Your patient has bacteriuria. Do you know when and how to treat it?November 3, 2020When evaluating a patient with bacteriuria, it's important to classify and localize the UTI to determine if antimicrobial therapy is required.
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A clinical approach to bacteriuria in dogs and catsSeptember 29, 2020Over the past few years, it has been evidenced the urinary tract is not a sterile environment and is instead inhabited by a unique microbiota.
Is cranberry effective for treating UTIs?April 29, 2019Like most herbal remedies, cranberry has traditionally been employed for a wide variety of unrelated problems, ranging from diseases of the liver and stomach to blood disorders and even cancer.1 These days, however, it is pretty firmly established in the minds of pet owners—and many veterinary professionals—as useful for urinary tract infections (UTIs). It may be surprising, then, to learn there is little convincing evidence to support the effectiveness of cranberry in preventing or treating UTI. The question of whether cranberries, in some form, have value in treating or preventing UTIs is a pretty old one. In addition to historical claims among herbal medicine practitioners, there are scientific references on the subject going back to the 1960s.2 An early theoretical rationale for using cranberry to treat UTIs was it inhibited bacterial growth by acidifying the urine.3,4 However, later research has not substantiated this theory, and this rationale is no longer commonly used to explain the purported benefits of cranberry in preventing or treating a UTI.1,5 The more popular theory today is compounds in cranberry juice, particularly a group called proanthocyanidins, interfere with the attachment of some bacteria to the bladder mucosa, reducing colonization and the establishment of infection.6,7 This …
Asymptomatic bacteriuria—To treat or not to treat?March 28, 2019Veterinarians and pet owners are highly motivated to find discrete, fixable problems when pets are unwell. Owners want the reassurance and sense of control that comes with knowing what the problem is and taking action. Veterinarians want to help our patients, while also satisfying clients. Their expectation is that we offer some clear preventive or therapeutic intervention justifying their time and the expense of coming to see us, as well as reassure them about their pets' condition. Finally, our medical training often emphasizes diagnosis and treatment as the core responsibility for a doctor; the importance of knowing when not to take action is frequently underemphasized.1,2 Such inherent bias toward finding and treating problems creates discomfort and resistance when scientific evidence suggests we should avoid some tests or treatments. Though there is widespread awareness of the risks of overdiagnosis and overtreatment in human medicine, these are relatively new and controversial concepts in the veterinary field.3,4 My own efforts in this column and elsewhere to suggest we might sometimes do better not to run a test (e.g. pre-anesthetic bloodwork)5 or prescribe a treatment (e.g. lysine)6 have generated the kind of pushback often greeting such suggestions. Nevertheless, we have a responsibility to …
