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| GI InTerVenTIon: PATIenT wITh AcuTe DIArrheA Table 3. Potential enteric Bacterial Pathogens in Dogs & Cats ORGANISM PREVALENCE Campylobacter Healthy: C perfringens C difficile* Salmonella ANTIBIOTIC CHOICE IF THERAPY APPEARS INDICATED Dogs, 21%–76% cats, 16%–58% Diarrheic: Dogs, 60%–97% cats, 16%–31% Healthy: Dogs, 11%–100% Diarrheic: Dogs, 27%–86% Enrofloxacin: Dogs, 5 mg/kg Po Q 12 h cats, 2.5 mg/kg Po Q 12 h (or marbofloxacin to avoid risk of retinal damage) Alternatives: Tylosin, tetracycline, or erythromycin usefulness of treatment unknown for mild cases; consider treatment of severe (hGe) or chronic diarrhea with metronidazole or tylosin; alternatives are ampicillin or amoxicillin-clavulanic acid Healthy: Dogs and cats, 0%–10% Metronidazole: See Table 4, page 55 Diarrheic: Data not available Healthy: Dogs, 0%–2.9% no indication to treat healthy carriers. use of cats, 0.4%–1.7% antimicrobials is controversial except in cases of Diarrheic: Data not available systemic illness (bacterial translocation); treat based on in vitro susceptibility testing. *Infections in pets appear to be community-acquired, not hospital- or antibiotic-associated, as in human patients. weese JS. Bacterial enteritis in dogs and cats: Diagnosis, therapy, and zoonotic potential. Vet Clin Small Anim 2011; 41:287-309. Marks SL, rankin SC, Byrne BA, weese JS. enteropathogenic bacteria in dogs and cats: Diagnosis, epidemiology, treatment, and control. J Vet Intern Med 2011; 25:1195-1208. (ELISA), C difficile toxin A/B ELISA » Fecal culture or polymerase chain reaction (PCR): For potential bacterial pathogens, such as Salmonella and Campylobacter It is very difficult to establish evidence for a causal association between the presence of a specific bacterium in the feces and occurrence of diarrhea (Table 3). • Such diets for dogs should have a low or modest fat content; fat restriction is not required for cats. • Useful choices include boiled rice with lean chicken, low-fat cottage cheese, or tofu; Prescription Diet i/d Low Fat GI Restore (hillsvet.com); Purina Veterinary Diets EN Gastroenteric (nestlepurina.com); and Veterinary Diet Intestinal Low Fat (royalcanin.us). When diarrhea resolves, the animal's usual diet can be slowly reintroduced over a 2- to 3-day period by adding 25%, 50%, 75%, and finally 100% of the usual diet. If vomiting is concurrently present, an antiemetic can be administered. High-fiber diets. For pets with signs of acute large bowel diarrhea (Table 1), a high-fiber diet is often used instead of a bland diet as fiber may be beneficial in reducing tenesmus and facilitating colonic epithelial repair. Commercial ACUTE DIARRHEA: MEDICAL THERAPY Most cases of self-limiting diarrhea resolve within 1 to 5 days, following correction of the underlying cause and/or symptomatic treatment. Nonspecific symptomatic therapy may include one or more of the following: • Nutritional management • Therapeutic deworming • Antidiarrheal • Antiemetic and/or gasA recent British study documented the prescribing habits of veterinarians for troprotectant dogs with acute diarrhea seen in general practice.15 A total of 371 dogs of various • Probiotic breeds, ages, and sexes were represented. See Box for study results. • Antimicrobial (selected cases) THERAPY USE IN CASES • Fluid therapy. Nutritional Management Administration. Animals with acute diarrhea often benefit from withholding food for 6 to 12 hours followed by frequent (3–6 small meals/day) feeding of small amounts of a highly digestible, so-called "bland," diet; amount fed per meal can be slowly increased. Antibacterials Probiotics/antidiarrheal Steroids Antiemetics (vomiting present concurrently) Gastric protectants (primarily if vomiting/melena present) Sulfasalazine (use associated with presence of fecal mucus) 71% 26% 19% 13% 10% 7% The frequent use of antibacterials for acute diarrhea is surprising and somewhat alarming. There is evidence that resistance to antimicrobials is increasing among bacteria isolated from pets.16 nutritional management, therapeutic deworming, and probiotic therapy, accompanied in some cases by an antidiarrheal agent, should be considered first-line therapies (Table 4, page 55). (continued on page 54) 24 Today's Veterinary Practice May/June 2013