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Today's VeTerinary PracTice | november/december 2015 | tvpjournal.com symPTomaTic managemenT of Primary acuTe gasTroenTeriTis Peer reviewed 50 Misoprostol Misoprostol is a synthetic prostaglandin E1 that acts on parietal cells to inhibit secretion of gastric acid. Additionally, it has a cytoprotective effect by increasing secretion of mucus by gastric goblet cells, increasing gastric mucosal blood fow and increasing turnover of gastric mucosal cells. PPIs and H 2 -receptor antagonists are thought to be more effective for treatment of gastrointestinal ulcers, and misoprostol may cause vomiting, diarrhea, and abdominal pain. Use of misoprostol is, therefore, not advised in dogs with acute gastroenteritis unless gastroduodenal ulceration associated with nonsteroidal anti-infammatory drug (NSAID) use is thought to be the cause. ANTIDIARRHEAL THERAPY Most cases of uncomplicated acute gastroenteritis that present with either small or large bowel diarrhea resolve without therapeutic intervention. Cases that present with diarrhea should have a fecal examination and consider empirical deworming with a broad spectrum anthelminthic. However, there are a few options for symptomatic treatment of diarrhea. Loperamide Loperamide, an opioid antimotility drug, has been used off-label in dogs with diarrhea. It decreases intestinal motility and reduces mucosal secretions. Doses used to treat diarrhea can cause neurologic toxicity in dogs with the ABCB1 (formerly MDR1) mutation; therefore, avoid this drug in all dogs carrying this allele and at-risk dog breeds (ie, Australian shepherd, Shetland sheepdog, long-haired whippet, collie, English shepherd, German shepherd) that have an unknown status. We do not recommend use of this drug for treating dogs or cats with acute gastroenteritis due to this potential toxicity and because the diarrhea associated with gastroenteritis is usually self-limiting. Probiotics Probiotics are live microorganisms that confer a health beneft on the host. 16 These health effects are exerted by direct inhibition of colonization by pathogenic microorganisms, or by immune- enhancing effects on gut-associated lymphoid tissue. 17-19 Probiotics (Table 4) are sometimes used to treat dogs and cats with acute diarrhea. Each probiotic has a different formulation of bacteria, and it is unknown which, if any, are most useful for treatment of acute gastroenteritis with resultant diarrhea. Therefore, further study of these products is needed before defnitive recommendations can be made. The effcacy of some probiotics for treatment of chronic diarrhea in dogs and cats has been evaluated but, to our knowledge, there have only been 2 studies evaluating the effcacy of probiotics in dogs with acute diarrhea; both found that probiotics decreased the duration of diarrhea in dogs with acute idiopathic diarrhea. 20-23 When selecting a probiotic, it is important to choose a product that has been subjected to adequate quality control during the manufacturing process, such as the ones listed in Table 4. Antimicrobial Therapy Antimicrobial therapy with metronidazole or tylosin is sometimes used empirically in dogs and cats with idiopathic acute gastroenteritis that present with either small or large bowel diarrhea. Both antibiotics are used to potentially treat specifc bacteria that may cause acute gastroenteritis (eg, Clostridium perfringens). However, a study evaluating the effcacy of amoxicillin/clavulanic acid in dogs with acute hemorrhagic diarrhea syndrome (formerly called hemorrhagic gastroenteritis) demonstrated no beneft in treated dogs versus control dogs. 24 Therefore, routine antibiotic therapy (including the use of metronidazole) is not recommended in dogs or cats with acute gastroenteritis. Antibiotic therapy may have a role in dogs and cats suspected to have bacterial translocation through a damaged gastrointestinal mucosal barrier, and this is potentially more likely in cases of gastrointestinal bleeding. However, we reserve antimicrobial therapy for patients with: • More definitive evidence of translocation, such as leukocytosis, elevated immature white blood cell count, and pyrexia • Leukopenia or those that are immunosuppressed • A specific bacterial enteropathogen (eg, campylobacteriosis) • Chronic diarrhea (as a therapeutic trial to rule out dysbiosis). Table 4. Examples of Commercial Probiotics for Dogs & Cats • FortiFlora (purina.com) • Prostora (iams.com) • Proviable (nutramaxlabs.com) • Sivoy (sivoy.net)