scott@vtx-cpd.com

Hi Raquel,

The Minnesota Urolith Center recommendation to perform routine urine cultures every one to three months in dogs with a history of struvite stones is based on the fact that infection-induced struvites are caused by urease-producing bacteria, most commonly Staphylococcus pseudintermedius. These organisms raise urinary pH and promote precipitation of magnesium ammonium phosphate, making early detection and treatment of even asymptomatic infections theoretically beneficial for preventing recurrence.

When it comes to evidence, the picture is a bit nuanced. The 2019 ISCAID Guidelines recommend against treating subclinical bacteriuria in most dogs, unless they are at increased risk due to immunosuppression, pending urinary tract surgery, or recurrent urolithiasis. For dogs with previous infection-induced struvite uroliths, the guidelines acknowledge that monitoring and possibly treating subclinical bacteriuria may be warranted, particularly in the first six to twelve months following stone dissolution or surgical removal. That said, there is currently no strong evidence showing that routine prophylactic urine cultures or treating asymptomatic infections leads to better long-term outcomes or reduces recurrence if the dog is clinically stable.

A reasonable approach might be to perform urine cultures every three months during the early post-treatment period, especially in dogs that are high-risk or have a history of multiple stone episodes. If subclinical bacteriuria is detected and the organism is urease-producing, treatment could be justified, particularly if there are signs of rising urinary pH or if the sediment suggests crystal formation. Over time, if the dog remains stable, is on a preventive diet, and has consistently acidic urine with no signs of active crystalluria or urinary discomfort, it may be reasonable to stop routine cultures and simply monitor with urinalysis. If the pH starts to trend upward or if the sediment changes, that would be a good point to consider a culture again.

When discussing this with clients, I usually explain that some bacteria in the bladder are benign bystanders, while others are more disruptive and can promote stone formation. It’s important to strike a balance between preventing future stones and avoiding unnecessary antibiotic use. I might say something like, “Some bacteria are just visitors, others rearrange the furniture; we only treat the latter if they’re likely to cause trouble.”

So, in summary, while routine cultures may have a place early in the monitoring period or in high-risk individuals, long-term prophylactic culturing and treatment of subclinical bacteriuria is probably not necessary for most dogs. The decision should be tailored based on individual risk factors, urinary trends, and the bacterial species involved.

Happy to discuss further if needed.

Scott 🙂

Hi Rosanna,

You’re absolutely right, Elura (capromorelin) is technically available in the UK only via a Special Import Certificate (SIC) at the moment, and the cost is definitely on the high side. I spoke to Elanco and they confirmed it’s not officially available in the UK yet, despite being listed on the VMD database. It hasn’t been launched or marketed here, so it has to be imported under an SIC if you want to use it.

We used to get capromorelin (for dogs, Entyce) through Ramapharma in the UK. That might still be an option worth exploring: https://www.ramanpharma.com/. Are you currently getting the dog version through anyone? Honestly, I would just use that in cats if needed, especially for off-license appetite stimulation in palliative or CKD cases where cost and access are limiting factors.

If you do want to go the Elura route, you’d need to apply for a Special Import Certificate through the VMD. Supply is usually arranged through a wholesaler that handles imports.

As far as I’m aware, there is no data directly comparing capromorelin and mirtazapine in cats, so we can’t say it’s better or worse based on evidence. That said, I’ve found it effective in practice. Cats often respond well, though many do salivate quite a lot after administration.

Also worth noting, there’s a good safety study on capromorelin in cats:

Randomized Controlled Trial

J Vet Pharmacol Ther. 2018 Apr;41(2):324–333. doi: 10.1111/jvp.12459
Evaluation of the safety of daily administration of capromorelin in cats
Wofford JA, Zollers B, Rhodes L, Bell M, Heinen E
PMID: 29057482 https://pubmed.ncbi.nlm.nih.gov/29057482

Two studies looked at daily oral administration in cats over 14 and 91 days. Doses up to 60 mg/kg were tested. Adverse effects were mostly mild and included vomiting, hypersalivation, lethargy, head shaking, and lip smacking. No significant differences in clinical pathology values were seen between treated and placebo groups.

Hope that helps.

Scott

Hi Raquel,

Yes, I’ve looked into the KeyScreen™ GI Parasite PCR from Antech. It’s a multiplex PCR that screens for 20 intestinal parasites from a single fecal sample and reportedly detects 2x more infections than standard in-clinic fecal flotations (O&P), which could be really helpful in those low-burden or intermittent shedding cases.

Some useful features:

Detects benzimidazole resistance in hookworms, which can guide treatment choices
Flags the zoonotic potential of Giardia
Offers fast, sensitive detection for earlier intervention
It also aligns with CAPC recommendations for routine parasite testing—four times in the first year for puppies/kittens and one to two times per year for adults, depending on lifestyle and risk factors.

That said, I’m struggling to find a clear list of exactly which parasites it includes. Do you know? I get the impression it’s more focused on parasites and worms, whereas the IDEXX faecal PCR panels seem more geared toward bacterial pathogens (like Campy, Salmonella, Clostridium, etc.). If that’s the case, this might actually be a useful complementary test, especially in routine or preventive care. I haven’t personally used it yet, though.

Best,

Scott

Sorry!

One more random question… how exactly is it that they do the palatability work? Do they do it with sick or well animals?

I know they pay humans to taste food… but never thought about how this works for our patients. Most of the prescription diets are for ‘sick’ animals so must be tricky to do palatability in these populations?

Scott 🙂

Replying to Georgia 21/03/2025 - 16:00

Thanks for the reply!

I did see that JFMS had just published this article this week:

https://pmc.ncbi.nlm.nih.gov/articles/PMC11874005/pdf/10.1177_1098612X251320877.pdf

Scott 🙂

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