Bacterial Interference Therapy for UTI's?

Hello Summarians,!

Wow, here are a couple of out of the box and traditional therapies. Amazingly, we are part of a greater scientific community that never fails to show its ingenuity.

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Bacterial Interference Therapy in Dogs

Bacterial cystitis is a common health issue in dogs, traditionally treated with antimicrobials. However, the rise of antimicrobial resistance has led to the exploration of alternative treatments. One promising approach involves using asymptomatic bacteriuria (ASB) strains of Escherichia coli, which can colonize the bladder without causing symptoms and may prevent pathogenic bacteria from establishing infections through mechanisms like immunomodulation or bacterial interference. 

This study evaluated the efficacy of ASB E. coli 212 compared to standard antimicrobial therapy in a randomized prospective non-inferiority trial involving dogs with recurrent urinary tract infections (UTIs). The hypothesis was that ASB E. coli 212 would not be inferior to antimicrobial treatment within a 12% margin of difference in achieving clinical cure. 

The results confirmed that ASB E. coli 212 was not inferior to antimicrobial therapy over a two-week period. Some dogs experienced prolonged clinical cure lasting up to 13 months. The treatment was well-tolerated, with no major adverse events reported, and the administration procedure was efficient, taking about 20 minutes and allowing dogs to be discharged shortly after. 

Methodologically, the study employed a multilevel regression model to account for repeated measures and clustered data, enhancing the robustness of the findings. Even when applying a more conservative noninferiority margin, the results remained significant. Some dogs required a second instillation of ASB E. coli 212 due to insufficient improvement by day 3, suggesting that additional doses or higher concentrations might improve outcomes. 

Interestingly, several dogs showed clinical improvement despite ASB E. coli 212 not being isolated from their urine, indicating potential antimicrobial and analgesic effects beyond mere colonization. This aligns with murine studies where ASB E. coli strains demonstrated analgesic properties. 

The study underscores the potential of ASB E. coli 212 as a viable alternative to antibiotics for treating recurrent UTIs in dogs, contributing to antimicrobial stewardship by reducing reliance on traditional antimicrobials. Limitations include the 14-day study duration, absence of molecular diagnostics to confirm bacterial colonization, and the need to determine optimal dosing strategies. 

In conclusion, up to two intravesical administrations of ASB E. coli 212 were as effective as standard antimicrobial therapy for treating recurrent UTIs in dogs, with minimal adverse effects. Future research should focus on optimizing the dosage and frequency to enhance the therapeutic efficacy of ASB E. coli 212. 

Segev G, Chen H, Dear JD, et al. Evaluation of the efficacy of a live Escherichia coli biotherapeutic product (asymptomatic bacteriuria E. coli 212). J Vet Intern Med. 2024; 1-8. doi:10.1111/jvim.17167 

Bottom line — A potentially useful alternative therapy.

Duration of Treatment for Pneumonia in Dogs

Bacterial pneumonia in dogs is typically treated with antimicrobial therapy, traditionally administered for 4 to 6 weeks or until 1 to 2 weeks after the resolution of clinical and radiographic signs. This extended duration is based on expert opinion rather than solid scientific evidence, leading to concerns about antimicrobial resistance, disruption of the gut microbiome, increased treatment costs, and decreased owner compliance. 

Recent studies have begun to question the necessity of prolonged antibiotic use. A randomized, double-masked, placebo-controlled clinical trial investigated the outcomes of dogs with pneumonia treated with either a shorter course (2 weeks of antibiotics followed by 2 weeks of placebo) or a longer course (4 weeks of antibiotics) of antimicrobial therapy. The study included 30 dogs, none of which experienced recurrent clinical signs or radiographic worsening during the one-month study period. This suggests that dogs receiving shorter durations of antibiotics have similar clinical and radiographic recovery courses compared to those receiving longer durations. 

The study also highlighted that clinical improvement in dogs often precedes radiographic resolution of pneumonia. Only 60% of the dogs showed radiographic resolution at the first follow-up, yet all were clinically improved. This finding aligns with human medicine, where clinical improvement is preferred over serial radiographs to guide the discontinuation of antibiotics. Relying solely on radiographic signs may lead to unnecessarily prolonged antibiotic use and increased healthcare costs. 

Despite its findings, the study faced limitations, including a smaller sample size than initially planned due to difficulties in recruiting participants. This may have underpowered the study, making it challenging to detect modest differences in relapse rates between the two treatment durations. Additionally, the lack of routine airway sampling to confirm bacterial pneumonia and assess antimicrobial susceptibility reflects common clinical practice but may introduce variability in treatment efficacy. 

In conclusion, the study suggests that shorter durations of antimicrobial therapy may be sufficient for treating uncomplicated pneumonia in dogs. It advocates for using clinical signs rather than radiographic findings to guide the duration of antibiotic treatment. While larger, more robust studies are needed to confirm these results definitively, the current evidence supports reconsidering traditional prolonged antibiotic use to prevent unnecessary treatment and its associated risks. 

Reineke, E. L., McClosky, M. E., Mauro, K. D., Schlax, A., McGonigle, K. M., Scavello, H., Cole, S. D., & Redding, L. E. (2024). Clinical course and radiographic resolution of pneumonia in dogs treated with a shorter versus longer course of antimicrobials: a randomized, double-masked, placebo-controlled study. Journal of the American Veterinary Medical Association https://doi.org/10.2460/javma.24.04.0259 

Bottom line — Supports a shorter course of antibiotics if clinical issues are resolved.

Ear Cleaning Before Treatment?

This study assessed the importance of ear cleaning in treating canine otitis externa (OE) by comparing the effects of an otic suspension containing hydrocortisone aceponate, miconazole nitrate, and gentamicin sulfate (Easotic) in cleaned versus non-cleaned ears of 23 dogs (40 ears). One dog was withdrawn due to difficulty with otoscopy. Ears were randomized, with 20 receiving a simple wipe of the external canal entrance and 20 undergoing thorough cleaning with salicylic acid solution (Epiotic Advanced). Both groups were then treated with 1 mL of otic suspension every 24 hours for 5 days. On Days 0 and 7, ear cytological scores, the otitis index score (OTIS3), and otic pruritus Visual Analog Scale (PVAS) were evaluated. No significant difference in scores was found between the two groups at Day 7. Both groups showed significant reductions in OTIS3, PVAS, and cytological scores for yeast and cocci from Day 0 to Day 7. However, only the cleaned ears demonstrated a significant reduction in rod bacteria scores. Additionally, there was a significant improvement in OTIS3 immediately after cleaning on Day 0. The study concluded that both treatment approaches were effective, but ear cleaning is particularly recommended for reducing rod bacteria. 

Corb E, Griffin CE, Bidot W, Hall M, Kirby A, Rosenkrantz W. Effect of ear cleaning on treatment outcome for canine otitis externa. Vet Dermatol. 2024; 00: 1–10. https://doi.org/10.1111/vde.13292 

Bottom line — Ear cleaning seems to help with reducing rod bacteria

Just putting things in perspective …