What antibiotic should I be using with suspected infectious cholangiohepatitis in dogs?

The most common bacterial infections of the liver ascend through the biliary system from the duodenum, and include Staphylococcal spp, E coli, and Clostridia. Good old Amoxycillin clavulanate at 20mg/kg BID would be an ideal choice to cover these most common organisms. If I am not seeing a response (resolution of pyrexia, reduction of liver enzymes), I get suspicious that this may not be a bacterial infection and consider liver biopsy / bile cytology and culture, and recommend further testing before escalating antimicrobial coverage.

The relationship between NSAIDs and chronic renal failure is a bit tricky. We know they can cause acute renal injury but the association with CRF is not as clear. Cats with CRF treated with meloxicam have a longer life expectancy than those not treated as they are euthanised for their OA!

In some patients with stable stage 2 CRF we recommend NSAIDs for OA management, but monitor renal parameters two weeks after starting, then three monthly ongoing. It is important to educate owners that dosing when dehydrated may trigger acute renal failure, so it is best they contact you for alternative pain management strategies if their kitty is unwell.