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Famciclovir is safer and more effective than acyclovir and is now being used for long-term therapy. One dose that has been used is 1/2 tablet of a generic 250 mg tablet (125 mg), PO, q8-12 hr. The drug is safe at up to 90 mg/ kg, PO, q8hrs and so the dose should be increased if the initial response is suboptimal and FHV-1 is still suspected. However, it is now known that famciclovir is excreted
in high levels in the tears for 4 hours after a dose and
so topical treatment with anti-FHV-1 drugs may not be needed if famciclovir is prescribed at 90 mg/kg, PO 2-3 times daily. Administration of one dose of famciclovir
(125 or 500 mg) on admission to an animal shelter was ineffective in lessening clinical signs of disease. Topical cidofovir (product for humans) can be used for the treatment of FHV-1 conjunctivitis twice daily and was effective in a controlled research project. The drug was easier to administer (twice daily) than idoxuridine or other anti-FHV-1 ocular therapies and does not cause as much irritation. This drug is available in some compounding pharmacies (www.rxfixer.com).
Many of the cats with chronic recurrent signs of disease are likely to be infected by FHV-1 or FCV. Stress reactivation of feline viral infections is thought to be common, in particular for FHV-1. All the principles of stress relief for management of feline interstitial cystitis also apply to cats with recurrent signs of URI. In a
recent published study, we showed that use of a facial pheromone diffusor could lessen recurrent signs of FHV-1 in a mild stress model in experimentally inoculated cats (Contreras et al, 2017). The commercially available probiotic Enterococcus faecium SF-68 (FortiFlora, Purina), is a known immune stimulant in cats and feeding this probiotic to cats with FHV-1 infection lessened recurrent disease in a stress model (Lappin et al, 2009).
Feline leukemia virus and feline immunodeficiency
virus can induce immunosuppression predisposing
to bacterial rhinitis. However, there is no universally effective treatment. Interferon alpha as described can be tried. In addition, AZT at 5 mg/kg, PO, twice daily can be tolerated and improved clinical parameters in some cats with FIV. Both FIV and FeLV have been associated with nasal lymphoma and so if upper respiratory tract signs occur in retrovirus positive cats, this neoplasm should be excluded.
References
Contreras ET, Hodgkins E, Tynes V, Beck A, Olea- Popelka F, Lappin MR. Effect of a pheromone on stress-associated reactivation of feline herpesvirus-1 in experimentally inoculated kittens. J Vet Intern Med. 2017 Dec 8. doi: 10.1111/jvim.14894. [Epub ahead of print]
Fenimore A, Carter K, Fankhauser J, Hawley JR, Lappin MR.. Evaluation of intranasal vaccine administration and high-dose interferon- α 2b therapy for treatment of chronic upper respiratory tract infections in shelter cats.
J Feline Med Surg. 2015 Aug 12. pii: 1098612X15596199. [Epub ahead of print].
Lappin MR, Blondeau J, Boothe D, Breitschwerdt EB, Guardabassi L, Lloyd DH, Papich MG, Rankin SC, Sykes JE, Turnidge J, Weese JS. Antimicrobial use Guidelines for Treatment of Respiratory Tract Disease in Dogs and Cats: Antimicrobial Guidelines Working Group of the International Society for Companion Animal Infectious Diseases. J Vet Intern Med. 2017;31:279-294.
Lappin MR, Veir JK, Satyaraj E et al: Pilot study
to evaluate the effect of oral supplementation of Enterococcus faecium SF68 on cats with latent feline herpesvirus 1, J Feline Med Surg 2009;11:650.
Spindel ME, Veir JK, Radecki SV et al: Evaluation of pradofloxacin for the treatment of feline rhinitis, J Feline Med Surg 2008;10:472.
Thomasy SM, Shull O, Outerbridge CA, Lim CC, Freeman KS, Strom AR, et al. Oral administration of famciclovir
for treatment of spontaneous ocular, respiratory, or dermatologic disease attributed to feline herpesvirus type 1: 59 cases (2006-2013). J Am Vet Med Assoc 2016;249:526-538.
Zirofsky D, Rekers W, Powell C, Hawley J, Veir J,
Lappin M. Feline herpesvirus 1 and Mycoplasma spp. conventional PCR assay results from conjunctival samples from cats in shelters with suspected acute ocular infections. Topics Comp Anim Med 2018; 33:45-48.
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