Antibiotics use in diarrhoea

RE: Antibiotics use in diarrhoea

Julian Earl — Wed, 19 Oct 2016 22:04:49 GMT

[quote user="Martin Atkinson"]It is recognised that the gut will recover faster if feeding continues as parts derive nutrition from the contents not the blood supply. Only Old Wives and Dinovets now advise starving GI cases. There may be less to clean up but it [/quote]

I believe the gut wall cells depend on glutamine for their energy source hence the presence of that in oral solutions. So the companies say anyway!

RE: Antibiotics use in diarrhoea

Stephen Spencer — Wed, 19 Oct 2016 17:31:52 GMT

[quote user="Julian Earl"]the benefit or otherwise of stuff like hyoscine or the P[ whatever that stood for, I forget.] in yeolde Neobiotic P pump[/quote]

I remember ye olde Neobiotic-P too Julian. The 'P' stood for Pamine http://www.generon.co.uk/amine-oxides-1830/methscopolamine-bromide-scopolamine-231014264.html

Why I remember that after not using it for at least 20 years, I don't know...

RE: Antibiotics use in diarrhoea

Martin Atkinson — Wed, 19 Oct 2016 17:03:00 GMT

[quote user="Richard Carter"]I think the worst thing vets can do is to patronisingly discuss diet modifications to a client who has already done the starve/ bland food route before making the appointment.[/quote]It isn't patronising if that is what they have done because the advice now is not to starve. It is recognised that the gut will recover faster if feeding continues as parts derive nutrition from the contents not the blood supply. Only Old Wives and Dinovets now advise starving GI cases. There may be less to clean up but it doesn't help the patient.

RE: Antibiotics use in diarrhoea

Francisco Gomez — Mon, 17 Oct 2016 15:04:36 GMT

[quote user="Richard Carter"]

I think the worst thing vets can do is to patronisingly discuss diet modifications to a client who has already done the starve/ bland food route before making the appointment. [/quote]

I don't know about patronising, but when they change from 'full of sh*t' brand to 'full of sh*t' other brand, diet talk does become necessary - no patronising necessary, only a bit of asking routine questions to see what the client has been doing in the last 2 weeks

RE: Antibiotics use in diarrhoea

Neil Wheadon — Mon, 17 Oct 2016 13:45:00 GMT

[quote user="Richard Carter"]I like a dex/ metronidazole route because it pretty much stops the pain and tenesmus on day 1 and then we can talk about diet, treats, pancreatitis, chronic changes, IBD, parasite control etc[/quote]

Buscopan could be added to this list?

RE: Antibiotics use in diarrhoea

Richard Carter — Mon, 17 Oct 2016 13:39:27 GMT

I think the worst thing vets can do is to patronisingly discuss diet modifications to a client who has already done the starve/ bland food route before making the appointment. We get quite a few second opinions that start 'I went to the other vets and they treated me like I don't know anything about my dog - the dog has been starved and it is now 3 days and I need the diarrhoea under control because it is ruining the carpet/ my sleep....'

I like a dex/ metronidazole route because it pretty much stops the pain and tenesmus on day 1 and then we can talk about diet, treats, pancreatitis, chronic changes, IBD, parasite control etc

RE: Antibiotics use in diarrhoea

Francisco Gomez — Mon, 17 Oct 2016 12:38:06 GMT

Let's slow down things a bit. I try to differentiate from acute and chronic diarrhoea - If we are talking chronic and the rest of physical examination is sound, I try to manage it with diet first - Metronidazole I reach for, but because of its antiinflammatory effect too, I'm not looking to kill anything specifically with it. I don't find cultures particularly useful (except by the odd Campylobacter, etc.) - If diet/metronidazole doesn't solve, I tend to investigate a further underlying reason for it.

RE: Antibiotics use in diarrhoea

Clive Ansell — Mon, 17 Oct 2016 10:47:42 GMT

I don't use antibiotics routinely, but do if patients are systemically ill, pyrexic, haven't responded to probiotics and/or a light bland diet, or where laboratory work indicates it.

I'm not convinced probiotics make a jot of difference either, other than giving clients something to do and helping get them in and out quicker in high throughput practices.

Why is Metronidazole so popular for diarrhoea? up until recently it was unlicensed so I have always used licensed products first line.

RE: Antibiotics use in diarrhoea

Julian Earl — Mon, 17 Oct 2016 09:36:46 GMT

I tended to use metronidazole especially in cats, but believe that it has an anti-inflammatory effect as well that might be more significant than the antoibacterial one? In dogs, with chronic diarrhoea, then apart from dietary measures I might use prolonged oxytetracycline instead of metronidazole.

Both based on what I was taght plusthe improvements seen with either on occasion.

This topic leads me to ask about the benefit or otherwise of stuff like hyoscine or the P[ whatever that stood for, I forget.] in yeolde Neobiotic P pump. Why try and stop the body ejecting the offending agents? I had this discussion with the drug reps when I argued that it might be best to let the body get rid of all the offending bacteria/ the toxins and as long as we replaced the fluids that is the best we can do. Maybe nature knows best so the natural defence of physical evacuation should not be interfered with? The reps disagreed of course!

RE: Antibiotics use in diarrhoea

Iain Richards — Mon, 17 Oct 2016 08:47:02 GMT

The derivation of the word "diarrhoea" is "a flowing through". So let it out first!!

I only use antibiotics on specific individual case, never as a routine or "diet hasn't worked" option.

RE: Antibiotics use in diarrhoea

Neil Wheadon — Sun, 16 Oct 2016 13:14:22 GMT

[quote user="Busybee"]I'm not sure many of my clients would be happy managing diarrhoea for 2 weeks before seeking further advice! [/quote]

It's a generalization

The fact I poorly put across what that if an adult dog has diarrhoea for more than 2 weeks then it's time to get out the diagnostics, faecal samples, B12 assays/folate etc, because the vast majority are 'garbagitis' and simply need a bit of support from the vet. In my case I'd ask them to come back before 2 weeks if it continued, check up, ask about the diarrhoea etc etc. What I don't feel is applicable is on the second visit at 4 days, putting a dog on antibiotics simply for something to do.

Neil

RE: Antibiotics use in diarrhoea

Busybee — Sun, 16 Oct 2016 12:12:32 GMT

Hi Mary,

Firstly, I don't think there are any 'rules' as such, though I would say that the majority of diarrhoea cases do not require antibiotics. Most canine (and feline) diarrhoeas are due to dietary indiscretion or viral causes and therefore antibiotics will be generally useless. Obviously, the sick, collapsed, haemorrhagic diarrhoea case will be managed differently from the happy, well, bouncy, slightly loose-stooled diarrhoea case.

In my hands, certainly some cases will receive metronidazole but these will be restricted to those 'sick' cases who are passing blood or really persistent diarrhoeas that don't respond to dietary control +/- probiotics - and I explain to the client I am mainly using it for it's anti-inflammatory effects.

The only other antibiotics I would use would be things like erythromycin for confirmed campylobacter cases.

I'm not sure many of my clients would be happy managing diarrhoea for 2 weeks before seeking further advice!

RE: Antibiotics use in diarrhoea

Virginia Campbell — Sat, 15 Oct 2016 22:52:16 GMT

Two weeks? Ye have patient clients.

RE: Antibiotics use in diarrhoea

Neil Wheadon — Sat, 15 Oct 2016 18:48:43 GMT

[quote user="Mary Salmons"] I try not to use antibiotics with diarrhoea. I will if faecal cultures show a need, or it is on going greater than two weeks and hasn't responded to the feeding little and often RC GI food and prokolin/yudigest. [/quote]

I do the same.

A doctor once told me that if a patient calls with diarrhoea, he says 'see you in 2 weeks'

[quote user="Mary Salmons"]Others in my practice have their own policies but will reach for metronidazole.[/quote]

In my experience this is quite common, Giardia etc and I do wonder if people use it for anti-inflammatory effect

[quote user="Mary Salmons"]Should I be using oxytetracycline for SI problems and metronidazole for LI conditions ?[/quote]

Again agreed. 20 years ago we used to use narrow spectrum drugs for body systems, these days everything gets broad spectrum, so I think this is very sensible

Neil