FIP Georgia > treatment info > protocol

FIP Georgia: treatment protocol 🔗

Treatment length 🔗

The standard treatment is twelve weeks (84 days) of GS. In some cases, treatment needs to be extended because bloodwork and/or clinical symptoms suggest a cure has not yet been achieved.

Twelve weeks may sound like a long time, but it's actual fairly typical for anti-viral treatment. (For example, treatment of Hepatitis C in humans lasts 8-16 weeks.) The twelve-week treatment period was determined experimentally by Dr. Pedersen to be necessary for most cats to achieve a full cure. Your kitty may appear to be totally healthy again within the first few weeks of treatment, but the virus will still be present, and if we stop treating before it's been fully eradicated, it can rebound and cause a relapse, requiring another course of treatment at a higher dosage level (and cost) than the first.

Frequency of doses 🔗

The GS is generally administered once daily; if a cat's condition is critical, we may start with twice-daily doses for the first 3-5 days until their condition has stabilized.

Dose adjustment for weight 🔗

The size of each dose is calculated based on your kitty's weight. You need to weigh your cat regularly and report any changes so that we may adjust the injection size or number of pills accordingly. (See Other supplies for information on getting a suitable scale.) Early in treatment, when weight gain can be rapid, you should weigh your kitty at least every other day; later in treatment, if weight seems to be leveling off, once or twice a week may be sufficient.

If your scale can be set to display in kg, that will be easiest and least prone to error. If you must use pounds, make sure you clearly distinguish between tenths of a pound and ounces: "6.5 lbs" is not the same as "6 lbs 5 oz."

Injections vs. pills 🔗

FIP is an inflammatory disease, and absorption of oral medication may be compromised by inflammation in the digestive tract until that inflammation is under control. For that reason, we recommend starting with a week or two of injections if a cat is not eating normally or has been vomiting. Once the kitty’s condition is stabilized, injections and pills are generally equally effective. (The pills are, however, somewhat more expensive than injections.)

Startup procedure 🔗

Due to the importance of starting treatment as quickly as possible, the same day that you first contact us we will try to connect you with someone nearby who can provide a startup supply of GS. (That person will be another parent who is already treating, or someone in our network who is done treating their own kitty, but maintains a stock of extra GS specifically to help new parents get started.) Your startup contact may also be able to show you how to administer the first dose.

After the startup supply, you'll mail order the rest of the GS (we'll provide details on how to do that), and—if injecting—syringes and needles from a vendor of your choice (see the Other supplies page). Getting your initial supplies from the startup contact enables you to begin treatment without having to wait for your first order to arrive.

Supportive care 🔗

Cats are usually very ill at the beginning of treatment, and often need supportive care at home or from your vet in order to keep them alive long enough for the effects of the GS to kick in. The needs of each cat will vary, and some require no special assistance at all, but here are some areas where you should be aware of the possible need for supportive care:

• Breathing difficulties: The accumulation of fluid in wet FIP can interfere with your kitty's breathing. Breathing that is abnormally fast (over 50 breaths per minute), labored, or open-mouthed constitutes an emergency and may require the removal of fluid and/or administration of oxygen. Pleural effusion (chest fluid) should be fully drained, and may need to be done more than once before the GS treatment stops the fluid from accumulating. (Abdominal fluid should be left in place if possible, but if there's so much that it's causing breathing difficulty, up to 30% may be removed.) Fluid accumulation should stop within the first week or so of treatment.

• Undereating ("inappetance"): It's critical that your kitty consume sufficient calories. If they're not eating enough on their own, they may need anti-nausea and/or appetite stimulant meds, they may need to be syringe fed, or—for more extreme inappetance—they may need to have a feeding tube inserted. Appetite usually returns within the first few days of treatment, but anti-nausea meds may be needed for up to a few weeks, until internal inflammation resolves.

• Dehydration: If needed, subcutaneous fluids can be administered at home; for more extreme dehydration, IV fluids may be needed at a clinic.

• Abnormal temperature: Cat temperatures fluctuate more than human ones, and you'll see varying definitions of the "normal range," but roughly speaking, anywhere between 99.5°F and 102.5°F is not a cause for concern. To address fever (a temperature above that range), subcutaneous fluids may help, and your vet may also prescribe anti-inflammatory meds; for abnormally low temperatures, your kitty may be placed in a box or other enclosed space with a hot water bottle or electric heating pad (but do not set a cat that is unable to move on their own directly on a heating pad). Body temperature should return to normal within the first few days of treatment. (See Other supplies for information on getting and using a suitable thermometer.)

• Anemia: Mild to moderate anemia may benefit from B12 administration; severe anemia may require a transfusion. Signs of anemia include lethargy, very pale, whitish gums, and rapid breathing.

• Eye inflammation: The eye inflammation caused by ocular FIP will usually resolve after a week or two of GS treatment, but until then, symptomatic treatment may be called for, in the form of anti-inflammatory eye drops, as the inflammation is painful and can cause permanent eye damage.

• Seizures: Neurological FIP can cause seizures. GS treatment will, again, resolve the seizures over time, but meanwhile, anti-seizure meds may be needed.

• Steroids: Steroids like prednisolone can be very helpful at the beginning of treatment, slowing the symptoms and stabilizing the kitty until the GS can kick in. Because steroids also suppress the immune response, if your kitty is on steroids we'll want to wean them off as they become healthy enough to survive without them, so the immune system can get back into the fight and eliminate the FIP virus. We do try to avoid injections of depo-medrol (methylprednisolone), because of how long it remains in the body. Note that steroids are contraindicated in cats with certain health issues; your vet can advise whether that applies to your kitty.

Bloodwork 🔗

During our initial conversation, we ask that you provide copies of any recent lab tests that your vet may have done. We can start treatment without bloodwork, but if it isn't already available, it is important to have a CBC and a Chem panel done within the first several days of treatment, for two reasons:

1. To help confirm the diagnosis of FIP (and make sure we don't have some problem other than FIP that's going untreated)
2. To serve as a baseline for the FIP treatment, so we can gauge your kitty's progress during treatment, determine whether the dosage needs to be adjusted, and decide whether your kitty is ready to stop treatment at twelve weeks.

During the 12-week treatment period, it's important to have bloodwork repeated at four weeks, at eight weeks, and a few days before the end of the twelve weeks (in time for us to review the results before you reach twelve weeks, and advise on whether to stop treating then).

Please record the results on this spreadsheet, to help us see the trends more easily. Follow the directions in the top left corner of the document to make a personal copy of the template that you can edit and share with us. Post all lab reports in your treatment chat, along with the tracking spreadsheet.

Side effects 🔗

GS has few side effects. The injections do sting briefly (due to the acidity of the GS solution), but apart from that, the only common side effect is that most cats do develop a few skin lesions over the course of treatment. The sores usually scab over and heal up on their own; if you find any open sores, we recommend treating them with Vetericyn Plus wound and skin care spray, available from the manufacturer, from Amazon and other online retailers (Chewy, Petsmart, etc.), and possibly from local pet stores. Monitor any open sores and see your vet if you find signs of infection (pus draining from the sore, fever, the area of the sore feeling warmer than surrounding areas).

Typical timeline 🔗

Cats vary in how they respond to treatment, but most often within the first day or two we see improvements in appetite and energy level, with fevers dropping back into the normal range. Chest fluid and breathing difficulties usually resolve within the first week or so, with reabsorption of abdominal fluid starting a week or two into treatment, and taking another week or two to complete. Ocular symptoms usually take a week or two to resolve. Lab results usually improve more slowly than clinical symptoms, and don't return fully to normal levels until the last few weeks of treatment.

This visual timeline, based on the data from Dr. Pedersen's original study, shows how long it took for various improvements to be seen for the cats in his study.

Spay/neuter 🔗

If your kitty has not yet been spayed or neutered, please schedule the procedure about two weeks before the end of the treatment period. That way, the remaining treatment will help with any stress caused by the procedure.

Observation 🔗

After the treatment period, there’s a 12-week “observation” period during which you’ll monitor for a return of any symptoms, and optionally have periodic bloodwork performed. Relapses are fairly uncommon; when they do occur, it's most often within the first 3-4 weeks of observation.

Bloodwork is required at the end of the observation period. If bloodwork and clinical symptoms indicate no relapse has occurred by the end of observation, your kitty is considered cured!

As it has only been about six years since the first GS trial, there is no truly long-term survival data, but it does appear that once cured, cats remain free of FIP.

FIP Georgia > treatment info > protocol