SIBO/antibiotic-responsive diarrhoea

Re: SIBO/antibiotic-responsive diarrhoea

Kate Richardson — Wed, 26 Jan 2011 17:44:58 GMT

I also have no qualms about using metacam even in cats already diagnosed with renal insufficiency. The key, IMO, is to drill into the owners absolutely definitely not to give it if the cat is unwell for any reason and not eating and more importantly drinking as it does normally, in which case to seek vet advice. The only cats I have seen renal problems in secondary to metacam are ones where they were continuously dosed with it despite being off their food and lethargic for even as little as 1-2 days, and one other case where a cat had been given a MASSIVE overdose- (had been dispensed dog metacam and been given a 30kg dog dose by the owner instead of a 3kg cat dose...that's another story,) but with treatment all cats survived and the one with the 30kg dog dose regained completely normal renal function!

Re: SIBO/antibiotic-responsive diarrhoea

Rob Loxley — Wed, 26 Jan 2011 17:36:30 GMT

[quote user="Martin Atkinson"]out of 6 cats treated and possibly a couple of others[/quote]

So what do you give the arthritic cats, or do they just creak along? I know it's about as scientific as your sample, but we have tens to hundreds of cats on longterm metacam, with cases going back to before the cat formulation came out.

Re: SIBO/antibiotic-responsive diarrhoea

Martin Atkinson — Wed, 26 Jan 2011 16:26:36 GMT

[quote user="Hannah Chilton"]

[quote user="Martin Atkinson"]IME Metacam kills even apparently healthy cats with alarming regularity![/quote]

I have never seen a cat die of metacam! I grant you judicious use is warranted but a short course of metacam in a cat with bleeding (that would respond straight away to the antibiotics) is hardly likely to cause that!?

[/quote]

2 perfectly healthy young cats (tested for renal function before treatment and were normal) dying of renal failure within a few days of starting treatment with Metacam for orthopaedic pain, out of 6 cats treated and possibly a couple of others suspicious is too high an attrition rate for me I'm afraid. It is a known issue, certainly worse in anorexic cats, I am very reluctant to use it at the best of times but I wouldn't use in anything that was less than 100% healthy even as a one off. I have no doubt there are many cats doing very well out there and I have one client who insists on using it long-term for arthritis because her previous vet gave it but for her own sake I insist on doing a renal function test every 3 months.

Re: SIBO/antibiotic-responsive diarrhoea

Richard Carter — Tue, 25 Jan 2011 10:14:15 GMT

[quote user="Bob Russell"]have found it effective [/quote]

Yup - and you not straying into the disaster area of ronidazole

Re: SIBO/antibiotic-responsive diarrhoea

Bob Russell — Tue, 25 Jan 2011 09:47:50 GMT

[quote user="Michael Woodhouse"]

[quote user="Bob Russell"]I seem to remember metronidazole is considered ineffective against giardia [/quote]

BNF states "Metronidazole (section 5.4.2) is the treatment of choice for Giardia lamblia infections."

I personally have found it more useful than Panacur in a run of puppies with Giardia we've had recently. Had a couple with Panacur recur.

[/quote]

I quote from the BSAVA formulary 'It is no longer used in dogs and cats for the treatment of giardiosis but may still have a role in chinchillas with this condition'.

I was covering myself in case I am the only vet that doesn't 'know' it is no good for giardiosis. I have to say I have found it effective and I do use it where panacur alone fails to work. Seems to work pretty well IMHO!

Re: SIBO/antibiotic-responsive diarrhoea

Michael Woodhouse — Mon, 24 Jan 2011 23:51:28 GMT

[quote user="Bob Russell"]I seem to remember metronidazole is considered ineffective against giardia [/quote]

BNF states "Metronidazole (section 5.4.2) is the treatment of choice for Giardia lamblia infections."

I personally have found it more useful than Panacur in a run of puppies with Giardia we've had recently. Had a couple with Panacur recur.

Re: SIBO/antibiotic-responsive diarrhoea

Richard Carter — Mon, 24 Jan 2011 15:55:04 GMT

I would start with diet change avoiding jelly/gravy type foods, find out if using litter tray or access to outside (cats with access to proper soil better bacterial flora mix), repeat panacur and /or metronidazole flagyl 1ml/4kg cat bid for 7 days. Tenesmus/ bleeding likely to be secondary.

Re: SIBO/antibiotic-responsive diarrhoea

HMC — Mon, 24 Jan 2011 15:44:47 GMT

[quote user="Kate Richardson"]Did you do a PCR for Tritrich foetus?[/quote]

yes, pcr done.

Re: SIBO/antibiotic-responsive diarrhoea

Bob Russell — Mon, 24 Jan 2011 15:05:40 GMT

We are testing all cats with diarrhoea problems for Giardia. So far we have had a number of positives and they have all responded to treatment. Most have been fine with panacur but one problem case resolved with panacur and metronidazole. I seem to remember metronidazole is considered ineffective against giardia (BSAVA formulary I think) but other texts have indicated it may be useful.

This may have been an 'antibiotic responsive' diarrhoea but cat got better and owner was happy so job done!

Re: SIBO/antibiotic-responsive diarrhoea

Rob Davis — Mon, 24 Jan 2011 15:02:08 GMT

[quote user="Bob Russell"]

[quote user="Hannah Chilton"]

[quote user="Martin Atkinson"]IME Metacam kills even apparently healthy cats with alarming regularity![/quote]

[/quote]

Have to agree with this. I cannot think of any cases that have had problems I can associate with metacam administration.

[/quote]

Ditto, however metacam appears to be receiving a bit of a bashing on the internet (as rimadyl has in the past) - see

www.metacamkills.com

Re: SIBO/antibiotic-responsive diarrhoea

Bob Russell — Mon, 24 Jan 2011 14:59:34 GMT

[quote user="Hannah Chilton"]

[quote user="Martin Atkinson"]IME Metacam kills even apparently healthy cats with alarming regularity![/quote]

[/quote]

Have to agree with this. I cannot think of any cases that have had problems I can associate with metacam administration.

Re: SIBO/antibiotic-responsive diarrhoea

Kate Richardson — Mon, 24 Jan 2011 14:46:40 GMT

Did you do a PCR for Tritrich foetus? If not would definitely do this, as hard to diagnose and cats with tritrich often respond to antibiotics, but it doesn't resolve it; you would need ronidazole (which needs to be used with informed consent- can forward more info if needed). Otherwise I would repeat faecalanalysis on 3 pooled samples, just in case something missed first time round.

If all negative I would put them onto a hypoallergenic diet such as zd for a couple of months to see if it is diet related. Also consider the antibiotics aren't actually doing anything, and that it is just waxing and waning of its own accord. Plus checking B12/folate/PLI as suggested.

Re the cystitis, I don't think metacam is such a killer, but probably not the best choice here- try oral vetergesic for pain relief (assuming it is idiopathic/stress related and no other cause of the cystitis).

Re: SIBO/antibiotic-responsive diarrhoea

HMC — Mon, 24 Jan 2011 14:38:41 GMT

[quote user="Martin Atkinson"]IME Metacam kills even apparently healthy cats with alarming regularity![/quote]

Re: SIBO/antibiotic-responsive diarrhoea

Martin Atkinson — Mon, 24 Jan 2011 12:53:57 GMT

Eek...the last thing I would put a cat on with any inflammation of the bowel is NSAIDs - IME Metacam kills even apparently healthy cats with alarming regularity! I would put them both on an exclusion diet for much longer as this case is suspicious of a dietary intolerance/IBD/colitis (call it what you like) and any "bacterial overgrowth" is likely to be secondary to that. If so preds may be more appropriate than NSAIDs and why not use Cystease/Cystaid for the cystitis? - may also help the bowel problem. If that doesn't work I'd also do TLI/B12/folate rather than just jab them with B12, specfPL to try and eliminate pancreatitis although thats less likely if 2 cats are simultaneously affected (I assume these are related cats from the same household) and pancreatic lipase can be unreliable in cats after the acute phase, plus if you've only sent faecal samples for culture send one for PCR. May all turn out to be stress and cured by Feliway.

Re: SIBO/antibiotic-responsive diarrhoea

Richard Fox — Mon, 24 Jan 2011 12:22:17 GMT

[quote user="Hannah Chilton"]

The male cat has developed cystitis (?related to the stress of the GI dz) and so is on metacam.

[/quote]

Would thinks its more likely secondary to the diarrhoea ?

Have a read of this?

Google Books Link

Re: SIBO/antibiotic-responsive diarrhoea

Michael Woodhouse — Mon, 24 Jan 2011 12:15:40 GMT

Is this not just collitis? I have seen a few cases respond nicely to Sulphasalazine suspension. Had one cat on it for last three years of its life. They seemed to like the taste.