Expert: Dr. Louis N. Gotthelf - 4/8/2007

Question
My 14 year old neutered cornish rex has had chronic nasal discharge most of his life.  He has also had chronic peridontal disease and teeth root adsorbtion and tooth issues.  

Last year (8/06) after two months of diarrhea and a full intestinal biopsy, he was dx'd as IBD and put on prednasone and put on an alternative protien diet.  Maintaining the alternative protien diet, I have managed to reduce his predgasone treatment to once every 4-5 days and maintain lack of diarrhea.  He was doing quite well.  

last December he required an emergency upper cainine tooth extration due to infection/impaction.  X-rays showed significant bone loss of the sinus cavity on the side of the infected tooth.  Subsequent CAT scan, biopsies and cultures revealed negative for neoplasia, and positive for pseudomonas aeruginosa.  He was then dx'd as having distructive rhinitus.  The culture revealed the pseudomonas aeruginosa to be resistant to many antibiotics (Ampicillin, Augmentin, Cephalothin, Chloramphenicol, Gentamicin,Tetracycline, Tribrissen) and sensitive to the following:  Amikacin, Carbenicillin, Ceftazidime, Ciprofloxacin, Piperacillin, Ticarcillin, Ticarcillin, and Torbramycin.  he was placed on 15 mg Cipro 1X day and then was upped to 15 mg bid (oral in fish oil).  He was also treated with L-Lysene for possible herpes.  He was on Cipro for more than 2 months (almost 3).  His nasal discharge decreased intermittantly.  

After 3-4 weeks after the Cipro treatment, he was tested again via nasal smear.  Once again he was + for pseudomonas aeruginosa (same restistances, same sentitivities, same lab).  

Can you explain this and suggest treatment?  Due to his age I do not want to risk an antibiotic which could compromise his eyes or renal system.  

Can he be re-infecting?  He is an indoor cat who goes out into the fenced back yard only once in a while.  We also have a dog, and they share a water bowl (charcoal filtered, aerofiltered).  Can this be transferred from the dog or the humans in the house (me and my husband)?  We have no health issues.  My cat sleeps with us.  

Thank you!

Gilbert's "mom"

Answer
Pseudomonas is very difficultt o get ot and to fing an antibiotic that will kill it.  There are many ways to administer an antibiotic. In the sinuses, it may be better administered topically.  This is very difficult in a cat because it requires an anesthetic to flush the nasal passages and sinuses.  Ceftazadime (Fortaz) seems to be a good choice for a systemic, injectible antibiotic as most pseudomonas organisms have never seen that antibiotic.