Category Clinical signs Probable Interpretation 1a. Clear from Mild viral URI Clear eyes or nose, sneezing, Discharge squinting 1b. Clear Discharge 2a. URI with colored 2b. URI with colored, fails to respond Category 1a. Fever, dehydration, anorexia, oral ulcers, congestion, depressed Category 1a. Green, brown, yellow or bloody nasal or ocular Category 1b. Green, brown, yellow or bloody nasal or ocular Fails to respond to doxycycline Moderate to severe viral URI Viral URI with secondary bacterial rhinitis and/or ocular Viral URI with moderate to severe secondary bacterial Treatment Isolate (either in a separate room or note to clean/feed after healthy cats). Monitor appetite and hydration status daily 1 As for 1a. Administer additional treatment and supportive care as described below. Doxycycline 2 or Minocycline 2 10 mg/kg q24h PO until resolution of clinical signs. Re-evaluate at 3-5 days, if no improvement, consider alternate antibiotic. If there is improvement but relapse after discontinuing antibiotic, consider testing for Chlamydia. If Chlamydia confirmed or suspected, treat with doxycycline for 4-6 weeks. Okay for adoption when clinical signs resolve. NOTE: For compounding (e.g. mixing with some liquid vehicle), keep in mind that doxycycline and minocycline are highly unstable drugs and will degrade quickly and rapidly lose its potency within 7 days 3. The capsules could be opened and diluted just prior to administration. Enrofloxacin 5 mg/kg q24h PO or SQ until resolution of clinical signs Other fluoroquinolone (e.g., pradofloxacin, marbofloxacin, orbifloxacin) Azithromycin (macrolide) 5 10 mg/kg q24h PO for 5 days, then q48h until resolution of clinical signs (has been shown to be ineffective in eliminating Chlamydia felis in cats thus if this is suspected/diagnosed do not use this medication). Re-evaluate at 3-5 days for response to treatment. If fails to respond to treatment, perform full veterinary exam and consider diagnostics (see below). 1 In all cases, cats should be monitored at least daily by staff and examined by a veterinarian every 2-3 days or more frequently as needed. 2 Doxycycline or minocycline tablets can cause esophagitis and subsequent esophageal strictures in cats and, if used, must be flushed with at least 6 cc of liquid. Liquid doxycycline formulations are recommended and can be compounded in-house. Citric acid-based liquids and vitamin/mineral supplements should not be used as compounding agents, as they can negatively affect the availability of tetracyclines and the breakdown products can be toxic when mixed with citric acid. All compounded doxycycline should be stored in light proof containers and used within 7 days. 3 Papich, M.G., etal. (2013). Doxycycline concentration over time after storage in a compounded veterinary preparation. JAVMA 242 (12): 1674-1678.
3a. Ocular Signs Unilateral to bilateral ocular with mild to moderate conjunctivitis and/or chemosis Primary bacterial or viral ocular As for 1a/b or 2a if mucopurulent Erythromycin Ophthalmic OU BID x 7 days Gentamicin Ophthalmic OU BID x 7 days Tobramycin Ophthalmic OU BID x 7 days 3b. Ocular Signs, fails to respond Category 3a. Persistent ocular or corneal edema, corneal ulceration, blepharospasm Severe primary viral ocular with or without secondary bacterial component Re-evaluate after 3-5 days for response to treatment. If fails to improve with treatment within 5 days, discontinue topical treatment (some ointments can cause primary irritation). Provide systemic antibiotic treatment if not already done, consider diagnostic tests, see notes on Chlamydia above, ocular exam by veterinarian, consider anti-herpetic treatment (see below) if other causes ruled out and sufficient resources exist. As for 2a. if colored ocular Cidofovir 0.5% Ophthalmic 1 drop q12h OU until resolution of clinical signs Idoxuridine 0.1% Ophthalmic 1 drop q2-4h OU until resolution of clinical signs Idoxiuridine-Gentamycin-Flurbiprophen (from a veterinary compounding pharmacy) 1 drop q8-12h OU until resolution of clinical signs 4. Systemic Signs or prolonged illness Fever > 106. Rapid or difficulty breathing, coughing, vomiting, severe diarrhea, swelling of any part of the body Failure to respond to two rounds of antibiotic treatment Complicated URI or additional problems Re-evaluate after 5-7 days for response to treatment. If fails to improve with treatment, perform full veterinary exam and consider additional diagnostics (see below). If no improvement of corneal ulceration, perform full ophthalmic exam and consider surgical options. Full veterinary exam. Supportive care as needed for dehydration, pyrexia, pain, congestion, anorexia. Perform diagnostic tests (see below). Rule-out additional medical problems.
Condition Dehydration Congestion Anorexia Feline URI: Supportive Treatment Treatment <5% Subcutaneous fluids (LRS or Normosol-R) 250-500 ml q 12-24 hrs. >5% Administer intravenous fluids at 1-2 times the maintenance rate until dehydration is corrected Vitamin B Complex may be administered with fluids (1 ml per L). Cover fluid bag with a paper bag to prevent degradation of the vitamins. Add KCL to fluids for anorexic cats (20 meq per liter) See below for low stress fluid administration Clean nose with warm moist gauze or Kleenex Humidifier for 10 minutes q 6-24 hrs. Nebulization for 10 minutes q 6-24 hrs. Sterile saline with or without acetylcysteine and/or antibiotics (gentamicin or amikacin) As last resort only if cat is severely congested and not eating, try a decongestant (phenylephrine or oxymetazoline). One drop BID before feeding in alternating nostrils. Left nostril AM and right nostril PM for no more than 3 days. Continuous use of decongestant nose drops will decrease its effectiveness and cause a rebound effect when stopped. Correct dehydration, treat congestion, provide analgesia, offer strong-smelling food. Consider appetite stimulants. Cats are particularly sensitive to environmental factors. Attempt the following: warm food slightly (alternatively chilling the food if aromas appear to result in nausea), then offer a novel brand/flavor of food including strongly scented wet cat food or tuna. Encourage eating by petting and soft talk, or try feeding out of the cage in a quiet environment. Remove food after ten minutes; do not leave food in the cage. Offer food several times per day. Perform a complete oral examination. Severe oral ulcerations can cause anorexia and will require analgesia. If steps given above fail and cat does not eat for > 2 days, administer appetite-stimulating drugs: Mirtazapine 15 mg tablets 1/8 tablet q 24 hrs. PO (Mirtazapine demonstrates anti-nausea properties as well since it acts at the 5HT3 receptor similarly to ondansetron) Cyproheptadine 2 4 mg per cat q 12 24 hrs. PO (has anecdotal efficacy in many patients, however its efficacy has never been scientifically evaluated) Midazolam 1.25 mg SQ or IM once with food present If appetite does not respond to appetite stimulants, and anorexia persists for more than 5 days, consider placing an esophageal feeding tube. Force-feeding or syringe-feeding high calorie foods (e.g., a/d or MaxCal) are also options, but may cause food aversion and worsen anorexia. Remember - kittens need 250 kcal per kg per day Monitor weight at least weekly
Pain Fever Assess pain associated with oral or nasal planum ulceration, corneal ulceration, or severe systemic disease (e.g. joint pain associated with calicivirus, pain associated with dehydration), and treat accordingly. Assess renal function and hydration status prior to administration of NSAIDs. Buprenorphine SR (sustained release) 0.12 mg/kg q72 hours SQ Buprenorphine 0.01 0.02 mg/kg q4-6 hrs. prn IM, SQ, trans-mucosal Meloxicam 0.1 mg/kg once PO, SQ. Subsequent dose starting 24 hours after initial dose at 0.05 mg/kg q 24 hrs. PO x 3 days. 4 Lidocaine 4% viscous. Apply directly to affected area q 6-8 hrs. prn. If temperature > 106.5 F, administer crystalloid fluids (subcutaneous or intravenous) Rule-out other systemic problems or lower respiratory tract involvement (thoracic radiographs if possible) Antipyretic drug treatment only if temperature > 106.5 F and fails to respond to external cooling treatment FeLV / FIV Test Polyp check PCR Respiratory Pathogen Panel Aerobic Culture and Sensitivity Radiographs Feline URI: Diagnostic Tests In-house ELISA tests to determine retrovirus status Full visual oro-nasopharyngeal examination under anesthesia Deep pharyngeal and/or nasal swab samples needed for submission to a laboratory (e.g. IDEXX) Deep pharyngeal and/or nasal swab samples needed for submission to a laboratory (e.g. IDEXX) Minimum of two views of thorax to determine lower respiratory tract involvement Low stress SQ fluid administration Let the cat choose where they are most comfortable in their box, on exam table, on your lap, not being touched, climbing on you, etc. Use appropriate needle size Avoid making a kitty pin cushion relative large volumes (300-400 ml) can be given in one location in most adult cat Use a line Do not inject too fast do not squeeze the fluid bag Warm the fluids Gently massage the injection area facilitates dissemination of fluids and serves as a positive diversion 4 Oral off-label dosage derived from the International Society of Feline Practitioners and the American Association of Feline Practitioners joint consensus guidelines published in 2010 (Journal of Feline Medicine and Surgery (2010) 12, 521 538.).
Feline URI Health Check Before initiating medication, always perform a complete physical exam. Check the cat all over for other problems that may complicate treatment or affect treatment decisions - it s a shame to get a cat through URI only to discover a tumor or some other serious medical condition that affects adoptability. For a URI treatment candidate, particularly consider: Overall appearance (bright, quiet, depressed) Very depressed Suspect serious disease, consider parvo test and take temperature. Vet check immediately. Hydration: check skin turgor between shoulder blades and feel gums to see how tacky they are Decreased turgor (skin returns, but slowly) ~ 5% dehydrated. Requires 500 mls fluid/10 pounds to correct. Skin stands in a fold ~ 10-12% dehydrated (severe). Probable secondary or systemic illness. IV fluids preferred. Vet check. Eyes, including cornea and conjunctiva: Assess presence of, conjunctival swelling, corneal irritation or ulceration, cloudiness in front chamber of eye (between iris and cornea), color of iris. Detectable ulcer or extremely sore eye perform full ophthalmic exam plus diagnostics. Vet check. Cloudiness in front chamber of eye or discoloration of iris possible systemic illness, perform full ophthalmic exam plus diagnostics. Vet check. Nose: Discharge: assess color, severity Degree of congestion Scabs or bleeding (often associated with calicivirus or intranasal vaccine reaction) Mouth: Ulcers or sores on tongue (often associated with calicivirus) Gingivitis, especially disproportional to degree of dental disease: often associated with calicivirus or (less commonly) FIV. Test all cats with ongoing, severe gingivitis for FIV. Lungs: Listen to lungs to check for lower respiratory problems. Upper respiratory sounds caused by congestion can also be heard in the lungs, but are usually louder when the stethoscope is placed directly over the nose. When in doubt, have the vet double check. Abnormal lung sounds perform radiographs to determine possible pneumonia or other serious disease. Put cat on a Vet check. Temperature: Temperature need not be taken in every case, but should be taken if the cat is: Depressed Not eating Dehydrated Has oral ulcers Has any clinical signs besides nasal or ocular and sneezing (such as vomiting, diarrhea, coughing)