. 
Really starting to bum me out.
Another vet wants to give a different antibiotic eye drop, Based on what it is, I may want to try it out.


----------



## 21inCostaRica (Aug 18, 2013)

I gave trimethoprim-sulfamethoxazole to one of my cats who was sneezing blood. Then cephalexin with an expectorant. I finally asked my vet if we could try Baytril (enrofloxacin) and it worked. 
As for the eye, perhaps you could also ask about ketorolac and gentamicin sulfate.

I hope he gets better soon.


----------



## rayrhonda (Jul 31, 2012)

My kitties had the herpes virus and their eyes were a mess. After some unsucessful treatments from the vet, I was referred to an animal eye specialist. They were prescribed Idoxuridine, and lysine. I would take them to a specialist, if you can. Hope they get better soon


----------



## Chewysmom (Mar 31, 2009)

Thank you for all the info, he's doing well except for the ongoing issues. He's seeing another vet tomorrow, hopefully we can get some resolve on this.


----------



## Chewysmom (Mar 31, 2009)

Another vet supplied the info for ofloxacin drops possibly being something to try.
We had an almost completely untouched bottle of ciprofloxacin drops in the med cabinet.
My husband gets sloppy with his contacts and gets pink eye once a year or so. 

After he swore he never habitually touched the tip to any surfaces I started using them on Shredder (after checking that the .3% solution was the same formula one would get from a vet for a cat, and that they were similar enough drugs to do the job).
After 24 hours and 3 drops his eye looks about 90% on the way back to normal. I stopped the Tobra over 2 days ago so I know this is what he's responding to.

Vet #1 told me 'no cat eye medications exist that start with the letter C' when I was trying to remember the name of the ciprofloxacin on my last visit. He also told me if his eye didnt look any better after a week on Tobramycin tat I needed to take him to a specialist. all I really needed was to have a medicine he did not carry, and in fact didn't even want to telll me about.
I was aware there was another conjunctivitis med used for cats that was better with eyes that were inflamed.

Anyway I called husband's doc to get a refil in case this ever happens again. 
Nice fresh bottle for the shelf for $10.
I do not advocate using any human meds on a cat unless absolutely sure they will be safe and effective, but every now and then, it pays to do a little research.


----------



## laurief (Jun 22, 2008)

I don't know just how much research you did on ciprofloxacin before you started administering it to your cat, but here is some pertinent info from Plumb's:

"... primarily useful for established gram-negative corneal infections."

"Clinicians are strongly cautioned regarding the development of retinal neurotoxicity at or above the formerly recommended _systemic _enrofloxacin dosage in cats. There are no reports at the time of writing of retinal toxicity in cats administered topical fluroquinolone ophthalmic products."

" ... may cause crusting or crystalline precipitates in the superficial portion of corneal defects. Other potential adverse effects with quinolones include: conjunctival hyperemia, bad taste in mouth, itching foreign body sensation, photophobia, lid edema, tearing keratitis and nausea. Allergic reactions have been reported ... "


----------



## Chewysmom (Mar 31, 2009)

laurief said:


> I don't know just how much research you did on ciprofloxacin before you started administering it to your cat, but here is some pertinent info from Plumb's:
> 
> "... primarily useful for established gram-negative corneal infections."
> 
> ...


Well, the reason I knew about it at all was because the shelter I used to volunteer at primarily used two eye meds: Tobramycin and Ciprofloxacin, usually starting with Tobra and if it didn't work within a few days, switching to Cipro.
I read about both Cipro and Oflox and both had small risks listed, but both were listd as ok for cats in a .3% solution, whivh is what I used.
I believe when side effects are listed they are for longer term use or use at higher concentrations.


----------



## laurief (Jun 22, 2008)

Chewysmom said:


> I believe when side effects are listed they are for longer term use or use at higher concentrations.


Plumb's makes no such qualifications regarding potential side effects.

Laurie


----------



## Chewysmom (Mar 31, 2009)

laurief said:


> Plumb's makes no such qualifications regarding potential side effects.
> 
> Laurie


Ok, well... Potential is potential, and something had to be done.
Most vets don't even tell you the risks of the medication they are giving.
Last week I got my cat spayed and they gave ketaprophren as a take home pain med. my husband had picked her up and did not ask what type of medicine they were sending, they simply asked if I wanted pain meds to go home with her. 

When I saw the rather large looking dose, I read about it because I had never heard of it and and its known for sometimes prompting kidney failure and if not that it is simply hard on the kidneys in general. I did not use it even though I ended up buying it. I called to ask the vet about it and he actually seemed kind of bothered by the fact that I was asking about it's safety.


----------



## laurief (Jun 22, 2008)

Chewysmom said:


> Most vets don't even tell you the risks of the medication they are giving.


I'm well aware of that. That's why I took the time to provide you with information from the current edition of Plumb's - so that if you notice any behaviors or symptoms that are potentially congruent with the use of ciprofloxacin, you'll know to contact your vet about it.

Laurie


----------



## Chewysmom (Mar 31, 2009)

laurief said:


> I'm well aware of that. That's why I took the time to provide you with information from the current edition of Plumb's - so that if you notice any behaviors or symptoms that are potentially congruent with the use of ciprofloxacin, you'll know to contact your vet about it.
> 
> Laurie


Thanks...I did read the warnings and side effects, but wasn't too concerned since most of it applied to systemic dosing, like pills or injections, not the topical application. I will most definitely be watching his progress, but seriously the shelter used it about as readily as they used Tobra, which apparently does not kill every kind of bacteria.


----------



## laurief (Jun 22, 2008)

Just so you understand, the Plumb's information I quoted above came specifically from the section on ciprofloxacin ophthalmic preparations - NOT systemic cipro.


----------



## Chewysmom (Mar 31, 2009)

laurief said:


> Just so you understand, the Plumb's information I quoted above came specifically from the section on ciprofloxacin ophthalmic preparations - NOT systemic cipro.



>>"Clinicians are strongly cautioned regarding the development of retinal neurotoxicity at or above the formerly recommended *systemic enrofloxacin dosage in cats. **There are no reports at the time of writing of retinal toxicity in cats administered topical fluroquinolone ophthalmic products."
*


----------



## Chewysmom (Mar 31, 2009)

laurief said:


> Just so you understand, the Plumb's information I quoted above came specifically from the section on ciprofloxacin ophthalmic preparations - NOT systemic cipro.


I get what you are saying though, and I'm going to be checking him several times a day and tapering him off the drops after a five day course is run.


----------

