Table 10.

Considerations when selecting an antibacterial to treat urinary tract infections in cats with CKD

Consideration	Action	Antibacterials
Probably safe	No dose adjustment required, due to wide therapeutic index or excretion via extrarenal routes	Chloramphenicol
		Penicillins (including clavulanate)
Consider dosage adjustment	Adjust dose in moderate or severe CKD (IRIS stages 3 and 4)	Cephalosporins (most)*
		Fluoroquinolones†
		Sulphonamides (± trimethoprim)
Hazardous, avoid if possible	Accumulation of drug or its metabolites in CKD can increase risk of adverse events	Nalidixic acid
		Nitrofurantoin
		Tetracyclines‡ (except doxycycline)
Nephrotoxic	Avoid – high-risk drugs will exacerbate CKD	Aminoglycosides
		Polymyxins

^*Some cephalosporins accumulate in renal tubular cells and can cause damage

^†Avoid enrofloxacin in cats with CKD due to increased risk of retinopathy at standard therapeutic doses

^‡Water soluble tetracyclines (eg, oxytetracycline) depend partly on renal excretion. Tetracyclines also increase protein catabolism, and breakdown products of oxytetracycline have been shown to be nephrotoxic

IRIS = International Renal Interest Society