WSAVA Nov 2021 Proceedings - Flipbook - Page 17
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ACUTE DIARRHEA IN THE DOG - WHY ANTIBIOTICS
ARE ONLY RARELY NEEDED
F. Gaschen
Baton Rouge/United States of America
Qualifications:
Frederic Gaschen
Dr.med.vet, Dr.habil., DACVIM (SAIM), DECVIM-CA (IM)
Professor, Louisiana State University School of Veterinary Medicine
fgaschen@lsu.edu
situations. Dogs with acute diarrhea recovered faster after receiving a
probiotic mixture than after treatment with metronidazole. In dogs with
AHDS, a highly concentrated multi-strain probiotic shortened the recovery
time compared to placebo and accelerated the normalization of the gut
microbiome.
Fecal Microbiota Transplantation (FMT) is an important treatment modality for people infected with Clostridioides difficile. FMT also has the
potential to promote the restoration of a normal gut microbiota in small
animals. FMT has been used with success in dogs with acute diarrhea. A
recent study comparing the use of FMT with metronidazole in dogs with
acute uncomplicated diarrhea reported no significant differences in clinical improvement. However, FMT resulted in a more rapid recovery of both
the fecal microbiome and the fecal metabolome. Remarkably, in puppies
with parvovirus infection, repeated FMT shortened the time to resolution
of diarrhea and to hospital discharge.
4) Conclusion
1) Effects of Antibiotics on Gut Microbiota in Healthy Dogs
and Cats
Over the past decade, several studies performed in dogs have shown
the effects of various antibiotics such as amoxicillin (with or without
clavulanic acid), metronidazole, and tylosin on the fecal microbiota. Some
of these antimicrobials can cause diarrhea. In general, their effects are
characterized by a decrease in microbial richness, a decreased abundance
of useful microorganisms and an increased abundance of potentially
harmful microorganisms. The changes are most pronounced while the
animals are on antibiotics, but often persist for weeks after the drugs are
discontinued. In addition, dysbiosis also affects the fecal metabolome
as exemplified with increased lactate and decreased secondary bile acid
fecal concentrations.
Based on studies from human medicine, the resilience of the microbiome
after a disruption by antibiotics depends on key characteristics such as
type, timing, duration and spectrum of the antibiotic course as well as on
modulation factors of the microbiome such as age, underlying disease,
antibiotic resistance pattern and diet.
2) Use of antibiotics for acute digestive diseases
Antibiotics have traditionally been used in dogs with acute diarrhea, especially if the diarrhea was bloody. In recent years, several recent studies
have documented that antibiotics offer no significant benefit under these
circumstances. The use of amoxicillin and clavulanic acid in dogs with
acute hemorrhagic diarrhea syndrome (AHDS) had no positive effect on
clinical improvement or length of hospital stay. The same was documented in a study of dogs with uncomplicated diarrhea from Germany. In
addition, the fecal dysbiosis index did not normalize faster in dogs given
antibiotics. Importantly, the proportion of resistant fecal E. coli increased
during antibiotic treatment as could be expected and remained high for at
least 3 weeks after discontinuation.
It should be noted, however, that antibiotic use is recommended in a
subset of dogs with AHDS. This group consists of dogs that show signs
of sepsis (e.g. fever or hypothermia, hypotension, marked neutrophilia or
neutropenia, hypoglycemia, hyperbilirubinemia), disseminated intravascular coagulation (DIG), or massive intestinal protein loss, or are not getting
better after 24-48 h of treatment.
3) Alternative to antibiotics
Prebiotics promote a desirable intestinal microbiota. They are found in
several commercially available foods for dogs with acute and chronic
gastrointestinal disorders.
Taken together, these studies underscore the fact that antibiotic administration has important effects on the gut microbiota that must be considered. The appropriateness of prescribing antibiotics should be assessed
on a case-by-case basis, rather than as the standard of care for digestive
disorders. Ultimately, the decision to prescribe antibiotics will depend on
the clinical picture, the results of the laboratory tests, and the veterinarian’s experience. Alternatives like probiotics and possibly FMT should be
considered.
References:
Chaitman J, Ziese A-L, Pilla R, et al. (2020). Fecal Microbial and Metabolic
Profiles in Dogs With Acute Diarrhea Receiving Either Fecal Microbiota
Transplantation or Oral Metronidazole. Front. Vet. Sci. 7:192. https://doi.
org/10.3389/fvets.2020.00192
Manchester AC, Webb CB, Blake AB, et al. (2019). Long-term impact of tylosin on fecal microbiota and fecal bile acids of healthy dogs. J Vet Intern
Med. 33:2605–2617. https://doi.org/10.1111/jvim.15635
Pereira GQ, Gomes LA, Santos IA et al. (2018). Fecal microbiota transplantation in puppies with canine parvovirus infection. J Vet Intern Med. 32.
https://doi.org/10.1111/jvim.15072
Pilla R, Gaschen FP, Barr JW, et al. (2020). Effects of metronidazole on the
fecal microbiome and metabolome in healthy dogs. J Vet Intern Med. 34:
1853–1866. https://doi.org/10.1111/jvim.15871
Shmalberg J, Montalbano C, Morelli G and Buckley GJ (2019) A Randomized Double Blinded Placebo-Controlled Clinical Trial of a Probiotic or
Metronidazole for Acute Canine Diarrhea. Front. Vet. Sci. 6:163. https://
doi.org/10.3389/fvets.2019.00163
Unterer S and Busch K (2021). Acute hemorrhagic diarrhea syndrome
in dogs. Vet Clin Small Anim. 51; 79–92. https://doi.org/10.1016/j.
cvsm.2020.09.007
Werner M, Suchodolski JS, Straubinger RK, et al. (2020). Effect of amoxicillin-clavulanic acid on clinical scores, intestinal microbiome, and amoxicillin-resistant Escherichia coli in dogs with uncomplicated acute diarrhea.
J Vet Intern Med. 34:1166–1176. https://doi.org/10.1111/jvim.15775
Ziese A-L, Suchodolski JS, Hartmann K et al. (2018). Effect of probiotic
treatment on the clinical course, intestinal microbiome, and toxigenic
Clostridium perfringens in dogs with acute hemorrhagic diarrhea. PLoS
ONE 13(9): e0204691. https://doi.org/10.1371/journal.pone.0204691
The benefits of probiotics have been recently highlighted in several
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