The point of this page is to show that the resource is not marketing. These are the questions the literature itself says are unfinished, with what a rescue or a motivated owner could realistically do about each one.
The 2014 letter withdrawing twice-daily dosing said explicitly that the revised once-daily regimen had not been assessed for efficacy. The field has been operating on pharmacokinetics plus clinical impression ever since. A prospective efficacy trial of 30 mg/kg q24h is the most basic missing study in the field.
Contribution: a veterinary teaching hospital or a large rescue network with a research partner. Not something an individual can do.
A colon-targeted ronidazole in a guar-gum capsule achieved 84% clearance with no adverse effects — the best result in the literature — and is not commercially available or readily compoundable. No public explanation of the barrier exists.
Contribution: a manufacturer, or someone willing to publish why it cannot be made. This is a manufacturing problem, not a biology problem.
Enterococcus faecium inhibited the organism in vitro. Nobody has run the prevention trial in cats. Laboratory only
Contribution: a foster-based prospective cohort. A rescue that already sees this infection repeatedly is the natural place to run it, and it is the most achievable study on this list.
Guidelines disagree, and the review that named this as an open question has not been superseded on it. Treating only symptomatic cats risks leaving carriers; treating everyone means exposing healthy cats to a drug with a narrow margin.
Contribution: a multicat household or cattery willing to follow a protocol and record outcomes. Consent and record-keeping, not equipment. Why a cattery is the realistic place to run it →
Nobody knows whether years of chronic colonic inflammation leave lasting damage, or whether cats that clear the organism regain normal gut function. Nobody has followed a cohort long enough to say.
Contribution: longitudinal follow-up of cats already in your care. Ask owners of adopted positive cats to report back at 12 and 24 months.
Resistance has been documented in vivo and in vitro. Its prevalence is unknown, largely because failing cats are rarely retested with a resistance assay. Documented, unquantified
Contribution: systematic retesting after every course, and submission of repeat positives for susceptibility work rather than a second blind course.
ABCD advises stopping antibacterials about seven days before collection. The largest dataset (n = 1,717) found no association between prior treatment and PCR positivity. Both are published; they disagree; the question is open.
Contribution: a prospective study with actual dates of last dose. Retrospective data cannot settle it.
Nobody has established the right time to retest. Relapse has been observed up to 20 weeks after treatment, which implies that a widely used four-week retest cannot support a cure claim — but no standard interval has replaced it, and no study has measured the predictive value of a negative result at each time point.
"Retest after treatment" is universal advice, with no agreed interval behind it. A cat declared clear may not be.
Contribution: a standardized retest protocol with dates, published as a case series. Boring, useful, and entirely within reach of a large rescue.
