The safest antibiotic for a senior cat with an URI/other issues.. support/advice needed

My 15 year old has been more congested than usual for over a week now(we lost his brother, unrelated, over a week ago).  On a regular basis, he deals with congestion and coughing.  He's been diagnosed with asthma and has chronic upper respiratory issues.  The only medication he's on is Flovent(which I've now stopped) and various supplements(DMG, lactoferrin, ubiquinol, a heart supplement(CardioStrength), a kidney supplement(Renal Essentials), a multi(Life Extension Cat Mix), & krill oil.  He sometimes gets a dissolved oxygen product, colloidal silver, grapeseed extract(VetriScience), curcumin, probiotics, and I believe that's it. 

We brought him to a new vet(on an ER appt) on Tuesday and he received a very thorough exam(we were there for about 2 hours).  He had blood work, a urinalysis, culture and sensitivity(on the urine), xrays, and so on.  The Xrays revealed a large amount of gas(obscuring his liver in the image), which she surmised could be from taking in more air due to the URI, and he had a small amount of inflammation in his lungs but nothing too concerning.  His heart appeared to be slightly enlarged but I know it has been for a very long time.  He did not have a fever and was actually sounding/seeming a lot better while we were at the clinic and when we got home that day.  He continued to do about the same until we came home very late Friday night(Saturday morning).  We had been gone the entire day(usually here with him almost 24/7) and I think this pushed him over the edge.  He had some yellow/opaque nasal discharge and has continued to have some throughout the day.  No clinics are open until Monday, when his new doctor will be in.

I could, however, bring him in for an emergency appointment at the clinic if it's dangerous to wait until Monday.  I believe this is the third time he's had a flareup that involved yellow nasal discharge.  The first time, which also involved his eyes, was very scary and occurred over a year ago. 

The vet had said we could try Doxycyline even though he was not showing signs of an infection at the time.  She also said I could look into an antiviral(famciclovir) and Cerenia.  I've been looking into antibiotics and all of their potential side effects and warnings(ie; don't give to cats with kidney disease) and have wondered if Clindamycin might be a good option for him. 

I'm at a loss for what to do for him; it's very difficult making these decisions.  He's a VERY sensitive cat and he has a number of different issues going on.  He's had mild kidney disease for several years, a first degree AV block(he can't go under anesthesia due to his heart condition), some degree of gum disease(his gums bled in one place from the vet's exam :/), allergies, asthma, suspected polyp, neurological issues, and the chronic URIs.  I'm terrified of giving him something which could cause further harm to him but I realize yellow nasal discharge could be a sign of a bacterial infection.

He's currently sounding very congested, sneezing here and there, having a running nose(both nostrils, sometimes yellow in color), and his appetite has decreased(he's eating treats, cooked chicken, baby food, food off my fingers, etc).  I'm using Little Noses nasal drops in his nose(as best as I can), we have a warm mist humidifier with Vicks and Eucalyptus running, and I'm giving him colloidal silver in his eyes/nose here and there as well. 

My questions(I apologize for the length but I'm incredibly worried about him): 

Should I wait until we can get him in Monday or make an ER appt.?

Should I just pick up an antibiotic rather than stressing him by bringing him on an hr+ car ride in the cold again?

What antibiotics would be safest and most appropriate for him?  Which should I definitely avoid?  I'm not sure what they have available at the clinic or how long it would take to get one compounded. 

Should I hold off on antibiotics and see if he recovers on his own?

Should I push to have a culture/sensitivity test on the nasal discharge(if he still has it)?  I've been discouraged by other vets as well as an internal medicine specialist at a university but I've seen others who have benefited from it on here..

Any advice would be greatly appreciated.  I should also mention that the first time he developed a URI like this(over a year ago), I had also been away for a day.  We are extremely attached to each other and I know the loss of his brother and the vet visit were additional sources of stress on his poor immune system.

I should also mention that he's scheduled to see an internal medicine specialist about 4 hours away on the 13th(earliest date I could get).  He'll be having a cardiology exam and I'm hoping she has some suggestions for his respiratory problems. 

OceanBreathes said:

 
I should also mention that he's scheduled to see an internal medicine specialist about 4 hours away on the 13th(earliest date I could get).  He'll be having a cardiology exam and I'm hoping she has some suggestions for his respiratory problems. 

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Your cat's situation is very complicated and in my opinion you should be discussing this with your vet.   As to whether you should bring him in to an ER vet today instead of Monday, I don't feel qualified to advise you, you know your cat best and you are there - you need to decide if it appears to be an emergency or if it can wait.  I realize that doesn't sound helpful, but it really is your decision.  Typically ER vets are used when you think they can help your cat today in a meaningful way that delaying until tomorrow isn't advisable, or in a life threatening situation.

As to antibiotics, there are various issues here, but reading up on them and then making a selection isn't the way to go.  As an example Clindamycin is best for mouth infections and isn't prescribed for URI's.  Most antibiotics are well tolerated, some cause GI issues like diarrhea, Baytril has been known in theory  to cause blindness but its still very safe to use.  I would discuss with my vet doing a PCR test to nail down exactly what URI this is and a sensitivity test to see what antibiotic (if any) is effective.

Your cat is on a lot of medicines, perhaps you should go over this list with your vet as well.  The only supplement I didn't see was L-Lysine which is specifically effective in chronic URI's caused by felines herpes.  Has this been discussed?

Please keep us updated and good luck!

Update:  We ended up bringing him out in blizzard-like conditions for an emergency appointment at his new vet clinic(he's a trooper).  He did not have a fever and the discharge had disappeared by the time we got there.  I think he was possibly on the mend but we started him on liquid Clavamox very early this morning when we got home.  He appears to be feeling/breathing a lot better today.  He was his usual affectionate, purring, talkative self in bed and he's up walking around, eating food, etc.  I'm relieved. 

The vet did, however, say she would go ahead and order the Doxycycline that the other vet had suggested I think about.  I'm nervous about combining antibiotics/doing one so soon after Clavamox/giving him another antibiotic when it might not be necessary.  I always try to avoid antibiotics with my cats(and myself) unless they're absolutely required.  I know I'm not a vet but I've had vets prescribe antibiotics for problems that weren't bacterial in nature(ie; urine culture never revealed bacteria, URIs without signs of secondary bacterial infections, etc) and I'm always very cautious with him. 

She(vet who saw us on an ER appt at the clinic) did not feel that a PCR test would be helpful.

The vets are aware of the supplements he takes and he has been on lysine in the past.  It did not seem to help with his particular type of URIs, though, unfortunately.  After losing our kitten to FIP, I backed off of the lysine as it was discouraged by an FIP researcher/some other things I've read.  It's really difficult to say what helps him out of his current supplements mix, though, and I'll be rethinking that.  His blood work and kidney values(no sign of kidney disease) look great so I'd like to believe something is helping, if only a little(obviously still gets URIs :/).

I'm glad your cat is feeling a little better, and thank you for bringing up the lysine/FIP connection. I had had NO idea. Herpes is a pain, but FIP is terminal.

OceanBreathes said:

 
Update:  We ended up bringing him out in blizzard-like conditions for an emergency appointment at his new vet clinic(he's a trooper).  He did not have a fever and the discharge had disappeared by the time we got there.  I think he was possibly on the mend but we started him on liquid Clavamox very early this morning when we got home.  He appears to be feeling/breathing a lot better today.  He was his usual affectionate, purring, talkative self in bed and he's up walking around, eating food, etc.  I'm relieved. 

The vet did, however, say she would go ahead and order the Doxycycline that the other vet had suggested I think about.  I'm nervous about combining antibiotics/doing one so soon after Clavamox/giving him another antibiotic when it might not be necessary.  I always try to avoid antibiotics with my cats(and myself) unless they're absolutely required.  I know I'm not a vet but I've had vets prescribe antibiotics for problems that weren't bacterial in nature(ie; urine culture never revealed bacteria, URIs without signs of secondary bacterial infections, etc) and I'm always very cautious with him. 

She(vet who saw us on an ER appt at the clinic) did not feel that a PCR test would be helpful.

The vets are aware of the supplements he takes and he has been on lysine in the past.  It did not seem to help with his particular type of URIs, though, unfortunately.  After losing our kitten to FIP, I backed off of the lysine as it was discouraged by an FIP researcher/some other things I've read.  It's really difficult to say what helps him out of his current supplements mix, though, and I'll be rethinking that.  His blood work and kidney values(no sign of kidney disease) look great so I'd like to believe something is helping, if only a little(obviously still gets URIs :/).

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I'm glad your cat is feeling better!  The reason vets use antibiotics with viral infection is that cats are very prone to having bacterial infections present at the same time, or prone to getting them.  

I researched L-lysine/FIP connection based on your post and saw some interesting and very subtle research (see below) that suggests a logical argument without actually having data (as far as I could see) to back it up that states that giving L-lysine to a cat actively sick with FIP may be contraindicated. But there would be no reason to give an FIP cat L-lysine in the first place, it won't help at all and who's concerned about FHV (feline herpes)  when the cat is dying of FIP?  Secondly, the notion that a cat who is positive for coronavirus shouldn't get L-Lysine because some cats with coronavirus get FIP doesn't hold up logically since most cats test positive for carona and almost none get FIP.  I didn't see anything in the medical literature that even suggests that giving L-lysine to a coronavirus positive test leads to FIP.

For those that are curious, here is the logic of the issue as stated in the link below in summery:

Cats need arginine for herpes virus to replicate. L-lysine binds with arginine (make arginine unavailable) so as to prevent herpes replication.  Cats who are sick with FIP need arginine so giving l-lysine may not be a good idea. OK, fine, but finding the research that backs this up in real world-infected cats is lacking.  We have 1000's of drugs that were developed around a line of logic that had no positive effect on the patient.  But again, even Dr. Addie an FIP researcher quoted below says that there is no reason to give L-lysine to an FIP sick cat.

This is a quote reported to be from Dr DIane Addie that is floating around the internet where she is purported to say that "Since your query, I've done a lot of reading about arginine and
L-lysine in the cat and come to the conclusion that we should NOT give L-lysine to cats with FIP or to cats infected with feline coronavirus who may be at risk of developing FIP." (Emphasis mine).  Note she doesn't say that you shouldn't give L-lysine to cats who are coronavirus positive, she says that she believes (her personal view) that we shouldn't give it to cats who are both coronavirus positive AND at risk of FIP.  The distinction is a subtle one but it is there. A  healthy adult cat who is coronavirus positive is no more at risk of FIP then any other cat in the grand scheme of things, but, a coronavirus kitten from a breeder who has had FIP in their cattery is at higher risk.  That is the distinction but you will only see that distinction if you drill way down, very far down into an interview she gave in 2005, that is widely referenced in support of the above argument, except that in the interview she doesn't have this quote or make this argument.

Bottom line, it is easy to take one person's quote, add a dose of logic, reference an interview that is supposed to support your argument but actually doesn't (if one takes the time to read the interview) and come to a distorted conclusion.  That is what is done in this link, that is mixing and matching quotes to get the reader to a conclusion that I believe having read the primary source, is not even completely supported by the person they are quoting (Diane Addie).  So if you read this link,  then you really need to read the next two: http://www.stevedalepetworld.com/co...-a-conversation-about-fip-with-dr-diane-addie 

and http://www.dr-addie.com/treatment.htm

Thanks for clearing that up before I could.  I'm not wanting to discourage anyone from giving their cat l-lysine if it's helpful for them.  It can be a great supplement for preventing feline herpes flareups.  Unfortunately, my cat did not respond to it, most likely does not have a herpes component to his URIs, and takes plenty of other things for general immune support.  It DOES NOT cause FIP. 

I just received a voicemail from the vet who saw us in the ER appointment.  She said she wants him to continue taking the Clavamox AND add Doxycycline.  She'd like him to be on that until his appointment with an internal medicine specialist on the 13th.  I'm very weary of the side effects of the Doxy, especially when combined with another(Clavamox) antibiotic.  I don't think he's shown a response; the nasal discharge had already stopped before we brought him in and he sounds really congested today.  He's a sensitive guy and I don't want to make him even more miserable.  Also, I feel it's best to bring him in without new medications/with the symptoms I'm wanting the internal medicine specialist to address so he can get the most out of his appointment.  He did not have a fever when we brought him to the ER(or to the other recent appt.) and he's no longer having nasal discharge.   I'll be discussing this with the vet when I call her back.  I know I'm not a vet but I've been through a great deal with him over the years and have had to learn to say "no" to vet suggestions that I felt could be harmful(ie; putting him on a restricted, low quality protein diet at the first sign of kidney issues several years ago, a medication he was put on that was harmful for his heart.. which specialists were shocked he was put on, and the list goes on..).  After everything he's been through, I'm pretty overly protective.