[Smoking Cessation with E-Cigarettes? - Ad Hoc Statement of the German Respiratory Society (DGP)]. / Tabakentwöhnung mit E-Zigarette?

The German Respiratory Society (DGP) turns against the e-cigarette as a means for harm reduction because of potential health risk and dangers to young people. The aerosol of e-cigarettes contains toxic ingredients that have been shown to be damaging to the lungs, the cardiovascular system and the immune system and are potentially carcinogenic. Studies on e-cigarettes as a means of smoking cessation are not very convincing, in order to favor e-cigarettes over nicotine replacement therapy, which have been tried and tested for many years, or other drugs that reduce the desire to smoke.

[Chronic Obstructive Pulmonary Disease (COPD) - Rational Diagnostics and Therapy]. / Die chronisch obstruktive Lungenerkrankung (COPD) - Rationale Diagnostik und Therapie.

In general chronic obstructive pulmonary disease (COPD) can be diagnosed in family practice from history and spirometry. Inconclusive spirometry findings have to be assessed further by techniques available in a pulmonologist's office. Further testing is done for differential diagnostic reasons and for prognostic appraisal. Successful smoking cessation importantly alters the natural downhill course of the disease. Patient education and rehabilitative interventions (e. g. participation in lung sport groups) help to improve life quality. Medical therapies with bronchospasmolytics applied by inhalation as monotherapies, free and fixed combinations have symptomatic benefit. Considering the increase of pneumonia risk from inhaled corticosteroids their use should be restricted to patients with a straightforward indication, e. g. coexisting asthma.

Smoking Lung Cancer Patients and Tobacco Cessation - Is the Current Treatment in Germany Sufficient?

Lung cancer is the most preventable neoplastic disease for men and women. The incidence rate per year is 14.000 in Germany. Smoking is the main risk factor for the onset of lung cancer and for a share of 90% of cases, lung cancer is associated with smoking. Recent studies have shown that the time slot of diagnosing lung cancer is a teachable moment for tobacco cessation interventions. The therapy that was rated most effective was a combination of cognitive behavioral therapy and pharmacotherapy (e. g. NRT, Bupropion, Varenicline). We examined the smoking status of all patients undergoing lung cancer surgery in 2011, 2012 and 2013 in this study. A retrospective semi structured interview via telephone was conducted regarding smoking habits and current quality of life. 131 patients (36.6% female, average age of 68.7 years) of an urban German hospital were included.Results showed a relapse rate of 22.3%, while 86.2% used to be highly addicted smokers; A multivariate analysis of covariance (MANCOVA) indicated a significant overall impact of smoking status on quality of life with a medium effect size, controlled for age, gender, living conditions, tumor stage, duration of smoking abstinence, type of cancer therapy, type of resection method, and the time period between the date of surgery and of the survey. Two thirds of all smokers did not see an association between their habit and their disease.So far motivation to quit and long term abstinence rates are not sufficiently established even among seriously sick patients in Germany; further initiatives should focus on new and more intense interventions and educational strategies.

Strength and endurance training in the treatment of lung cancer patients in stages IIIA/IIIB/IV.

PURPOSE: This randomized controlled trial tested the effects of a specially designed strength and endurance training on the independence and quality of life in lung cancer patients in stages IIIA/IIIB/IV during palliative chemotherapy. METHODS: Between August 2010 and December 2011, 46 patients were randomized into two groups receiving either conventional physiotherapy or special physiotherapeutic training. The Barthel Index served as primary endpoint. The secondary endpoints were the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ C-30/LC-13) questionnaire, the 6-Minute Walk Test (6MWT), stair walking, the Modified Borg Scale, and muscle strength. Nonparametrical data were analyzed with the Wilcoxon and Mann-Whitney U test. For parametric, data student t tests were used. A p value of ≤.05 was accepted. RESULTS: Twenty-nine patients completed the trial (Intervention group (IG), n = 18; control group (CG), n = 11). Significant differences were detectable in the Barthel Index (IGmean = 92.08; CGmean = 81.67; p = .041), in single scores of the EORTC QLQ C-30/LC-13 questionnaire (physical functioning, p = .025; hemoptysis, p = .019; pain in arms or shoulder, p = .048; peripheral neuropathy, p = .050; cognitive functioning, p = .050), in the 6MWT, stair walking, strength capacity, and in the patient's dyspnoea perception during submaximal walking activities (IG > CG). CONCLUSION: According to these findings, lung cancer patients should receive enhanced physical activity intervention during palliative chemotherapy.

[Health promotion within health care - analysis of employees' smoking habits, consequences for patient care and resources for future smoking cessation initiatives]. / Gesundheitsförderung im Gesundheitswesen - Analyse der Rauchgewohnheiten der Mitarbeiter, Konsequenzen für die Patientenbehandlung und Ressourcen für zukünftige Tabakentwöhnungsinitiativen.

Smoking is still one of the most dangerous and avoidable health risks. This study "Healthy air at work" analysed smoking habits, state of change, the influence of the diagnosis F.17.0 in patient treatment and estimation of subjective workloads and personal resources in health-care workers. Almost 2 000 questionnaires were analysed. 19.9% of this study population were smokers, while 26.4% were considered to be heavy or very heavy smokers. Half of the current smokers were willing to change, while the majority had already tried to quit multiple times. The most important motive to stop smoking was fear of consequences (44.4%), followed by other reasons (42.3%) (e. g., pregnancy) and expenses (33.9%). Protection against second-hand smoke was estimated mostly as very relevant, especially for patients. Being a role model in terms of tobacco consumption seems to be important for health-care workers. 61.3% of all health-care workers stated that patients' nicotine dependency had been diagnosed and out of these 46.5% say it is a relevant factor in therapy. 60% of all interviewed employees evaluated themselves as working quantitatively under heavy and very heavy workloads, while 20% had to deal with high qualitative challenges. In terms of future work ability and personal resources 75% were considerably optimistic. We did not find any relation in terms of workloads and smoking habits. Rather few health-care workers used nicotine replacement therapy during former cessation trials. Health-care workers could play an important role in the treatment and prevention of smoking dependency. This potential is not used to its full extent up to now.

[Midwives and smoking--attitudes, smoking status and counselling competence in the course of training]. / Hebammen und Rauchen--Einstellungen, Rauchstatus und Beratungskompetenz im Ausbildungsverlauf.

Tobacco consumption is a major public health threat. Midwives can contribute to the reduction of tobacco use among pregnant women and young families. It can be assumed that personal smoking behaviour and knowledge of harmful effects influences counselling activities. The aim of this study was to assess smoking status, nicotine dependency and the will to change of midwifery students in german-speaking countries. Broad data on this population is not available so far. In 2010, a self-administered questionnaire survey was conducted among Austrian, German and Swiss midwifery schools. Sociodemographic characteristics, smoking habits, personal attitudes towards smoking, knowledge of cessation strategies, perceived self-efficacy and competence to counsel pregnant women regarding their smoking habits of midwifery trainees were examined. 1 126 students and 38 teaching midwives answered this questionnaire (RR=61.8%). 22.7% are daily or occasional smokers. 6.8% have to be considered as medium and heavy smokers. 98.1% consider cessation counselling for pregnant and breast-feeding women as a midwife's task, while 76.5% feel competent enough to do so. 75.5% rate cessation counselling through midwives as effective stop-smoking procedures compared to blurry knowledge on related health risks and effective stop-smoking strategies. The self-reported smoking prevalence is considerably lower than in previous studies and other populations. Knowledge of harmful effects and of effective treatment options needs improvement. Counselling competence needs to be included in a broader way in midwifery curricula.

[Smoke-free by ramadan: experience with a low-threshold prevention offer on smoking cessation for persons with migration background]. / Rauchfrei zu Ramadan. Erfahrungen mit einem niederschwelligen Präventionsangebot zur Raucherentwöhnung bei Personen mit Migrationshintergrund.

BACKGROUND: Persons with migration background exhibit higher smoking rates in comparison to the general population.These smokers often cannot be reached by prevention measures at the family doctor's office. METHODS: In summer 2011 the health campaign "Smoke-free by Ramadan" was launched in 11 German cities. Measures included the training of doctors on smoking cessation methods, general bilingual information flyers, and in some cases lectures on smoking, specifically for imams. A number of local events, especially for individuals with Turkish migration background were initiated. For these health events a specially equipped health bus of the BKK-vor-Ort was used, in which visitors were offered following elements: systematic data collection about age, sex and smoking behavior, a test to determine of the severity of nicotine dependence (Fagerström test, FTNA), as well as spirometric lung function test. Smokers were generally motivated to stop smoking. Data were anonymously collected and analysed in a documentation and communication sheet in Turkish language, and test results were handed over to participants on a printed information sheet. RESULTS: Data of 1012 people collected on 8 health days were analysed (70% men, mean age 46.5 years). The percentage of smokers was 41.5% (men) or 30% (women). Of 294 male smokers, according to FTNA 43.6% had low, 24.8% had moderate, and 31.6% strong nicotine dependence; in the 91 female smokers the corresponding rates were 54.9%, 30.8% and 14.3%. The distribution pattern of the dependency levels was statistically significantly different between genders (p = 0.006). Reduced lung function (FEV, < 80%) occurred in smokers more often than in nonsmokers (30% versus 21%). CONCLUSIONS: These results reinforce the importance of low-threshold prevention measures. By screening, here shown by the example of individuals with Turkish migration background, a significant number of smokers was identified who had in addition to strong nicotine addiction also significantly impaired lung function. As the odds for successful cessation without support are below 5%, evidence-based smoking cessation was advised to all smokers.

Effects of concurrent perioperative use of marbofloxacin and cimicoxib or carprofen in dogs.

OBJECTIVES: To investigate possible interactions visible on electroencephalogram recordings caused by concomitant administration of marbofloxacin and carprofen or cimicoxib in dogs without central nervous system disease. METHODS: Totally 21 client-owned dogs undergoing different surgeries were included in a randomised, blinded, clinical study. Each dog was assigned to one of two groups treated with either carprofen or cimicoxib pre- and postoperatively. After anaesthetic induction both groups received marbofloxacin intravenously while recording an electroencephalogram. Offline electroencephalogram analysis included qualitative evaluation and Fast Fourier Transformation. Postoperative analgesia was evaluated for 24 hours and after 10 days with the short-form Glasgow Composite Measure Pain Scale. Statistical analysis included Wilcoxon signed rank test, Mann-Whitney U test and Student's t-test with α set at 5%. RESULTS: Marbofloxacin injection caused no effects on quantitative and qualitative electroencephalogram parameters in both groups. No differences in postoperative pain scoring were found between treatment groups. CLINICAL SIGNIFICANCE: Concurrent use of marbofloxacin with either cimicoxib or carprofen did not induce neuroexcitatory activities in dogs without CNS disease directly after administration.

Differential frequencies of p16(INK4a) promoter hypermethylation, p53 mutation, and K-ras mutation in exfoliative material mark the development of lung cancer in symptomatic chronic smokers.

PURPOSE: The aim of this study was to investigate the frequency of three (epi)genetic alterations (p53 and K-ras mutations and p16(INK4a) promoter hypermethylation) in symptomatic chronic smokers compared with patients with lung cancer and to evaluate the use of exfoliative material for such analyses. PATIENTS AND METHODS: Fifty-one patients with histologically confirmed lung cancer and 25 chronic smokers (> 20 pack-years) were investigated for mutations in the K-ras (codon 12) and p53 (codons 248, 249, and 273) genes and for allelic hypermethylation of the p16(INK4a) gene. DNA was isolated from sputum and bilateral bronchial lavage, and brushings were taken at bronchoscopy. RESULTS: Forty-one genetic lesions were detected within exfoliative material from the group of 51 patients with lung cancer and 10 lesions in the chronic smoker group. K-ras mutations occurred exclusively in the lung cancer group, whereas p53 mutations and p16(INK4a) promoter hypermethylation were also found in chronic smokers. Three of eight chronic smokers who harbored an (epi)genetic alteration were subsequently diagnosed with lung cancer. Analysis of sputum yielded information equivalent to that of samples obtained during bronchoscopy. CONCLUSION: p16(INK4a) promoter hypermethylation and p53 mutations can occur in chronic smokers before any clinical evidence of neoplasia and may be indicative of an increased risk of developing lung cancer or of early disease. K-ras mutations occur exclusively in the presence of clinically detectable neoplastic transformation. Molecular analysis of sputum for such markers may provide an effective means of screening chronic smokers to enable earlier detection and therapeutic intervention of lung cancer.

Frequent detection of ras and p53 mutations in brush cytology samples from lung cancer patients by a restriction fragment length polymorphism-based "enriched PCR" technique.

RFLP-mediated PCR has been successfully applied as a reliable tool in the detection of ras mutations in many cancers and provides a basis for "mutant-enriched PCR" protocols. We have, therefore, modified this technique to the sensitive detection of K-ras codon 12 and also p53 "hot spot" mutations, which, frequently in lung cancer, affect codons at the positions 157, 175, 245, 248, 249, and 273. With a high sensitivity of 1 mutant allele in 10(4) normal alleles, our enrichment assay allows the detection of oncogene alleles when only a few tumor cells are present within a normal cell population. Brush cytology material obtained from the tumor site of 20 patients with endoscopically apparent bronchial carcinoma was compared to macroscopically normal mucosa taken from the contralateral bronchus ("control" cytology). We found K-ras codon 12 mutations in 5 cases (25%) and p53 mutations in 13 cases (65%) in the tumor-derived cell material but, with the exception of two cases, not in cell material taken from the control cytology. Seventy-five % of the samples analyzed showed that at least one of the two oncogenes was affected. In several cases, two p53 lesions were detected concomitantly. The majority of the mutations could be reconfirmed by an alternative approach exploiting changes in the genomic RFLP pattern induced by these mutations and were also demonstrated in separate diagnostic biopsies taken. Thus, we conclude that the established enriched PCR protocol ensures a high sensitivity and preserved specificity for the diagnosis of oncogene lesions associated with lung cancer. Because conventional techniques normally yield a lower incidence of corresponding ras and p53 mutations, we think that both the high rate and the heterogeneity of p53 mutations found in some cases are, indeed, related to the increased sensitivity of this new enriched PCR technique.

A cytofluorometric method to quantify membrane antigens on individual alveolar macrophages.

An immunofluorescence method for assaying membrane-bound antigens on individual alveolar macrophages (AM) collected by bronchoalveolar lavage (BAL) is described. Cells were labelled with FITC-conjugated anti-HLA-DR antibodies in a single (direct) step. Quantification of the fluorescence was performed by computer-assisted cytophotometry. Alveolar macrophages, especially when obtained from cigarette smokers, exhibited an autofluorescence which interfered with the measurement of specific fluorescence. The specific fluorescence was calculated by determination of total fluorescence in the wave-length optimal for FITC and the non-specific fluorescence in a different wavelength during a second measurement. Specificity and reproducibility testing confirmed the reliability of the method.

Influence of sleep apnea on 24-hour blood pressure.

OBJECTIVE: To study the influence of obstructive sleep apnea (OSA) on 24-h BP. SETTING: Sleep laboratory of the Medical Department, Neukölln Hospital, Berlin, Germany. METHODS: In 93 subjects, noninvasive 24-h BP monitoring was performed with BP recordings made at 15-min intervals. Apnea severity was evaluated by means of a portable device that allows calculation of an oxygen desaturation index (ODI). A normal 24-h BP profile (dipping) was defined by a night/day BP ratio of 0.9. RESULTS: ODI was related to systolic and diastolic daytime (p<0.001) and nighttime BP (p<0.001) as well as systolic and diastolic BP night/day ratios (p<0.001). Multiple regression analysis showed that age and ODI were independently related to daytime BP. When subjects were grouped according to apnea severity, daytime BP increased as ODI increased: 127/80+/-10/11 mm Hg in habitual snorers (ODI 0 to 5), 135/87+/-15/9 mm Hg in mild OSA (ODI 6 to 30), and 140/90+/-13/10 mm Hg in severe OSA (ODI >30) (p values <0.05 for comparisons of OSA groups with habitual snorers). Compared to subjects with mild OSA or habitual snorers, BP night/day ratios were greater in patients with severe OSA (p values <0.05). Accordingly, hypertension and nondipping increased as ODI increased. CONCLUSION: OSA is associated with hypertension independent of the confounding factors of age and obesity. Nondipping is related to apnea severity. These alterations might contribute to the increased mortality in patients with severe OSA.

Expiratory flow limitation and intrinsic positive end-expiratory pressure in obesity.

Breathing at very low lung volumes might be affected by decreased expiratory airflow and air trapping. Our purpose was to detect expiratory flow limitation (EFL) and, as a consequence, intrinsic positive end-expiratory pressure (PEEPi) in grossly obese subjects (OS). Eight OS with a mean body mass index (BMI) of 44 +/- 5 kg/m2 and six age-matched normal-weight control subjects (CS) were studied in different body positions. Negative expiratory pressure (NEP) was used to determine EFL. In contrast to CS, EFL was found in two of eight OS in the upright position and in seven of eight OS in the supine position. Dynamic PEEPi and mean transdiaphragmatic pressure (mean Pdi) were measured in all six CS and in six of eight OS. In OS, PEEPi increased from 0.14 +/- 0.06 (SD) kPa in the upright position to 0.41 +/- 0.11 kPa in the supine position (P < 0.05) and decreased to 0.20 +/- 0.08 kPa in the right lateral position (P < 0.05, compared with supine), whereas, in CS, PEEPi was significantly smaller (<0.05 kPa) in each position. In OS, mean Pdi in each position was significantly larger compared with CS. Mean Pdi increased from 1.02 +/- 0.32 kPa in the upright position to 1.26 +/- 0.17 kPa in the supine position (not significant) and decreased to 1. 06 +/- 0.26 kPa in the right lateral position (P < 0.05, compared with supine), whereas there were no significant changes in CS. We conclude that in OS 1) tidal breathing can be affected by EFL and PEEPi; 2) EFL and PEEPi are promoted by the supine posture; and 3) the increased diaphragmatic load in the supine position is, in part, related to PEEPi.

Determinants of circadian blood pressure rhythm and blood pressure variability in obstructive sleep apnoea.

The prevalence of hypertension in patients with obstructive sleep apnoea (OSA) is high and blood pressure profile is characterized by nocturnal blood pressure (BP) elevation and increased nocturnal BP variability. Ambulatory 24-hour-blood pressure monitoring (ABPM) is a valid, non-invasive method to describe circadian BP variation. Circadian BP profile and nocturnal BP variability were related to OSA severity (apnoea-hypopnoea index, mean low O2), age and body mass index (BMI) in 73 patients with OSA. Prevalence of hypertension was 75%, and in 59% BMI was greater than 30 kg m-2. A nocturnal decline of at least 10% from daytime mean BP values (night/day BP ratio <0.9; dipper) was found in only 25% of hypertensive patients and 39% of normotensive patients. Comparison between dippers and non-dippers showed significant differences in apnoea severity (apnoea-hypopnoea index 32 + 19 vs. 50 + 23/h, P < 0.01; mean low O2 84.5 + 4 vs. 80.2 + 5.8%, P < 0.01) but not for age and BMI. In multiple regression analyses with age, body mass index, apnoea-hypopnoea index and mean low O2 as independent and BP ratios and BP variability as dependent variables, sleep apnoea severity was the only independent predictor for circadian BP rhythm and nocturnal BP variability. The results presented here suggest that independent of age and obesity the severity of sleep apnoea is an important determinant of circadian BP variation and nocturnal BP variability.

Influence of obstructive sleep apnoea on circadian blood pressure profile.

A high prevalence of systemic hypertension in obstructive sleep apnoea (OSA) has been described but data on circadian blood pressure (BP) profile are limited and give inconsistent results. The present study examines 24-h BP in 106 patients referred because of loud snoring or excessive daytime sleepiness in combination with snoring. Patients were classified as OSA (n = 62) or habitual snorers (HS) (n = 44). Respiratory disturbance index (RDI) in OSA was 47 + 24 vs. 2 +/- 2 in HS. Mean age and body mass index in OSA was significantly higher. BP was measured non-invasively at 15-min intervals during a 24-h period. Daytime and night-time BP was higher in OSA compared to HS. BP night/day ratio in OSA was 0.92 +/- 0.07 vs. 0.86 + 0.06 in HS (P < 0.05). To investigate the influence of variables other than breathing abnormalities during sleep on our results we compared BP profiles of 25 OSA and 25 HS matched for sex, age and body weight. Again differences in daytime and night-time BP and BP night/day ratio were significant. Using a value of at least 10% fall in nocturnal BP to describe a regular BP profile (dipper) 68% of OSA were classified as non-dippers vs. 24% of HS. Influence of short-term (2-4 days) nCPAP therapy on circadian BP profile was investigated in 34 patients with OSA. Systolic and diastolic nocturnal (but not daytime) BP was significantly reduced. The percentage of non-dippers was 79% before and 50% after treatment. In conclusion results of this study indicate a causal link between OSA and abnormal circadian BP profile.

Influence of proportional assist ventilation on diaphragmatic activity in normal subjects.

In six awake healthy adults we studied the physiological effects of mechanical unloading of the respiratory muscles during increased ventilatory demand. We were interested in whether respiratory muscle activity is down regulated and if this is mainly a consequence of chemical factors, i.e. CO2-reduction, or non-chemical neuromuscular inhibition. With 33 mmHg inspiratory CO2 we induced modest hyperpnea of 24.4 +/- 3.9 L/min. Proportional assist ventilation (PAV) was applied with flow-related assist of 2.5 cm H2O/L/s and volume-related assist of 6 cm H2O/L. Respiratory muscle activity was measured by transdiaphragmatic pressure. Unloading caused a 57 percent reduction of the inspiratory transdiaphragmatic pressure-time product (p<0.05), while tidal volume, breathing frequency, and breathing pattern did not significantly change. These observations suggest that during increased ventilatory requirements, PAV results in down regulation of respiratory muscle activity and that this effect is mainly a consequence of neuromechanical inhibition.

[Effect of noninvasive ventilation on work of breathing in obesity]. / Der Einfluss der nichtinvasiven Beatmung auf die Atemarbeit bei Adipösen.

BACKGROUND: Noninvasive ventilation with nose- or face-masks has been increasingly used in the past. The objective of mechanical ventilation is in addition to improve gas exchange to reduce breathing work. While improvement on breathing work has been shown mainly on normal-weight patients with different respiratory diseases, there is no existing data about the effect of noninvasive ventilation on the breathing work of patients with massive obesity. PATIENTS AND METHODS: Assisted mask-ventilation with bilevel positive airway pressure (BiPAP) was carried out on 5 overweight control subjects (overweight controls), 7 overweight patients with obstructive sleep apnea (OSA), 6 patients with obesitas-hypoventilation syndrome (OHS), and 7 overweight patients with chronic obstructive lung disease (COLD). Inspiratory pressure assist (IPAP) was set to 12 or 16 cm H2O, exspiratory pressure (EPAP) was set to 5 cm H2O. All, subjects were massive overweight (body mass index [BMI] 42.2 +/- 5.8; range 31.8 to 55.4 kg/m2). Respiratory muscle activity was measured as esophageal pressure change (delta Pes) and transdiaphragmatic pressure change (delta Pdi) and calculated as pressure time integral. RESULTS: With noninvasive ventilation respiratory muscle activity was significantly (p < 0.05) reduced in all groups at least 40% compared to baseline values during spontaneous respiration. CONCLUSIONS: Noninvasive ventilation via face masks can efficiently reduce work of breathing in subjects with massive obesity.

[Work of breathing in noninvasive proportional assist ventilation in patients with respiratory insufficiency]. / Atemanstrengung unter nichtinvasiver Proportional Assist Ventilation (PAV) bei Patienten mit respiratorischer Insuffizienz.

BACKGROUND: The aim of the present study was to evaluate if Proportional Assist Ventilation (PAV), when applied noninvasively via face mask, can reduce ventilatory effort in patients with respiratory failure. We present preliminary results of an ongoing study. PATIENTS AND METHODS: In 5 patients with respiratory failure due to different underlying disorders (pulmonary fibrosis, bilateral diaphragm paralysis, COPD) we compared the transdiaphragmal pressure-time integral. PTdi (integral off Pdi dt) after 15 minutes of noninvasive PAV to the baseline values without ventilatory support. RESULTS AND CONCLUSION: Four patients showed reduction of PTdi to various extend. One patient who presented low diaphragmal activity at baseline due to diaphragmal paralysis showed a slight increase in PTdi during ventilation. Mean PTdi decreased by 26.7%. PaCO2 in the 5 patients showed no significant change after 15 minutes of ventilation, thus indicating that with noninvasive PAV patients can maintain constant ventilation with reduced effort.

[The use of fluoroquinolones in bacterial urinary tract infections in cats]. / Einsatz von Fluorchinolonen bei bakteriellen Harnwegsinfektionen der Katze.

Older cats (>10 years) with FLUTD (Feline Lower Urinary Tract Disease) symptoms are often affected by urinary tract infections. In most of these cats organ diseases (e.g. chronic renal failure, diabetes mellitus) or iatrogenic factors (immunosuppressive drugs, indwelling catheter) are found that clearly predispose cats to this kind of infection. From a diagnostic point of view, urinalysis and urine culture are the most important tools in detecting bacteriuria. The microbiological spectrum is thereby comparable to that found in dogs, revealing Escherichia ( E. ) coli but also Staphylococcus spp. and Enterococcus spp./ Streptococcus spp. Antibiotic therapy should be based on the results of susceptibility testing. If this kind of information is not available, drug selection has to be decided on an empirical basis unless it is a complicated urinary tract infection. Preferred antibiotics should have a high renal excretion rate and thus ensure therapeutically effective drug levels in the urine. In this respect, the fluoroquinolones belong to the group of appropriate drugs to be used in cats. The relevance of therapeutical drug concentrations achievable in the urine is discussed for the example of marbofloxacin, a third-generation fluoroquinolone. New pharmacokinetic data showed that marbofloxacin concentrations of ≥2µg/ml are maintained in the urine of healthy cats for 72 and 103 hours after administration of 2 and 4mg/kg BW s.c., respectively.