d,l-Methionine in combination with amoxicillin–clavulanic acid successfully dissolves spontaneously occurring infection-induced struvite urocystoliths in dogs: a pilot study

Amber S. M. Harris College of Veterinary Medicine, University of Georgia, Athens, GA

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 DVM
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Joseph W. Bartges College of Veterinary Medicine, University of Georgia, Athens, GA
College of Veterinary Medicine, University of Tennessee, Knoxville, TN

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 DVM, PhD, DACVIM, ACVNU
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Tamberlyn D. Moyers College of Veterinary Medicine, University of Tennessee, Knoxville, TN

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Abstract

OBJECTIVE

To determine the efficacy and safety of a urinary acidifier (d,l-methionine [Methio-Form]) and an antimicrobial agent (amoxicillin–clavulanic acid [Clavamox]) without changing diet for dissolving infection-induced struvite urocystoliths in dogs.

ANIMALS

14 dogs were recruited for this prospective study; 11 completed it and 3 dogs withdrew due to inability of the owners to administer the treatment (n = 2) or refusal of treatment by the dog (1).

PROCEDURES

All dogs were administered d,l-methionine (approx initial dose of 75 mg/kg, PO, q 12 h) and amoxicillin–clavulanic acid (22 mg/kg, PO, q 12 h) based on urine culture and sensitivity. Urine pH, urinalysis, urine culture, venous blood gas and serum biochemical analysis, and lateral survey abdominal radiographic images were evaluated initially and every 4 weeks until urolith dissolution (success) or lack of change in size and/or shape of urocystoliths on 2 consecutive reevaluation points (failure) occurred.

RESULTS

Uroliths dissolved in 8 of 11 dogs in a median of 2 months (range, 1 to 4 months) with a final effective dosage of d,l-methionine of approximately 100 mg/kg, PO, every 12 hours. In 3 dogs, uroliths failed to dissolve and were removed surgically; they contained variable amounts of calcium oxalate. No adverse events occurred.

CLINICAL RELEVANCE

Infection-induced struvite urolithiasis is 1 of the 2 most common minerals occurring in canine uroliths. Results of this study supported the use of d,l-methionine and amoxicillin–clavulanic acid without changing diet for dissolution of infection-induced struvite urocystoliths in dogs.

Abstract

OBJECTIVE

To determine the efficacy and safety of a urinary acidifier (d,l-methionine [Methio-Form]) and an antimicrobial agent (amoxicillin–clavulanic acid [Clavamox]) without changing diet for dissolving infection-induced struvite urocystoliths in dogs.

ANIMALS

14 dogs were recruited for this prospective study; 11 completed it and 3 dogs withdrew due to inability of the owners to administer the treatment (n = 2) or refusal of treatment by the dog (1).

PROCEDURES

All dogs were administered d,l-methionine (approx initial dose of 75 mg/kg, PO, q 12 h) and amoxicillin–clavulanic acid (22 mg/kg, PO, q 12 h) based on urine culture and sensitivity. Urine pH, urinalysis, urine culture, venous blood gas and serum biochemical analysis, and lateral survey abdominal radiographic images were evaluated initially and every 4 weeks until urolith dissolution (success) or lack of change in size and/or shape of urocystoliths on 2 consecutive reevaluation points (failure) occurred.

RESULTS

Uroliths dissolved in 8 of 11 dogs in a median of 2 months (range, 1 to 4 months) with a final effective dosage of d,l-methionine of approximately 100 mg/kg, PO, every 12 hours. In 3 dogs, uroliths failed to dissolve and were removed surgically; they contained variable amounts of calcium oxalate. No adverse events occurred.

CLINICAL RELEVANCE

Infection-induced struvite urolithiasis is 1 of the 2 most common minerals occurring in canine uroliths. Results of this study supported the use of d,l-methionine and amoxicillin–clavulanic acid without changing diet for dissolution of infection-induced struvite urocystoliths in dogs.

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