Prednisolone dosage for cats with fip. FIP: Advances in Treatment
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Dr Addie - feline infectious peritonitis (FIP) treatment.Is It Possible to Treat Feline Infectious Peritonitis? - WSAVA Congress - VIN
Niels C. We use the same criteria for monitoring treatment as described in the JFMS field trial paper. Owners are asked to keep track of temperature, weight, activity, appetite, clinical signs of original disease at daily or weekly intervals. Blood tests including at a minimum CBC hemogram and serum chemistry panel including serum protein values -total protein, albumin, globulin, A:G ratio at onset of treatment and every 4 weeks thereafter.
It is always helpful when these values, along with weight, are updated in a graph form. The goal is to have a health, alert and active cat at the end of 12 weeks of treatment and with normal blood test values, especially for hematocrit, total protein, globulin, albumin and A:G ratio.
A significant weight gain is also a good sign and some young or particularly wasted cats can more than double their weight during their treatment. Of course, this is an idealized treatment, and one must expect that dosage may need to be adjusted upward if response is slow or if complications such as ocular or neurological involvement should manifest during treatment. Supportive symptomatic care may be needed to stabilize cats that are critically ill at the time of diagnosis or during the first few days of GS GS treatment.
Abdominal effusion should not be removed unless it is compressing the chest and interfering with breathing, as it will just be rapidly replaced at the expense of the rest of the body. However, thoracic effusions are usually associated with varying degrees of dyspnea and should be removed.
Thoracic effusions are much slower to recur. Symptomatic care also frequently includes fluids and electrolytes to counteract dehydration, antibiotics when a secondary bacterial infection is suspected, and anti-inflammatories usually systemic corticosteroidsand rarely blood transfusion.
Topical medications may also be needed to counteract severe inflammation and increased intraocular pressure glaucoma in some of the cats with ocular involvement. Corticosteroids such as prednisolone should only be used for the first few days of GS treatment and then discontinued as rapid improvement in health occurs. Long-term use of corticosteroids with GS is strongly discouraged as it can mask improvement signs caused by the GS, especially in cats with neurological FIP, it has no curative power, and may interfere with the development of a protective immune response to the FIP virus.
It is possible that this immune response plays a major role in the ultimate cure. If cats are on chronic steroid treatment, there is no need in cats to taper the dosage as there is no evidence that severe adrenal atrophy, such as occurs in humans on long-term steroid treatment, occurs in cats. Many owners, GS treatment advisors, and veterinarians will use various supplements advertised to improve liver, kidney or immune system health as well as vitamins such as B These substances have no proven efficacy and I consider them a waste of money.
The treatment with the injection form of GS, which is most common, can also be complicated by injection site sores. The treatment is also hard on both owners and cats, as injections can be painful. There is also a problem in some cats, especially those with neurological involvement, with development of partial drug resistance, which requires an increasing dosage.
Response to treatment is usually within h and most cats are back to normal or near normal within weeks, which is a good sign. If cats with wet or dry FIP at the beginning develop ocular or neurological signs they go to the appropriate ocular or neurological dosage. There is an oral form of GS available from at least two sources out of China Aura, Mutian and I do not use it so am not familiar with the comparable dosage.
I recommend that the dosage be adjusted with weekly weight checks. If there is some weight loss at first of treatment, I stay at the original dosage and do not lower it. Failure to gain a good amount of weight during treatment is considered a bad sign.
I do not raise a dosage unless there are significant reasons to do so, such as failure or blood tests to improve, slow improvement, poor activity levels, failure of original clinical signs to disappear, or change in disease form to include ocular or neurological signs.
This is where the art comes into play, because you do not want to get stuck on single blood values that are not quite normal and neglect the overall health status of the cat. For example, the globulin may still be a little high, but other critical blood test values and health status are good. If 4 weeks extends the week treatment time, the treatment time is extended to accommodate.
One should expect a positive response to any increase in the dosage and a failure to see improvement indicates that the dosage is still not high enough, drug resistance is occurring, the brand of GS is not what it should be, the cat does not have FIP, or there are other diseases confusing the treatment.
One of the most difficult decisions is to determine when to stop treatment. Although some cats, often younger ones with wet FIP, can be cured in as little as 8 weeks and possibly sooner, the usual treatment time is 12 weeks. Some cats may even require dosage adjustments and even longer treatment periods.
Critical blood values such as hematocrit, total protein, albumin and globulin levels, and total WBC and absolute lymphocyte counts usually normalize in cats destined for cures at weeks, at which time there is often an unanticipated increase in activity levels. This is a situation that occurs with hepatitis C treatment in people, which is also a chronic RNA virus infection that often requires up to 12 weeks or more of antiviral drug treatment.
Unfortunately, there is no simple test that will determine when a cure has occurred and the fear of relapse often drives owners, treatment advisors, and veterinarians to extend treatments beyond 84 days. Fear of relapses will also cause those people involved in the decision process to be overly cautious about single blood values that are a little abnormal e.
It must be remembered that a normal range for a blood value covers most animals, but that it is a bell-shaped curve and that there will be a few exceptional patients that will have values on the margins of these curves. Ultrasonographers need to consider the degree of pathology that can occur in a FIP diseased abdomen and how scarring and other residual effects can alter normal appearances in successfully treated cats.
In situations where such questions arise, it is best to look more closely at the total picture and not just one small part. The most important result of treatment is the return to normal health, which has two components — outward signs of health and inward signs of health. The latter is often one of the best measures of health for a cat. Inward signs of health are manifested by a return to normal of certain critical values based on periodic complete blood counts CBC and serum chemistry profiles.
The most important values in the CBC are the hematocrit and the relative and absolute total white blood cell, neutrophil and lymphocyte counts. The most important values in the serum chemistry panel or serum electrophoresis panel are the levels of total protein, globulin, albumin, and the A:G ratio. Bilirubin is often elevated in cats with effusive FIP and can be useful in monitoring the severity and duration of the inflammation.
There are many other values in a CBC and serum chemistry panels, and it is not unusual for some of them to be a little higher or lower than normal, and it is best to ignore these values unless they are significantly elevated and associated with clinical signs.
For instance, a high BUN and Creatinine that is also associated with increased water consumption, excess urination, and abnormalities in the urinalysis. Platelet counts by machine are notoriously low in cats due to trauma from blood collection and platelet clumping and should always be verified by manual examination of the blood smears.
The final decision to stop or extend treatment when confronted with vague doubts from various test procedures should always be based on the outward manifestations of health more than any single test result. Various modifications in the treatment have been created by different FIP treatment groups.
Some groups will treat with an exceedingly high dosage of GS from the onset rather than escalating the dosage only when indicated, or cap off the treatment during the last two weeks or in an added two weeks with a higher dosage of GS on the hope that it may reduce treatment time or the chances of relapse.
Some advocate the use of interferon omega or non-specific immunostimulants to further stimulate the immune system, and some employ even different modifications. There is no evidence that capping the treatment with an extra high dosage will improve cure rates.
Likewise, interferon omega and non-specific immunostimulants have no proven beneficial effects on FIP when given as sole treatments or as supplements to GS. The practice of adding another antiviral drug, GC viral protease inhibitor, to GS treatment in cats developing GS resistance is also emerging and needs research.
Finally, it is common for owners, treatment groups, and veterinarians to add in many supplements, tonics, or injections e. Such supplements are rarely necessary in cats with pure FIP disease. Relapses of FIP during the week post-treatment observation period do occur, and there is no simple blood test to predict when a cure has occurred or if a relapse will occur.
Relapses usually involve infections that have escaped to the central nervous system brain, spine, eyes during treatment for wet or dry FIP not accompanied by neurological or ocular signs.
The dosage of GS used to treat these forms of FIP are often insufficient to effectively overcome the blood-to brain or blood-to-eye barriers. Partial resistance may allow for control of disease signs, but not a cure, while total resistance is manifested by varying severity of clinical signs in the face of treatment. Resistance to GS can exist at the time of diagnosis, but this is uncommon. Rather, it tends to occur during treatment and is often partial at first and necessitates a higher dosage to accommodate for it.
It can become total in some cats. Resistance is the biggest problem in cats with neurological disease, especially those that present with neurological disease or develop brain infections during treatment or during a relapse after what appears to have been a successful treatment.
Many cats with partial drug resistance can be treated for their disease signs but will relapse as soon as the treatment is stopped. GS treatment is amazingly free of systemic side effects. It can cause minor kidney damage in some cats, but this does not progress to overt renal disease. Systemic drug reactions of the vasculitis type have been seen in a few cats and can be confused with injection site reactions. However, these drug reactions are at non-injection sites and are often self-limiting or respond well to a short-term low dose of steroids.
The major side-effect of GS treatment is pain at the injection sites, which varies from cat to cat and according to the injection prowess of the person doing the treatment usually the owner. Injection site sores are a problem with some owners and usually occur when the injection site is not moved around the body stay away from between the shoulders and not given into the muscle and nerve layers below the subcutis. I recommend selecting sites starting an inch behind the shoulder blades, down the back to inches before the tailhead, and one third to one-half of the way down the chest and abdomen.
Many people use gabapentin before injections to help ease the pain. Injection site sores are cleared of surrounding hair and gently cleaned 4 or more times a day with sterile cotton balls soaked in dilution of household hydrogen peroxide. They usually do not require any more sophisticated treatment and heal within 2 weeks or so. The current hope is that a legal form of GS will be soon available. A drug named Remdesivir is the best current hope, because Remdsivir it is immediately broken down to GS when administered intravenously in humans, mice, primates and cats.
Remdesivir has been given full approval by the US FDA and similar approval will probably follow in other countries. If so, it can be prescribed by any licensed human physician, and by default, by veterinarians. However, the use of Remdesivir in the US has been still limited to a specific subset of Covid patients and only under controlled conditions and with continued data collection.
Until all restrictions are lifted, it will not be readily available for even human use. I have no experience with treating cats with Remdesivir instead of GS However, groups in Australia and some Asian countries are starting to use it and report identical results to GS The dosage of Remdesivir on a molar basis is theoretically the same as GS The free base form of GS has a molecular weight of Therefore, it would take twice as much Remdesivir The diluent for Remdesivir is significantly different than the diluent used for GS and designed for IV use in humans.
How diluted Remdesivir will behave when injected subcutaneously over 12 or more weeks of daily treatment is not known. Finally, mild signs of both liver and kidney toxicity have been seen with Remdesivir in humans.
GS causes mild and non-progressive renal toxicity in cats but with no apparent liver toxicity. It is uncertain whether the renal toxicity seen in humans given Remdesivir is due to its active ingredient i. GC approval for cats and humans is in progress by Anivive but is still two or more years away. GC is a viral protease inhibitor and works downstream from GS, which inhibits the earliest stage of viral RNA replication.
❾-50%}Summary of GS treatment for FIP - Sock it to fip.
In addition, cats lose weight while on this treatment. Because FIP is an immune mediated disease, therapy sometimes includes suppressing the immune response, for example, with glucocorticoids, which can have lethal consequences if the diagnosis is erroneous e.
Before embarking on any of the following therapies, it is essential to ensure that the diagnosis is correct. See Diagnosis of FIP. Cats receiving immunosuppressants should also receive antibiotic cover to protect them against other infections. It is also important to maintain the cat's general nutrition status, by adding real meat, vitamins and antioxidants.
Meloxicam Metacam, Boehringer Ingelhiem. Of course we now have specific antiviral drugs available in some countries which render these treatments obsolete. Presnisolone is relatively safe and tends to make the cat feel better, it stimulates his or her appetite; prednisolone is inexpensive and available everywhere.
However, prednisolone suppresses both the humoral and cell-mediated immune response and alternative anti-inflammatory treatments are more effective in the treatment of FIP: Hugo and Reading reported prolonged survival— days—in a 4 year old cat with effusive FIP, whom they treated with meloxicam and one month of metronidazole and Tramadol. I am frequently shocked to learn of veterinary surgeons who forget the half the dose of corticosteroids every days: for example, this was not done in the Ritz study and 13 of the cats died of secondary bacterial infections.
Prednisolone has the advantage of also being the treatment for lymphocytic cholangitis, which can be mistaken for FIP, so where the diagnosis is in doubt between FIP and lymphocytic cholangitis, prednisolone can be given to assess the response: the cat with lymphocytic cholangitis has a good chance of recovery, the cat with FIP unfortunately will die.
Prednisolone should never be used in cats with toxoplasmosis, or leishmaniasis, neither is it safe in cases of septic peritonitis or pleurisy, which is why cytology is a very important part of effusive FIP diagnosis, as there will be many more white blood cells in the effusion of a cat with sepsis, and a good cytologist will detect the bacteria or fungi.
Prednisone is not effective in cats Trepanier, Meloxicam Metacam, Boehringer Ingelheim. Dose: 0. Thalidomide The rationale of using thalidomide in the treatment of feline infectious peritonitis is to reduce inflammation and the humoral immune response to feline coronavirus while leaving the cell mediated anti-viral immune response intact. Only 4 cats with FIP have been treated with thalidomide so far and unfortunately all died.
However, one with a thoracic effusion did eliminate his effusion and had a remission of 3 months. I think that, to be effective, thalidomide would need to be used very early in the disease, before too many blood vessels became damaged. Be sure to obtain the owner's consent for using a drug not licenced for cats. Dose: mg at night. In work I have not yet published, I saw a dramatic improvement in lymphocyte levels in 5 cats out of 6.
In my recent paper , four cats in the recovered group and one in the remission group were treated with PI amongst other things. In a study by Legendre et al, , survival was better in cats not concurrently treated with systemic corticosteroids, but it is probably safe to use topical ophthalmic corticosteroid treatment along with PPI in cats with intra-ocular signs of non-effusive FIP.
Dose : 3. To obtain PI: email orders vetimmune. UK veterinary surgeons will need to apply to the VMD for special import permission. I found the following video made by a cat's guardian, demonstrating how she doses her pet:. Back to top. If the anti-FCoV nucleoside analog GS pills Krentz et al , are licensed in your country, that would be the treatment of choice.
GS pills: 5mg of active ingredient per kg bodyweight until acute phase protein alpha-1 acid glycoprotein AGP or serum amyloid A, SAA levels consistently return to normal, or for up to 12 weeks. Most cats only require up to 7 or 8 weeks of treatment.
I recommend giving days of a double dose of antiviral at the outset of treatment to clear the brain of virus: this precaution seems to prevent neurological FIP relapses. If using the Bova GS they recommend doubling the dosage that is used for Mutian.
Once the cat has had two consecutive AGP or SAA tests within normal limits:then stop the pills and use oral Virbagen Omega at , units per cat per day per os.
In some countries, vets are able to use Remdesivir injections to treat FIP and that may be the only option, but it's not the best option see above. Meloxicam provided blood pressure and kidney function are normal : 0. Back to top 7. I have I have little personal experience of Polyprenyl Immunostimulant, the person with most experience using it is Dr Legendre whose paper is open access.
However, in my experience it is effective at reversing lymphopenia. Diluting feline interferon Virbagen Omega comes in vials of 10 million units. Mutian X pills, twice this dose for Bova GS for up to 12 weeks. Note: it is best to ask the antiviral supplier about their recommended doses for the clinical presentation of an individual cat.
Ivermectin dose: 0. Vitamin B12 injections should be given to all cats with FCoV-associated diarrhoea once a week. FCoV-associated diarrhoea is ameliorated but not totally cured by chicken and pumpkin cat food e. Applaws or Almo Nature chicken and pumpkin tinned food and Protexin Pro-kolin enterogenic probiotics.
Fortiflora probiotics are also helpful if the Protexin brand is not available but don't use any other probiotic brand unless you have had a bacteriology laboratory grow them: we grew a number at our laboratory in the University of Glasgow Veterinary School and were appalled by what we found.
Dr Weese had a similar experience with pet foods claiming to contain probiotics. S-adenosyl-L-methionine SAMe, e. Denamarin, Hepatosyl. Used to protect the liver if using a nucleoside analog drug which can be hepatotoxic, or if FIP itself has caused raised liver enzymes.
Vitamin B12 e. Multivitamins B are a good appetite stimulant and can be obtained from health food shops or chemists I particularly like the one from Boots chemists in the UK. Dose: paediatric dose. Vitamin A Vitamin A is an antioxidant. The dose of Vitamin A is i. Cats cannot metabolise the beta-carotene form so must be given vitamin A as fish oil, e. Too much vitamin A can cause excessive laying down of bone at the joints, so don't use this supplement for more than weeks.
Vitamin C Ascorbic acid mg twice daily given by mouth or in food. Vitamin C is an antioxidant. Remember that given over a long period of time, vitamin C can predispose to oxalate crystals in the urine, so only use with caution. However, it must be used with caution because of its role in calcium homeostasis there are more cases of vitamin D intoxication in the veterinary literature than there are of deficiency. Therefore I would recommend only using vitamin D3 supplementation for only a brief period days or weeks and constantly checking levels of blood Ca.
Vitamin E Dose of vitamin E: i. Vitamin E is an antioxidant. Other supportive drugs. Probiotics Probiotics such as Protexin Pro-Kolin enterogenic can help cats with FCoV associated diarrhoea and with FIP since the functioning of the immune system is dependent upon the health of the microbiome. Aspirin For anti-inflammatory activity and pain relief. Antibiotics Antibiotic cover is essential when immunosuppressing a cat. Your choice of antibiotics will depend on what your major differential diagnoses are, given the presenting clinical signs.
Metronidazole is effective against anaerobic organisms, so is a good choice where bacterial pleurisy is a differential diagnosis. It inhibits TNF-alpha—i. Hugo and Reading, However, it is horrible to taste and can be difficult to administer to cats. Anabolic steroids For appetite encouragement and anti-catabolism, especially if the kidneys are affected.
Nandoral tablets - one a day either whole or crushed into food. Orandrone tablets: 0. Remember to warn the owner that the cat's urine could become more strong smelling with this treatment. The injectables usually require to be kept in the dark. Whatever treatment you opt for, it is important to monitor the cat's progress. Abdominal effusions rapidly disappeared over a one- to two-week period starting around 10 to 14 days post-treatment. Cats with thoracic effusions were usually dyspneic struggling to breathe upon presentation to private veterinarians, prompting removal of pleural effusions prior to coming to UC Davis.
Residual dyspnea and thoracic effusion responded rapidly to treatment and were no longer apparent after seven days. With the advent of these two drugs, veterinarians began to celebrate the notion of an upcoming cure for FIP, but the COVID pandemic has slowed testing and funding. UC Davis reports that it may be two to five years before these drugs are routinely available to veterinarians.
Research investigating the development of a vaccine to prevent the coronavirus mutation that results in FIP and of an accurate diagnostic test is ongoing at Colorado State University, but neither of these options is available yet. Cats with naturally occurring FIP require at least 12 weeks of GS therapy, but this drug is currently not FDA-approved, is quite expensive, and should not necessarily be considered a cure for FIP at this stage.
There are black-market sources offering these medications to pet owners, but the quality and exact composition of these products can vary widely. Unfortunately, your veterinarian cannot legally prescribe these medications at this time. For now, owners of cats with FIP should discuss treatment options for their cats with their veterinarians. Preventing FeCV infection is challenging given its ubiquitous nature, especially in cats that are housed in high density shelters, catteries.
FeCV is contagious through feces and saliva of infected cats and infects other cats primarily via the oral cavity. Newly acquired cats and any cats suspected of being infected with FeCV may be separated from other cats, although the usefulness of this management strategy is debatable.
Obviously, the treatment of coronaviruses is a hot topic these days. Finally, it is common for owners, treatment groups, and veterinarians to add in many supplements, tonics, or injections e. Such supplements are rarely necessary in cats with pure FIP disease. Relapses of FIP during the week post-treatment observation period do occur, and there is no simple blood test to predict when a cure has occurred or if a relapse will occur. Relapses usually involve infections that have escaped to the central nervous system brain, spine, eyes during treatment for wet or dry FIP not accompanied by neurological or ocular signs.
The dosage of GS used to treat these forms of FIP are often insufficient to effectively overcome the blood-to brain or blood-to-eye barriers. Partial resistance may allow for control of disease signs, but not a cure, while total resistance is manifested by varying severity of clinical signs in the face of treatment.
Resistance to GS can exist at the time of diagnosis, but this is uncommon. Rather, it tends to occur during treatment and is often partial at first and necessitates a higher dosage to accommodate for it. It can become total in some cats. Resistance is the biggest problem in cats with neurological disease, especially those that present with neurological disease or develop brain infections during treatment or during a relapse after what appears to have been a successful treatment.
Many cats with partial drug resistance can be treated for their disease signs but will relapse as soon as the treatment is stopped.
GS treatment is amazingly free of systemic side effects. It can cause minor kidney damage in some cats, but this does not progress to overt renal disease. Systemic drug reactions of the vasculitis type have been seen in a few cats and can be confused with injection site reactions.
However, these drug reactions are at non-injection sites and are often self-limiting or respond well to a short-term low dose of steroids.
The major side-effect of GS treatment is pain at the injection sites, which varies from cat to cat and according to the injection prowess of the person doing the treatment usually the owner. Injection site sores are a problem with some owners and usually occur when the injection site is not moved around the body stay away from between the shoulders and not given into the muscle and nerve layers below the subcutis.
I recommend selecting sites starting an inch behind the shoulder blades, down the back to inches before the tailhead, and one third to one-half of the way down the chest and abdomen. Many people use gabapentin before injections to help ease the pain.
Injection site sores are cleared of surrounding hair and gently cleaned 4 or more times a day with sterile cotton balls soaked in dilution of household hydrogen peroxide.
They usually do not require any more sophisticated treatment and heal within 2 weeks or so. The current hope is that a legal form of GS will be soon available. A drug named Remdesivir is the best current hope, because Remdsivir it is immediately broken down to GS when administered intravenously in humans, mice, primates and cats.
Remdesivir has been given full approval by the US FDA and similar approval will probably follow in other countries. If so, it can be prescribed by any licensed human physician, and by default, by veterinarians. Fear Free Is Better Medicine. Urine Marking Cats. Use Technology to Drive Compliance. Employee Incentive Programs. Increasing Revenue Through Perceived Value 1. Team Collaboration Tools. Reward Program.
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Note: this section is intended for veterinary surgeons only and should NOT be used by cat guardians to attempt to treat cats themselves. However, before leaving the page, guardians please download the following to take to your veterinary surgeons:.
FIP diagnosis algorithm this will open in a new window. Questionnaires for step 1 of the FIP diagnosis algorithm for guardians to complete and give to your veterinarian to save time during your veterinary consultation. Note - these downloads should open in a new window and in some browsers will simply automatically download. Click here for printer friendly version i. FIP is now a curable condition: but prevention is better than cure!
However, with the introduction of feline interferon and more recently GSthe nucleoside analogue, we now have hope for more than remission of weeks to months: we have hope of complete recovery for some cats, especially those diagnosed in early infection. However, more work requires to be done so that an affordable treatment protocol can be established for people whose cats are not insured.
Therefore the emphasis must still be on totally preventing cats ever developing FIP in the first place, and on accurate diagnosis, so that cats with non-FIP conditions are not needlessly euthanased. This webpage represents only the personal opinions of the author, not all opinion leaders agree with me.
Disclaimer: this website and webpage are for information purposes only, I accept no responsibility for how you decide to use this information. Remember that many treatments listed here would be off label and that you must inform your client of this fact and have your client sign your practice's legal disclaimer form.
Updates on treatment will appear in the English version of the website before the translated pages. References and further reading. Work through the FIP diagnosis algorithm and be sure that the cat ticks most of the boxes of all of the steps. It is essential to ensure that the diagnosis is correct : immunosuppressive drugs will markedly worsen other conditions such as bacterial peritonitis or pleurisy and even be fatal in other cases, for example toxoplasmosis, leishmaniasis.
Subscribe to my YouTubeBitchute, and Rumble channels to see new cases when they are uploaded. Also see the FIP diagnosis webpages. Please watch my film: "Why did GS not cure this cat? The beauty of altering nutrition immediately is that it will help in any condition, not just FIP—and it is safe. Arginine is essential not only for the urea cycle but also for the normal functioning of monocytes and endothelial cells.
Give real meat daily to augment arginine levels: even just a tablespoonful a day will make a difference to FCoV infected cats. It is important that the meat or liver come from free range animals because they will have eaten grass which is rich in omega 3.
Alternatively, regularly use commercially available real meat based cat foods e. Feed cats with FIP a little salmon, sardines, pilchards or other fish rich in omega 3 Cereal based foods contain too much omega 6 polyunsaturated fatty acids and too little omega 3, leading to a state of chronic inflammation — we have seen this in human beings over the past couple of decades: an unprecedented rise in inflammatory conditions such as allergies, asthma and arthritis.
We see a similar rise in inflammatory conditions being recognised in the cat. Both Applaws and Almo Nature have canned food including real fish. However remember the risk of hypervitaminosis A excessive laying down of bone at the joints so be wary of feeding too much real fish — reassess the situation after 6 weeks.
The way to introduce a new food is to give it for one meal, then go back to the customary diet for the next few meals, then give a little of the new food again, and so on, gradually increasing the frequency of the new foods, until giving a different food every meal becomes the norm for the cat.
To introduce new foods gradually properly will take at least a month. Remember that you need to clear any infected in contact cats or they will simply re-infect your patient, giving the impression of a relapse. Some cats develop weeping, painful lesions at the site of injection Pedersen et al In addition, the injections are less effective than pills and do not reliably stop FCoV shedding in the faeces.
I am now being consulted about cats who are in relapse following a 12 week course of FIP treatment: these cats were almost always treated with injections, rather than pill forms, or their treatment was begun with an injectable anti-viral. Liver support using S-adenosyl-L-methionine is essential for longer term use with nucleoside analogue antiviral compounds.
Once we have two consecutive normal AGP results at least one week apart, we stop the oral GS and go onto low dose oral Virbagen Omega until the cat's FCoV antibody titre drops significantly Addie et al, In-contact cats are tested for FCoV shedding and we stop them shedding virus to prevent re-infection of the patient. Details of this protocol can be found below. A major hurdle in some countries is that none of the anti-coronavirus treatments for FIP is yet approved, therefore an alternative protocol needs to be found.
GS pills. GS injections : not recommended. Adenosine nucleoside analog GS pills: treatment of choice for feline infectious peritonitis. Cat guardians - you are not allowed to buy these pills directly, your vet will supply them for you.
Bova GS pills contain 50mg of active ingredient: the pills are scored and can easily be broken into halves or quarters. Note that this dose is double that used in Mutian X studies Addie et al, ; Krentz et al, : this is because two independent analyses of Mutian pills allege that Mutian X contains more of the GS component than is claimed by the manufacturers.
I have to admit that I have not yet supervised treatment of a cat with FIP using Bova pills therefore I am extrapolating dosages from what we know about treatment with Mutian X pills. PILLING: please warn the cat's guardian about the risks of oesophagitis following pilling, and that it's important to follow a pill with some food or drink to ensure it is properly washed down into the stomach and doesn't lodge in the oesophagus.
Another reason for giving the antiviral with food is because we want the active antiviral to be absorbed and not simply pass through the intestinal tract rapidly, so giving with food delays the passage through the gut. For cats who are difficult to pill, try a pill popper; wrapping the pill in tuna or salmon pate; or using Royal Canin's Pill Assist TM. If the cat tends to vomit with the antiviral, then give a little food before pilling.
Denamarin, Hepatosyl to protect the liver when using GS Be aware that high doses of nucleoside analogue may damage the kidneys therefore monitor SDMA and reduce dosage to 5mg active ingredient per bodyweight q24 hrs in divided doses as soon as clinical signs resolve.
Remember that this treatment would be off label and that you may want to have your client sign your practice's legal disclaimer form. Check with your own regulatory body for advice about the legality of its use in your own country. In China, Mutian Xraphconn Mutian X or simply Mutianwhich contains GS Krentz et al,is available as capsules or tablets: the Mutian pill is said to contain 10mg of active ingredient.
Their website is www. In my online referral practice, I am increasingly seeing cats who have relapsed following an 84 day course of GS these cats have usually been treated with the injectable form of GS, or they began their treatment with an injectable form of GS The reason these cats are more likely to relapse is because the drug does not adequately penetrate the gut which is where the virus maximally replicates, and so some virus escapes, crosses the blood-brain barrier where it causes a build up of CSF i.
There were promising results with GS in vitro and in one in vivo experimental study, Murphy et al. Pedersen et alThirty-one cats were enrolled in the field study: 17 of 20 with effusive FIP, 2 developed neurological signs and were euthanased and one died due to cardiomyopathy. Eleven other cats were treated with GS injections: 4 died shortly after treatment commenced, and of the remaining cats, 3 with presumptive non-effusive FIP recovered as did 4 dry-to-wet cases. Thus of the 31 cats treated, 24 survived by time of writing up the paper.
I do not recommend using GS or Remdesivir Veklury injections unless the cat is absolutely impossible to pill for the following reasons:. Giving GS pills targets FCoV where it replicates: in the intestine, whereas if you inject it, penetration to the inside of the intestine will presumably be less Addie et al Monitoring cats on GS or molnupiravir treatment.
Stop the GS pills when alpha-1 acid glycoprotein AGP levels consistently return to normal Addie et al, and put the cat ontounits of Virbagen Omega per cat sid per os instead. The best indicator that FCoV no longer exists within the body is when the FCoV antibody titre reduces significantly preferably to underusing a sensitive FCoV antibody test: see the FCoV antibody page for which test is best.
However, the FCoV antibody titre is the slowest parameter to return to normal i. Monitor weight to assess response to treatment: see my video www. I am investigating another treatment for stopping FCoV shedding, but have not got enough evidence yet to report upon it. Below is Skywise, who featured in a case study published in the peer-reviewed journal Viruses :.
Skywise had been blind: his sight was restored and he is alive and well almost two years following Mutian X treatment. Further information. Watch this space for updates on antivirals, and follow me on:. MeWe a privacy honouring alternative to Facebook : www.
Seek advice from your own veterinary body about using anti-coronavirus antivirals in your country. Disclaimer: I am not a lawyer, I do NOT know if this is legal, and I am not responsible for your choices about whether or not to use it: you do so at your own risk. GS not working in your patient? To obtain a consultation with me, please visit the www. GC is a 3C-like protease inhibitor antiviral drug, not currently commercially available so far as I know.
In my opinion, it has been eclipsed by GS see above. In the published field trial, 6 of 20 cats experienced remission. Here is a figure from the publication by Prof Pedersen et al :. One advantage of GC over GS is that it can be dissolved in water, so the injections aren't as nasty.
I have heard that the patent for GC was bought by Anvive and that they will market it as an FIP treatment in future, but I do not have evidence for this to show you. However, it may be worth watching the Anvive website. Interferons are the broad-spectrum antivirals that the body produces. They are fairly species specific, so it is more effective to use feline interferon than human interferon, although the latter is better than nothing.
Feline interferon omega. Human interferon alpha. Feline interferon omega Virbac, France Virbagen Omega made by Virbac is recombinant feline interferon omega IFN omega and is available in many countries now. This product was first used in treatment of FIP by Japanese vet and scientist Takuo Ishida in a study in which 4 cats of 12 completely recovered and two survived 4 and 5 months. Those cats which recovered completely all had the effusive form of FIP and were relatively older cats.
This treatment protocol is based on Dr Ishida's:. Dr Ishida used corticosteroid s in his studybut they reduce the life span of cats with FIP Legendre et al,so for many years now I have been recommending meloxicam instead provided blood pressure and kidney function are normaland have been achieving remission and even some cures Addie et al, Dose for non-effusive FIP:Units per cat per day dilution instructions are below.
It is very important to begin treatment as soon as possible after the onset of clinical signs. Virbagen Omega comes in vials of 10 million units.
A low to moderate dosage of prednisolone or prednisone (starting at 2 mg/kg, orally, once a day for two weeks and then mg/kg indefinitely), coupled with a. Bilkei () used a combination of cyclophosphamine (4 mg/kg for 24 h), prednisolone (4 mg/kg for 24 h), and ampicillin ( mg/kg for 24 h) in. Dose: mg/kg/ sid given by mouth, halving the dose every days, right down to mg/kg every other day or until an optimal dose for. Since FIP is in part immune-mediated in pathogenesis, treatment aimed at controlling the immune response has been used, using prednisolone at 2–4 mg/kg/day. While drugs such as prednisolone, a corticosteroid that is often used to treat chronic inflammatory diseases, have anecdotally been reported to. It is also important to maintain the cat's general nutrition status, by adding real meat, vitamins and antioxidants.However, there are no controlled studies to prove any beneficial effect of corticosteroids, although they are frequently used. One uncontrolled study suggested that feline interferon omega IFN-w given with glucocorticoids treatment could be beneficial in FIP but the diagnosis was not confirmed in those cats that survived, 1 and a subsequent randomized placebo-controlled double-blind treatment study in 37 cats with confirmed FIP 2 showed no benefit of IFN-w and immunosuppressive levels of glucocorticoids than glucocorticoids alone, although the cases treated were likely very late in the course of disease.
As long ago as , a small study 3 described the use of oral polyprenyl immunostimulant PPI , which upregulates Th-1 cytokines, in the treatment of 3 cases of non-effusive FIP.
In two of the cats the FIP diagnosis was based on the finding of pyogranulomatous lymphadenitis on lymph node aspirates whereas the third was confirmed as FIP by positive FCoV antigen immunostaining on histopathology of a lymph node. Two of the three cats remained alive and well on treatment 2 years after diagnosis whilst the third cat survived 14 months but was treated for only 4.
A larger study evaluating oral PPI treatment three times per week in 60 non-effusive FIP cases 16 gastrointestinal, 18 mixed, 11 non-localised, 9 ocular, 5 neurological, 1 with no clinical signs was recently published; 4 this study did not include untreated controls for ethical reasons. In this study the diagnosis of non-effusive FIP was largely made by the attending 1st opinion veterinarian, sometimes with the help of veterinary specialists, but only 13 of the 36 cats that had so-called specialised laboratory testing had FCoV immunostaining performed, although it is recognised that sampling for the diagnosis of non-effusive FIP cases is notoriously difficult.
During this study, cats could be treated with additional drugs, and it was found that the survival of the cats that were given corticosteroids concurrently with PPI was significantly shorter than those given PPI without corticosteroids.
No side effects were reported with PPI treatment. PPI is commercially available, although costly. Recent studies have focused on the use of novel anti-viral agents as treatment. These anti-viral agents have included protease inhibitors, which inhibit proteases that normally process FCoV polyproteins into mature proteins during FCoV replication, and nucleoside analogues, that act as an alternative substrate for RNA synthesis for FCoVs, resulting in RNA chain termination during viral RNA transcription.
None of the in vivo studies with protease inhibitors or nucleoside analogues described later have included untreated control cats for ethical reasons. Protease inhibitor agents, such as 3CLpro inhibitors, have been shown to have activity against FCoV in vitro, 5,6 prompting in vivo studies.
The 6 recovered cats all remained healthy during an observation period of 8 months, although a subsequent publication documented that one of these cats had succumbed to neurological FIP 6 months later. Thus it is important to evaluate potential treatments in naturally occurring FIP and GC treatment was thus then evaluated in naturally occurring FIP. Cats were confirmed as having FIP based on signalment, history, prior test results, clinical examination, repeat of blood and effusion testing and ultrasonography and ophthalmological examinations when necessary.
But the number of cats on which these diagnostic methods were used was not stipulated and a lack of reference to the use of histopathology or effusion cytology and immunostaining for diagnosis is a possible limitation of the study. However, the difficulties in obtaining a definitive diagnosis in such a study is acknowledged. Those successfully treated cats had usually had a long course 12 weeks of GC treatment. A sustained remission was not seen in all cats following GC treatment and some side effects were reported; injection reactions and abnormal eruption of permanent teeth.
A more recent study 9 has described treatment using the nucleoside analogue GS in an experimental study in young cats with effusive FIP. Two of the 10 treated cats required a 2nd treatment course following a relapse at 4 and 6 weeks post-treatment, respectively, and both improved again. All 10 treated cats remained clinically healthy until the time of publication, at least 8 months post-infection.
Cats ranged from 3. Five of the 31 cats died or were euthanized within 26 days of primary treatment. Of these 26 cats, 18 remained healthy, while eight others showed FIP relapses 6 non-neurological and 2 neurological at a mean of 23 days following treatment.
Of the original 31 cats, 25 long-time survivors that underwent successful treatment were described, but one of these cats was subsequently euthanized due to presumed unrelated heart disease, while 24 remain healthy at the time of publication published February , and some of the cats had started on the trial spring Neither GC nor GS are currently available but both are undergoing approval for commercial sale. Welcome, VIN Public!
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