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Management of Bacterial Bronchitis
and Pneumonia in Small Animals
Lesley G. King, MVB, MRCVS, Diplomate ACVIM (Internal Medicine) and ACVECC
Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
The normal upper respiratory tract
of the dog and cat is usually colonized
by a varied population of bacteria that
do not cause an inflammatory response
in healthy individuals. Cultures ob-
tained from the lower respiratory tract
are intermittently positive in 35% to
50% of normal dogs1,2,3 (Table 1),
although much less information is
available about cultures in normal
cats 4 (Table 2). Bacterial invasion,
infection, and inflammation usually
occur as a result of a primary process
that has damaged the airways or lung
parenchyma or has inhibited their nor-
mal defense mechanisms. Therefore,
the same organisms cultured in small
numbers from the airways of healthy
dogs and cats often become oppor-
tunistic pathogens that invade the air-
ways and lungs and cause clinical ill-
ness: bronchitis and pneumonia. The
existence of a population of bacteria
in the airways of normal animals can
make it difficult to assess the signifi-
cance of positive culture results from
the respiratory tract. As a general rule,
when samples from the airways are
cultured, light growth of one or multi-
ple organisms is likely to represent col-
onization, while heavy growth by a
single pathogenic bacterial species
may be a clinically significant sign of
infection.
Bordetella bronchiseptica is a gram-
negative, aerobic rod that can colonize
and invade the normal respiratory tract,
even in the absence of underlying respi-
ratory disease. Bordetella attaches to
the cilia of the respiratory columnar
epithelium and induces ciliary stasis,
60 Third International Veterinary Symposium on Fluoroquinolones Proceedings
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RESPIRATORY TRACT
INFECTIONS
crippling one of the most important
defense mechanisms of the respiratory
tract.5,6 Because the mucociliary escala-
tor no longer functions, the organism
can persist in the airways for a protract-
ed time, with isolates documented as
late as 14 weeks postinfection. This
slow rate of clearance is in sharp con-
trast to that of other potentially patho-
genic gram-negative bacteria. Bordetel-
la is transmitted between animals by
aerosolization and is one of the main
bacterial culprits in outbreaks of infec-
tious tracheobronchitis and broncho-
pneumonia.7
In practice, the clinician often sees
individual pets with spontaneous respi-
ratory tract infections that may not be
associated with exposure to other
affected animals. The bacterial patho-
gens growing in the respiratory tract of
these patients are often opportunistic
invaders, secondary to a primary dis-
ease process that has damaged the
normal defense mechanisms of the res-
piratory tract8,9 (Tables 3 and 4). As
such, unless the primary process is
infectious, most of these syndromes
are not transmitted between animals.
For example, if an Escherichia coli
pneumonia develops in a pet dog fol-
lowing aspiration of gastrointestinal
tract contents, the other animals in the
household are not at risk of developing
the same problem. In contrast, if one
cat in a household has a viral upper res-
piratory tract infection with super-
imposed bacterial infection, the other
cats may also be at risk of viral infection
and therefore may exhibit similar clini-
cal signs.
Many respiratory diseases have at
least some secondary component of
colonization or infection with patho-
genic bacteria. Positive cultures are
commonly obtained from the respirato-
ry tract, and patients can manifest a
partial or complete but temporary
response to antibiotic therapy. An
apparent failure to resolve a disease
syndrome, despite appropriate anti-
biotics, often means that the underly-
ing problem has not been effectively
diagnosed or resolved.
Variable bacterial isolates have been
reported in cases of bronchopneumonia
in small animals. When cultures are
obtained, most dogs demonstrate
growth of a single organism, but some
may have multiple isolates. Most stud-
ies report that about 65% to 88% of
the bacteria causing bronchopneumo-
nia in dogs are gram-negative rods such
as Pseudomonas spp., E. coli, Klebsiella
spp., B. bronchiseptica, and Enterobac-
ter spp.8,10 The remainder (20% to 35%)
are gram-positive, primarily Staphylo-
coccus spp. and beta-hemolytic strepto-
cocci.8,10 One study, however, revealed
that 62% of dogs had gram-positive
infection.11 The incidence of anaerobic
infections in dogs with bronchopneu-
monia is unclear, as most studies do not
report anaerobic cultures, but one
review article suggested a 19% inci-
dence of anaerobic infection in dogs
(n = 105) with bacterial pneumonia.12
The most common isolates in cats with
bacterial pneumonia include B. bron-
chiseptica and Pasteurella spp.13
Mycoplasma spp. pulmonary abscess
and pneumonia have been document-
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TABLE 1
Normal Bacterial Flora
in the Healthy Canine
Respiratory Tract
Enterococcus
Staphylococcus spp.
Streptococcus spp.
Escherichia coli
Pseudomonas spp.
Acinetobacter spp.
Enterobacter spp.
Klebsiella pneumoniae
Clostridium spp.
Proteus spp.
Alcaligenes spp.
Corynebacterium spp.
Bordetella bronchiseptica
Mycoplasma spp.
Modified from King LG: Bacterial
Infections of the Respiratory Tract in
Dogs and Cats. Shawnee Mission,
Kansas, Bayer, 1997.
ed in one cat,14 and another report doc-
uments pneumonia caused by Salmo-
nella choleraesuis in a cat with no signs
of gastrointestinal tract disease.15 (Cul-
ture and sensitivity results from dogs
with lung disease at the Veterinary Hos-
pital of the University of Pennsylvania
are shown in Table 5 and Figure 1.)
The underlying theme of bacterial
pneumonia in dogs and cats remains
clear: Most normal small animals
should not develop pneumonia sponta-
neously. Those that do have usually
undergone an event that has over-
whelmed pulmonary defenses, such as
aspiration. Even a single aspiration
event, if sufficiently severe, may lead to
pneumonia in a normal dog or cat.
Alternatively, the animal may be suffer-
ing from a condition that weakens or
eliminates the defense mechanisms of
the lung. Such animals are at risk of
development of bacterial pneumonia
that can be a serious and often life-
threatening complication of a previous-
ly undetected or subclinical problem.
Antibiotic Therapy for
Pneumonia
In most serious bacterial infections
involving the respiratory tract, antibiotics
should be considered part of overall
management rather than the only treat-
Supplement to Compendium on Continuing Education for the Practicing Veterinarian, Vol. 21, No. 12(M), 1999
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TABLE 2
Normal Bacterial Flora in
the Healthy Feline Lung
Pasteurella spp.
Pseudomonas spp.
Staphylococcus spp.
Streptococcus spp.
Escherichia coli
Micrococcus spp.
Modified from King LG: Bacterial
Infections of the Respiratory Tract in
Dogs and Cats. Shawnee Mission,
Kansas, Bayer, 1997.
ment. For an optimal outcome, the clini-
cian must focus on resolution of the
underlying problem as much as on the
bacterial infection itself. In some situa-
tions, antibiotics may be virtually ineffec-
tive if unaccompanied by other therapy,
such as resolution of the cause of regur-
gitation or vomiting, or resection of a
lung lobe in the case of a patient with a
lung abscess.
Except in acute, low-grade infec-
tions, representative cultures ideally
should be obtained from the respirato-
ry tract prior to initiation of antibiotic
therapy. If antibiotics have been previ-
ously prescribed and the patient is sta-
ble and will not be harmed by a delay
in therapy, withdrawal of antibiotics for
at least 1 week is ideal before cultures
are obtained. Samples are usually
obtained by transtracheal or endotra-
cheal wash or by bronchoalveolar
lavage. In patients with serious infec-
tions, appropriate antibiotic therapy
cannot be delayed. Once cultures have
been obtained, antibiotic therapy
should be instituted immediate-
ly, pending culture results. The ini-
tial antibiotic should provide broad-
spectrum coverage for the most likely
organisms, bearing in mind the possi-
bility of polymicrobial infection. Initial
cytologic results may assist in antibiotic
choice by documenting whether the
bacterial organisms are gram-positive
or gram-negative rods or cocci.12 Once
culture and sensitivity results are avail-
able, a specific, narrow-spectrum anti-
biotic can then be chosen for ongoing
care (Table 6).
When choosing an antibiotic, we
must consider (1) the penetration of
the antibiotic into the lung parenchyma
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TABLE 3
Primary Causes
of Tracheobronchitis
and Coughing in
Dogs and Cats
Bacterial infections: Bordetella
bronchiseptica, Mycoplasma
spp.
Acute viral infections: para-
influenza, adenovirus (dogs),
calicivirus and herpesvirus
(cats)
Parasitic infections: Filaroides
osleri, migrating ascarids,
lungworms, Dirofilaria
immitis
Structural abnormalities:
collapsing trachea,
collapsing mainstem
bronchus
Chronic bronchitis
Bronchiectasis
Bronchospasm
Foreign body aspiration
Neoplasia
Pulmonary disease: e.g.,
pulmonary edema (dog),
pneumonia, other
Laryngeal disease: laryngeal
paralysis, inflammation
Modified from King LG: Bacterial
Infections of the Respiratory Tract in
Dogs and Cats. Shawnee Mission,
Kansas, Bayer, 1997.
and respiratory secretions, and the
route by which it should be adminis-
tered; (2) mode and spectrum of activ-
ity and toxicity of the drug, and poten-
tial interactions with other drug
therapies; and (3) the most likely
pathogens.
In most instances, the main choice
that faces the clinician is whether a
particular patient can be successfully
treated with oral antibiotics or whether
the patient should be hospitalized for
parenteral drug administration. As a
general rule, parenteral antibiotic
administration should be considered in
any patient with serious illness that sig-
nificantly compromises respiratory
function. Thus, most dogs and cats
with fever, tachypnea, dyspnea, or oth-
er systemic signs caused by bacterial
pneumonia, pyothorax, or severe upper
respiratory tract infection probably
deserve hospitalization and parenteral
antibiotic administration in the early
stages of therapy. In contrast, oral
61
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matory disease of the respiratory tract,

TABLE 4 TABLE 5 in which normal barriers may be less
effective.20
Primary Causes of Bacterial Culture Results Most dogs with bacterial pneumo-
Bacterial Pneumonia from Dogs with Lung nia require treatment with antibiotics
for a prolonged period. Initially, par-
in Dogs and Cats Diseasea enteral antibiotics are administered
until the patient is not febrile, has nor-
Viral infections: Canine Number of mal gas exchange, and is eating. At
distemper virus (dog), Organism Cultures that point, the patient can be switched
calicivirus/herpesvirus (cat)
Fungal infections to oral medications for discharge from
Escherichia coli 71
Parasites Staphylococcus 34 the hospital. Ideally, thoracic radio-
Immunosuppression: neoplasia, Pseudomonas 25 graphs should be obtained approxi-
chemotherapy, retroviruses, Enterobacter 21 mately every 1 to 2 weeks during the
diabetes mellitus, Enterococcus 21 patient’s recovery, and oral antibiotics
hyperadrenocorticism, Klebsiella 11
are continued until 2 weeks after the
immunodeficiencies Pasteurella 11
Structural abnormalities: Bordetella 5 thoracic radiographs have become nor-
bronchoesophageal fistulas Acinetobacter 4 mal. In many cases, antibiotics are
Functional abnormalities: required for 4 to 8 weeks.
aBacterial culture results for all tra-
laryngeal paralysis
cheal washes and bronchoalveolar
Chronic airway disease: lavages performed at the Veterinary Use of Enrofloxacin in
bronchiectasis, collapsing
trachea, ciliary dyskinesia
Hospital of Pennsylvania during
1998. Two hundred twenty-one cul-
Patients with Bacterial
Aspiration: gastrointestinal tures were submitted in 190 dogs; Pneumonia
tract contents, foreign 165 samples were positive for aero- Fluoroquinolones are one of the most
bic growth. recent additions to the small animal
bodies
Thoracic trauma or antibiotic armamentarium and are an
hemorrhage: hit by car, excellent choice for treatment of many
coumarin toxicity bacterial infections of the respiratory
Inhalation of irritant
the bronchial secretions, we might tract.21 Oral administration results in
substances: smoke, noxious
gases expect some drugs to be ineffective in extremely good absorption and high
vivo, despite apparent in vitro sensitivity plasma and tissue concentrations.
Modified from King LG: Bacterial patterns. It is possible that the penetra- Despite the excellent oral absorption,
Infections of the Respiratory Tract in
Dogs and Cats. Shawnee Mission,
tion of antibiotics from the plasma may fluoroquinolones should be administered
Kansas, Bayer, 1997. be more efficient in dogs with inflam- parenterally when they are used for

antibiotic therapy is appropriate for

patients with localized disease that is
not seriously compromising function.
Thus, most animals with tracheobron-
chitis or mild pneumonia respond well
to oral antibiotic administration.
Most currently used antibiotics
achieve reasonable concentrations in
the extracellular fluid and therefore in
the lung parenchyma (alveoli). The
blood-bronchus barrier, however, may
prevent complete penetration of many
commonly used antibiotics to the interi-
or of the bronchi and the respiratory
secretions.16,17 Factors implicated in the
genesis of the blood-bronchus barrier
include molecular size, electrical charge,
protein binding, lipid solubility, mode of
drug transport (active vs. passive), and
Figure 1—We reviewed the bacterial culture results for all tracheal washes and broncho-
presence of a benzene group.17–19 The
alveolar lavages performed at the Veterinary Hospital of the University of Pennsylvania during
lack of antibiotic penetration into 1998. Antibiotic sensitivity results for selected bacteria in dogs are depicted above, represent-
bronchi can be particularly important in ing 165 positive cultures. It is important to note that these patients represent a largely refer-
the management of dogs with infec- ral-based population, many of which have been treated with antibiotics prior to culture. These
tious tracheobronchitis. If low concen- sensitivity results are based on old breakpoint values for enrofloxacin. New breakpoint values
trations of such antibiotics are present in and flexible labeling may allow higher efficacy.

62 Third International Veterinary Symposium on Fluoroquinolones Proceedings

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TABLE 6
Doses of Antimicrobials Used to Treat Respiratory Tract Infectionsa

Breakpoint MIC (µg/ml)b

Drug Susceptible Resistant Dose (mg/kg)c Interval (hr) Routed

Amikacin ≤16 ≥32 7–10 (D); 5–7 (C) 12 IV, IM

20 (D); 15 (C) 24 IV, IM
Amoxicillin ≤16 ≥32 11–22 8–12 PO, IM, SC
Amoxicillin with 4e–≤8 16–≥32 13.75–20 8–12 PO
clavulanic acid
Ampicillin ≤8f ≥32g 10–50 8 PO
≤0.25f 5–10 8 IM, SC, IV
Cefazolin ≤8 ≥32 15–25 4–8 IV, IM, SC
Cefotaxime ≤8 ≥64 20–80 6 IV, IM
Cefotetan — — 30 8 IV, SC
Cefoxitin ≤8 ≥32 10–30 6 IM, SC, IV
Ceftiofur — — >44 12 SC
Cephalexin ≤8 ≥32 10–30 6–8 PO
Cephalothin ≤8 ≥32 15–35 6–8 IM, SC, IV
Cephapirin — — 30 4–8 IM, SC, IV
Chloramphenicol ≤8 ≥32 50 (D) 4–6 PO, IM, SC, IV
50 mg/cat (C) 4–6 PO, IM, SC, IV
Clindamycin ≤0.5 ≥4 11 12 PO
Doxycycline ≤1 ≥4 5–10 12–24 PO
Enrofloxacin ≤1i ≥2–4 2.5–5j 12–24 PO, SC, IM, IVh
Gentamicin ≤4 ≥8–16 2–4 8–12 IM, IV, SC
8–12 24 IM, IV, SC
Imipenem-cilastatin ≤4 ≥16 3–10 6–8 IM, IVh
2–7.5 8 IM, IV
Kanamycin ≤4 ≥16 5–7.5 8 IM, IV, SC
Metronidazole — — 10 8 PO
Minocycline — — 5–12.5 12 PO
Penicillin G ≤8g ≥16g 20,000–40,000 U/kg 4–6 IM, SC, IV
Piperacillin ≤0.12e ≥0.25e 25–50 8–12 IV
Ticarcillin with or ≤64k ≥256 40–50 6–8 IV
without clavulanic acid ≤16g ≥128 75–100 (P. aeruginosa) 6–8 IV
Tobramycin ≤4 ≥14 2 8 IV, IM, SC
Trimethoprim-sulfadiazineg ≤2 ≥16 30 12–24 PO, SC

From Boothe DM: Drug therapy of respiratory bacterial infections, in King LG: Bacterial Infections of the Respiratory Tract in Dogs and Cats. Shawnee
Mission, KS, Bayer, 1997.
D = Dog; C = cat; IV = intravenous; IM = intramuscular; PO = oral; SC = subcutaneous.
aFor drugs recommended as initial antibiotic choices, see the article on p. 37 of the Bayer Selected Proceedings from the 1999 North American Veterinary
Conference, 1999.
bMIC values may vary among references and laboratories. Variations usually reflect only a single tube dilution.
cUnless noted otherwise, doses refer to both dogs and cats.
dSlow IV infusion recommended for most drugs.
eWhen testing Staphylococcus, susceptibility is ≤4.
fWhen testing gram-negative enterics.
gβ-Lactamase production is likely to preclude achievement of effective drug concentrations at tissue site.
hDilution in saline recommended prior to IV administration.
iVeterinary isolates.
jDose may be insufficient for organisms with a high MIC. Doses as high as 10 mg/kg every 12 to 24 hours have been used by some clinicians to treat
some cases of Pseudomonas aeruginosa.
kWhen testing Pseudomonas aeruginosa.

management of sick or dyspneic animals
with bacterial pneumonia. Tissue distrib-
ution of the fluoroquinolones is excel-
lent, and effective concentrations are
easily achieved in the respiratory tract,
with excellent penetration of the blood-
bronchus barrier and achievement of
high levels in bronchial secretions. In
addition, the fluoroquinolones are con-
centrated inside alveolar macrophages
and neutrophils.22,23
Enrofloxacin has a broad spectrum of
activity against both gram-positive and
gram-negative aerobic bacteria (includ-
ing B. bronchiseptica), but little activity in
anaerobic infections. Doses of 5 to 10
mg/kg sid are effective in most cases,
although higher dosages may be neces-
sary to exceed the minimum inhibitory
concentration for Pseudomonas iso-
lates.24 Although enrofloxacin is not mar-
keted for intravenous use, this author
routinely administers it by that route
without apparent complications. Vomit-
ing and nausea have been seen follow-
ing rapid intravenous administration of
enrofloxacin in dogs but can be avoided

Supplement to Compendium on Continuing Education for the Practicing Veterinarian, Vol. 21, No. 12(M), 1999 63
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by slow administration (30-minute infu-
sion) of a saline-diluted solution of the
drug (1:2 or 1:3). Because enrofloxacin
tends to precipitate when mixed with
alkaline solutions, it should not be mixed
with balanced electrolyte replacement
solutions for intravenous administration.
Many patients with pneumonia
have polymicrobial infections. If there is
a concern about the presence of anaer-
obic organisms, streptococci, or ente-
rococci, enrofloxacin should be com-
bined with another antibiotic. This
author routinely adds intravenous
metronidazole (10 mg/kg IV tid) or clin-
damycin (10 mg/kg IV tid) as combina-
tion therapy with enrofloxacin if an
anaerobic infection is suspected. If
enterococci are a concern, ampicillin
can also be added.
The fluoroquinolones are associated
with relatively few and mild toxic
effects. Fluoroquinolones should not
be administered to puppies less than
approximately 1 year of age because
articular cartilage damage may take
place during periods of rapid
growth.25,26 Thus, although the spec-
trum includes Bordetella and its ex-
cellent bronchial penetration would
suggest efficacy for infectious tracheo-
bronchitis, this drug should probably
be avoided in puppies with kennel
cough. Although neurologic symptoms
and signs have been suggested in
humans and animals, this appears to
be a relatively unusual phenomenon,
and the prior presence of neurologic
disease is not considered an absolute
contraindication for their use.
Although plasmid-mediated re-
sistance to fluoroquinolones does not
occur, mutational resistance may be
becoming more common and is likely
to increase with extensive fluoro-
quinolone use. Clinicians should there-
fore make every effort to avoid indis-
criminate use of these drugs in patients
with mild disease. Because of its good
tissue concentration after oral adminis-
tration and its minimal toxicity, enro-
floxacin is a good first choice for aero-
bic gram-negative coverage in most
serious bacterial infections of the respi-
ratory tract.
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Tissue
distribution of
the
fluoroquinolones
is excellent, and
effective
concentrations
are easily
achieved in the
respiratory tract,
with excellent
penetration of
the blood-
bronchus barrier
and achievement
of high levels in
bronchial
secretions.
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