Best anti-diarrhoeal medication ?

Re: Best anti-diarrhoeal medication ?

Michael Woodhouse — Sun, 28 Nov 2010 17:54:38 GMT

[quote user="Julian Earl"]Isn't it better to keep them off all red meats... ?[/quote]

Reminds me of an owner who's dog continued with diarrhoea despite advice to modify diet and feed it chicken. Up on further questioning they were feeding the dog about 6 tins a day of chicken in white sauce!

Re: Best anti-diarrhoeal medication ?

Julian Earl — Sun, 28 Nov 2010 10:51:12 GMT

[quote user="Peter Ding"]

Horses for courses...

[/quote]

Isn't it better to keep them off all red meats... ?

Re: Best anti-diarrhoeal medication ?

Simon Neuhoff — Tue, 23 Nov 2010 17:23:52 GMT

Mine was on the hands - specifically the knuckles. Despite high factor susncreen there was an intense tingling/brunign sensation and eventually the skin blistered and peeled off, leaving depigmented lesions that took severeal months to normalise.

Re: Best anti-diarrhoeal medication ?

bob lehner — Tue, 23 Nov 2010 17:16:58 GMT

[quote user="Simon Neuhoff"]Interesting re the photosensitivty on Doxycyline. In theory this is a rare side effect but on a trip to Southern Africa some years ago [/quote]

I always took Doxy as an anti-malarial - but once got terrible photosens (not just conventional sunburn) on a trip to Zanzibar - localised to under sides of arms and back of legs - seemed to be due to u.v rays bouncing off the blindingly white beach (fortunately I was wearing shorts). Also my son once went down with severe oesophagitis after doxy - need to take it with loads of fluid.

Re: Best anti-diarrhoeal medication ?

Simon Neuhoff — Tue, 23 Nov 2010 16:51:42 GMT

[quote user="Martin Atkinson"]

[quote user="Clive Ansell"]

Doxycycline causes terrible photosensitisation with me, I will burn even wearing a factor 50. I've often had sickness and/or diarrhoea on mountaineering expeditions that will not resolve until Ciprofloxacin and/or Metronidazole is on board. And given that it is inconveinient, and one doesn't want to lose days with illness, antibiotics tend to get taken sooner rather than later.

[/quote]

At risk of turning this into a side show on this thread, the possibility of photosensitisiation was why I didn't take some Ronaxan off my shelf (I'd figured 19,000 feet up on the equator is about the most likely place to be photosensitised) but it wasn't a problem with those who took it so I would certainly take it next time. Ciprofloxin does seem to be spectacularly effective for gut rot but we shouldn't really be condoning it should we?

[/quote]

Interesting re the photosensitivty on Doxycyline. In theory this is a rare side effect but on a trip to Southern Africa some years ago (canoeing and scuba diving) 3 of 6 of us developed such severe photosensitivity that we had to swap to an alternative anti malarial.

Re: Best anti-diarrhoeal medication ?

Martin Atkinson — Tue, 23 Nov 2010 16:03:37 GMT

[quote user="Clive Ansell"]

[/quote]

Re: Best anti-diarrhoeal medication ?

Vikki Halliday LLB — Tue, 23 Nov 2010 12:56:37 GMT

[quote user="emerald"]

How about lungworm treatment too?

[/quote]

If you think it's warranted, most of my clients are on monthly Advocate, so I would probably look for another cause first.

Re: Best anti-diarrhoeal medication ?

emerald — Tue, 23 Nov 2010 12:44:50 GMT

How about lungworm treatment too?

Re: Best anti-diarrhoeal medication ?

Vikki Halliday LLB — Tue, 23 Nov 2010 12:38:01 GMT

[quote user="Jillian Hall"]I'm surprised how many people advocate starving for 24hours[/quote]

Me too! I would only prescribe this for vomiting, particularly where there is evidence of a breach of the gastric mucosa, i.e blood in vomitus, or those cases which do not respond to Cerenia within 12 hrs. 24 hrs starvation is way too long for juvenile and paediatric cases, where the energy levels and maintenance of normal intestinal mucosa depends upon a supply of nutrients from food.

If it's a first line acute case, in the absence of pyrexia and blood, a change to Hills i/d or bland food, along with probiotic, prebiotic and kaolin/pectin usually sorts most out. If there is pyrexia I would normally give a potentiated amoxycillin, again like Martin I want to keep my metronidazole for those cases that require it as a result of culture. I do sometines give steroids if I am sure it is inflammatory and lower bowel, but I'm never convinced of this on first presentation. Also advocate plenty of fluids, it's amazing how fast little dogs get to 10% dehydration!

If it's chronic, then a workup, worming, bloods etc, before using e.g prokolin enterogenic, alongside metronidazole or salazopyrin in some cases.

I never use any motility reducing drugs with the exception of buscopan tablets only if the dog is exhibiting marked tenesmus or abdominal cramping. Having suffered from IBS for years I can honestly say that I would not like to have a bung put in my bottom via Immodium, honestly it's better out than in!

Re: Best anti-diarrhoeal medication ?

Jillian Hall — Tue, 23 Nov 2010 11:51:22 GMT

I'm surprised how many people advocate starving for 24hours. I'll only recommend starving for vomiting dogs, and then only for minimal time (dpdt on case). I know that even for severe pancreatitis and parvo cases some of the specialists want to get them eating ASAP, and will use tube feeding if necessary. Local enteral nutrition is vital for GIT healing. I not infrequently overhear receptionists telling people to starve their dogs - apart from the fact they should be offering an appointment - I don't believe this is the best thing for many dogs and could be outright harmful if they are very young, dehydrated etc. How many cases do you see that come in for a tummy upset that has been grumbling on for a week or more and the poor dog has been starved for 2 or 3 days (or more) because its not 100% better?

Re: Best anti-diarrhoeal medication ?

Clive Ansell — Tue, 23 Nov 2010 11:45:46 GMT

[quote user="Martin Atkinson"]

PS As an aside on this subject, those who took doxycycline as their anti-malarial on a trip to Africa didn't get the dreaded gut rot whereas the rest of us did - it doesn't condone taking antibiotics for diarrhoea but its food for thought.

[/quote]

Re: Best anti-diarrhoeal medication ?

Martin Atkinson — Tue, 23 Nov 2010 09:33:48 GMT

First off: adsorbant/absorbant agent with probiotics (Promax, Prokolin, Canigest etc etc) oral eletrolytes, bland diet (DONT starve - isn't that contraindicated these days?) usually RCW sensitivity control. If we're talking about sick patient with a temperature or severe haemorrhagic diarrhoea I would also give antibiotic cover, probably with pot. amox. (not metronidazole as I want to preserve the anerobic bacteria, if I want to utilise its legendary immunomodulatory properties I'd give a dose of steroid), I would consider IV fluids and test for pancreatitis. If it goes on for any time I require a faecal sample and would probably do a PCR tests now rather than culture as cultures are usually a waste of time/money. I would consider immodium in cases of refractory diarrhoea where every other possible method of diagnosis and control had been exhausted. However I wouldn't dismiss immodium for myself as it certainly save the day climbing Killimanjaro and on some epic bike rides!!!

Re: Best anti-diarrhoeal medication ?

Peter Ding — Tue, 23 Nov 2010 09:11:35 GMT

It all depends whether it is a SI pattern diarrhoea, a LI colitis or a gross severe gastroenteritis.

Horses for courses, but would agree that withholding food for 24hours and giving just electrolytes and probiotics often sorts uncomplicated cases. Illness, Pyrexia and high WBC indicating the need for antibiosis. Not sure a few flecks of fresh blood indicates the need for antibiotics though.

Ultimately however a cork is safer than a rubber bung !

Re: Best anti-diarrhoeal medication ?

Aurelijus vet — Tue, 23 Nov 2010 07:56:50 GMT

Indygest inyectable or Genabil IM. - Hepagen IM.- Probiotics (Canicur, Stabigel, Enteroferment, Enterofilius etc.) -- change diet .Complicated diarrhea Pharmasin (tilozin) 2-10 mg/ 1 kg.body weight.

Re: Best anti-diarrhoeal medication ?

Mark Hedberg — Tue, 23 Nov 2010 07:14:48 GMT

Immodium is not indicated. Diarrhea is the body's attempt to get rid of something unhealthy. Solve the underlying problem and you do not need immodium.

Re: Best anti-diarrhoeal medication ?

Michael Woodhouse — Tue, 23 Nov 2010 00:02:33 GMT

For mild diarrhoea I will give Eukanuba Intestinal or

Costs a couple of pounds with a mark up from Dunlops. Brilliant stuff. If there is blood they get abs

Re: Best anti-diarrhoeal medication ?

nikki — Tue, 23 Nov 2010 00:01:34 GMT

never used Immodium. tend to go for starve, then bland diet with Protexin Pro-kolin and I use Metronidazole if any haematochezia or d+ is more persistent or if pyrexia.

Re: Best anti-diarrhoeal medication ?

Christopher Saul — Mon, 22 Nov 2010 23:03:54 GMT

In theory we shouldn't use anti-diarrhoeals where infectious diarrhoea is suspected( most of the time for acute diarrhoea); though this is a relative rather than absolute contraindication.

Generally for mild acute diarrhoea I don't use immodium; I use dietary management + fenbendazole + oral rehydration +/- pectin or kaolin based products eg kaogel.

In cases where antibiotics are indicated ( generally if there is haematochezia), metronidazole can be useful as it has significant immunomodulatory properties .

If the diarrhoea is persistent then I do a work up as for chronic diarrhoa ( faecal exam, haem/bio, TLI, B12, folate, ACTH stim etc)

It's a pretty rare occasion when I reach for the immodium, though I wouldn't say never

Re: Best anti-diarrhoeal medication ?

Emily Nightingale — Mon, 22 Nov 2010 22:01:09 GMT

Buscopan IV or IM (this hurts though..)

Re: Best anti-diarrhoeal medication ?

Emily Nightingale — Mon, 22 Nov 2010 22:00:29 GMT

Friend of mine overdosed on Imodium by accident whilst travelling in Vietnam, and ended up taking a double dose. She didn't pass anything for 30 days, until she went to a McDonalds which sorted her out.. Poor poor lass with a poor poor...... botty.

Re: Best anti-diarrhoeal medication ?

Clive Ansell — Mon, 22 Nov 2010 20:38:08 GMT

If it is just diarrhoea with no other clinical signs I just advise 24 hr starvation and then a light bland diet for 3-4 days. Don't usually prescribe anything.

Careful with Imodium though. I have a friend who is a mountain guide that leads expeditions, he once had a client in the Andes that had taken Imodium Prophylactically because he was frightened of getting diarrhoea. After about 7 days and no faeces passed; rather than being evacuated off the mountain by helicopter, he had to be evacuated on the mountain by gloved finger - that's going beyond the call of duty I would say !!

Re: Best anti-diarrhoeal medication ?

Mark Holmes — Mon, 22 Nov 2010 17:52:46 GMT

Be careful with immodium in rough collies, similar problems to ivermectin. A large %age will find it toxic