Why aren’t antibiotics working for a chronic upper respiratory infection in cats?

Original Question: Any other advice regarding sneezing? She was on DX feline herpes as a kitten. No real symptoms since 2010 but it became bad in November 2017 and it continues to be. Not responding to lysine paste and have tried 3 different antibiotics. Good response to full dose of 2 week Azithromycin but the response was not good when we reduced the dose. Tried a second round of a full dose but saw no real improvement at all. Little response to Doxycycline 2 weeks and Famciclovir. Tried nose drops but it didn’t seem to help and was too stressful for her to receive it so we stopped. Wheezing at night did improve after the first dose of Azithromycin. But she’s still sneezing lots and a lot of discharge from her right nostril. Her eyes clear, clear to somewhat yellowish, not opaque or green so no real infection? Do you have any other advice? Can the discharge be cultured to maybe determine a better choice of antibiotics? Next idea is to try a holistic vet! It’s a significant enough problem that I am always wanting to push her away before she sneezes on me or the countertop! We are both unhappy campers! Any ideas? - Ida

Jul 9, 2018

Hi Ida,

Thanks for your question. Sorry to hear that you’re dealing with this.

I’ve seen this issue before….basically a chronic upper respiratory infection in cats only improves but never resolves with antibiotic treatment.

One of the interesting things about your question is that you’ve listed a bunch of treatments you have tried and you probably feel that you’ve ‘tried everything.’ However, nowhere in your question do you list the results of any diagnostics. Cases like these tend to start off with assumptions like: ‘it must be herpes’, or ‘it’s got to be a bad bacteria.’ An antibiotic is chosen and when it doesn’t work, different ones are tried. It’s time to go back to the start.

You need to have your veterinarian perform diagnostics. I’m sure you’ll agree that the cost of repeating RX after RX is more expensive than doing diagnostics and then using the right treatment. I recommend you perform a viral panel and also a ‘culture and sensitivity’ to determine what infectious agents are present and what combination of antibiotics will resolve it. Then use the right treatment and don’t stop until at least a week after all clinical symptoms have resolved.

This would likely have helped right off the bat, had it been done. However, you may have a bigger problem. In cases like these, there is often a great deal of damage and scarring in the nasal turbinates and sinuses. This can limit the ability of the antibiotic to penetrate to the areas that it needs to go. In this case, you’ll need to consider a sedation and nasal flushing to start off the treatment.