Evaluating the effect of metronidazole plus amoxicillin‐clavulanate <i>versus</i> amoxicillin‐clavulanate alone in canine haemorrhagic diarrhoea: a randomised controlled trial in primary care practice

Ortíz, Víctor; Klein, Laura L.; Channell, S.; Simpson, Brenda; Wright, Benjamin L.; Edwards, Caitlin E.; Gilbert, Ruth; Day, R S; Caddy, Sarah

doi:10.1111/jsap.12862

Cited by 22 publications

(17 citation statements)

References 25 publications

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“…Based on experience from our hospital and current research projects, large observer variations (both intra‐ and interobserver) occur—especially in the subjective variable “activity level,” necessitating in‐depth uniform guidelines to increase observer agreement. However, despite the lack of validation, the AHDS index constitutes a method to quantify degree of clinical disease, which is both easily understood and applied 2,11,12,14,29,30 . When interpreting results reported using the AHDS index, it is important to recognize that the term “severe disease” denotes an index of ≥9.…”

Section: Discussionmentioning

confidence: 99%

A retrospective study of 237 dogs hospitalized with suspected acute hemorrhagic diarrhea syndrome: Disease severity, treatment, and outcome

Dupont

Jessen

Moberg

et al. 2021

Veterinary Internal Medicne

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Background: Few studies have investigated management and outcome in dogs with acute hemorrhagic diarrhea syndrome (AHDS), and there is a paucity of data on dogs with concurrent signs of sepsis. Objectives: To report outcome in dogs with suspected AHDS according to disease severity and antimicrobial treatment, and to evaluate effect of fluid resuscitation on clinical criteria. Animals: Two hundred thirty-seven dogs hospitalized with suspected AHDS. Methods: Retrospective study based on medical records. Disease severity was evaluated using AHDS index, systemic inflammatory response syndrome (SIRS) criteria, and serum C-reactive protein (CRP) according to 3 treatment groups: No, 1, or 2 antimicrobials. Results: Sixty-two percent received no antimicrobials, 31% received 1 antimicrobial, predominantly aminopenicillins, and 7% received 2 antimicrobials. At admission, median AHDS index was 13 (interquartile range, 11-15), which decreased significantly after the first day's hospitalization (P < .001) for all groups. Compared with no antimicrobials (7%), more dogs had ≥2 SIRS criteria in the antimicrobial groups (15% and 36%, respectively). C-reactive protein (CRP) correlated positively with AHDS index at hospitalization (P < .001). Across treatment groups, rehydration markedly reduced number of clinical SIRS criteria. Survival to discharge was 96%, lower for dogs receiving 2 antimicrobials (77%, P < .05). Conclusions and Clinical Importance: The majority of dogs hospitalized with suspected AHDS improve rapidly with symptomatic treatment only, despite signs of systemic disease on initial presentation. The often-used SIRS criteria might be a poor proxy for identifying dogs with AHDS in need of antimicrobial treatment, in particular

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Section: Discussionmentioning

confidence: 99%

A retrospective study of 237 dogs hospitalized with suspected acute hemorrhagic diarrhea syndrome: Disease severity, treatment, and outcome

Dupont

Jessen

Moberg

et al. 2021

Veterinary Internal Medicne

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“…Metronidazole may increase the risk of selection of multidrug resistant E coli 50 51 and possibly favours bacterial translocation 52. Finally, metronidazole can cause a potentially severe neurotoxicity in dogs,53–55 as well in humans56–59 and should therefore be used cautiously.…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial prescriptions and adherence to prudent use guidelines for selected canine diseases in Switzerland in 2016

Lutz

Lehner

Schmitt

et al. 2020

Veterinary Record Open

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BackgroundAntimicrobial resistance is an increasing problem in human and veterinary medicine and is closely linked to the use of antimicrobials. The objective of this study was to describe antimicrobial prescriptions for selected canine diseases in Switzerland during 2016.MethodsDogs presented to two university hospitals and 14 private practices for acute diarrhoea (AD; n=371), suspected or confirmed urinary tract infections (UTIs; n=245), respiratory tract infections (RTIs; n=274) or wound infections (WIs; n=175) were included. Clinical history, diagnostic work-up and antimicrobial prescription (class, dosage and duration) were retrospectively assessed. A justification score was applied to evaluate appropriateness of antimicrobial therapy based on available national and international consensus guidelines.ResultsAntimicrobials were prescribed in 65 per cent of dogs with AD, 88 per cent with UTI, 62 per cent with RTI and 90 per cent with WI. The most prescribed antimicrobial classes (monotherapy and combination therapy) were potentiated aminopenicillins (59 per cent), nitroimidazoles (22 per cent), non-potentiated aminopenicillins (16 per cent) and fluoroquinolones (13 per cent). Overall, 38 per cent (95 per cent CI 0.35 to 0.41) of the prescriptions were in accordance with consensus guidelines. In dogs with AD, antimicrobial therapy was associated with the presence of haemorrhagic diarrhoea (P<0.05) and complied in 32 per cent with consensus guidelines, which recommend antimicrobial treatment only when sepsis is suspected. A bacterial aetiology was confirmed via culture and/or sediment examination in 36 per cent of dogs with suspected UTI.ConclusionsOverall, adherence to consensus guidelines was poor both, at university hospitals and private practices. Antimicrobial stewardship measures are therefore needed to improve prudent use.

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“…2011, Ortiz et al . 2018). The perceived role of bacterial infection in AHDS is widely debated as the underlying cause for AHDS remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Clostridium perfringens alpha toxin and enterotoxin in the faeces of dogs with acute haemorrhagic diarrhoea syndrome

Allen-Deal

Lewis

2021

J of Small Animal Practice

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Objectives To investigate the prevalence of Clostridium perfringens alpha toxin encoding gene and C. perfringens enterotoxin encoding gene in dogs with acute haemorrhagic diarrhoea syndrome. Materials and Methods Retrospective study looking at the prevalence of C. perfringens alpha toxin and C. perfringens enterotoxin in the faeces of three groups of dogs – those with acute haemorrhagic diarrhoea syndrome (n = 16), those with haemorrhagic diarrhoea from another cause (n = 17) and those without haemorrhagic diarrhoea (n = 10). Correlation between the presence of C. perfringens alpha toxin and/or C. perfringens enterotoxin and Acute Patient Physiological and Laboratory Evaluationfast scores, acute haemorrhagic diarrhoea index scores and length of hospitalisation in dogs with acute haemorrhagic diarrhoea syndrome was assessed. Results Prevalence of C. perfringens alpha toxin was not higher in dogs with acute haemorrhagic diarrhoea syndrome (43.75%) than dogs with haemorrhagic diarrhoea from another cause (58.82%) (difference in prevalence 15.07%; 95% CI −37% to 32%) or in dogs without haemorrhagic diarrhoea (60%) (difference in prevalence 16.25%; 95% CI −4% to 36%). Dogs with acute haemorrhagic diarrhoea syndrome did not have a significantly higher prevalence of C. perfringens enterotoxin (18.75%) compared to dogs without haemorrhagic diarrhoea (11.76%) (difference in prevalence 6.99%; 95% CI −18% to 32%). Prevalence of C. perfringens enterotoxin was similar in dogs with acute haemorrhagic diarrhoea syndrome and dogs without haemorrhagic diarrhoea (20%) (difference in prevalence 1.25% 95% CI −33% to 30%). The presence of C. perfringens alpha toxin did not correlate with increased Acute Patient Physiological and Laboratory Evaluationfast scores, acute haemorrhagic diarrhoea index scores or length of hospitalisation in dogs with acute haemorrhagic diarrhoea syndrome. Clinical Significance This study does not demonstrate increased prevalence of C. perfringens alpha toxin or C. perfringens enterotoxin in dogs with acute haemorrhagic diarrhoea syndrome compared to dogs with haemorrhagic diarrhoea from another cause or dogs without haemorrhagic diarrhoea.

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Evaluating the effect of metronidazole plus amoxicillin‐clavulanate versus amoxicillin‐clavulanate alone in canine haemorrhagic diarrhoea: a randomised controlled trial in primary care practice

Abstract: This study strongly suggests that addition of metronidazole is not an essential addition to amoxicillin-clavulanic acid therapy for treatment of severe cases of haemorrhagic diarrhoea in dogs.

Cited by 22 publications

References 25 publications

A retrospective study of 237 dogs hospitalized with suspected acute hemorrhagic diarrhea syndrome: Disease severity, treatment, and outcome

A retrospective study of 237 dogs hospitalized with suspected acute hemorrhagic diarrhea syndrome: Disease severity, treatment, and outcome

Antimicrobial prescriptions and adherence to prudent use guidelines for selected canine diseases in Switzerland in 2016

Prevalence of Clostridium perfringens alpha toxin and enterotoxin in the faeces of dogs with acute haemorrhagic diarrhoea syndrome

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