Metronidazole treatment of acute diarrhea in dogs: A randomized double blinded placebo‐controlled clinical trial

Abstract

Background: Metronidazole is commonly administered to dogs with acute diarrhea, but there is limited evidence to support this practice.Objective: To investigate the effects of metronidazole administration on dogs with acute nonspecific diarrhea.Animals: Thirty-one dogs, including 14 test population dogs and 17 controls.Methods: Randomized controlled clinical trial. Dogs with acute diarrhea in which causation was not determined by routine fecal diagnostic testing were randomly assigned to metronidazole treatment (10-15 mg/kg PO q12h for 7 days) or placebo.Fecal cultures and characterization of Clostridium perfringens isolates also were performed. Owners maintained medication and fecal scoring logs, and fecal diagnostic tests were repeated on day 7.Results: The mean ± SD time to resolution of diarrhea for test population dogs (2.1 ± 1.6 days) was less than that for controls (3.6 ± 2.1 days, P = .04). Potential relationships of C. perfringens with acute diarrhea pathogenesis were not investigated, but only 3 of 13 (23.1%) test population dogs had persistent C. perfringens carriage at day 7, which was less than the 11 of 14 (78.6%) controls with persistent growth (P = .007).Conclusions and Clinical Importance: Our results suggest that metronidazole treatment can shorten duration of diarrhea and decrease fecal culture detection of C. perfringens in some dogs with acute nonspecific diarrhea. Additional studies are needed to assess the benefits and risks of routine use of metronidazole for this purpose because most dogs achieve resolution of diarrhea within several days regardless of treatment.

Fecal Microbial and Metabolic Profiles in Dogs With Acute Diarrhea Receiving Either Fecal Microbiota Transplantation or Oral Metronidazole

“…We compared FMT to metronidazole in this study because, while acute uncomplicated diarrhea is often self-limiting, treatment with antibiotics is still initiated in 50% to 71% of patients in practice (2,3). Just recent data would suggest that there is limited clinical benefit of giving metronidazole over placebo as both treatments had similar outcomes in clinical signs (4,5), but both studies did not report effects on the microbiota and metabolome (4,5). Therefore, future studies should also include comparisons between FMT and placebo to evaluate whether FMT treatment has improved outcomes in the metabolome and microbiota.…”

“…Only very recent studies have examined whether administration of antimicrobials does lead to shorter duration of diarrhea, and the results remain unclear. While one study has shown metronidazole to shorten duration of acute diarrhea (mean duration 2.1 vs. 3.6 days for placebo), another study did not reveal statistical differences in the duration of diarrhea when dogs were treated either with a probiotic (mean duration 3.5 days) metronidazole (4.6 days), or placebo (4.8 days) (4,5).…”

Acute Diarrhea in Dogs: Current Management and Potential Role of Dietary Polyphenols Supplementation

“…As regards antibacterial administration in canine acute diarrhea, it should be properly evaluated on a case-by-case basis, as it has been recently reported in a chronic disorder [ 30 ]. Different molecules (e.g., amoxicillin/clavulanic acid, and metronidazole) have been studied over time in AD, and it is now generally accepted that their use should be mainly reserved for those cases presenting sepsis, or at a clear risk of sepsis (evidence of infection associated to systemic inflammatory response syndrome) [ 5 , 6 , 10 , 54 , 55 , 56 ]. For instance, it has been shown that the administration of amoxicillin/clavulanic acid in dogs presenting with acute hemorrhagic diarrhea did not significantly improved parameters, such as severity of clinical signs, fecal consistency, and time of hospitalization, if compared with a placebo group [ 54 ].…”

“…Although AD tends to be self-limiting in most cases, and with a mild impact on dog wellbeing [ 4 , 5 , 6 ], owners commonly ask for veterinary consultation or even resort to self-medication. Etiologic treatments are rarely established because the exact etiology is hardly identified, and only in a few cases (e.g., intestinal parasites) a targeted therapy exists [ 7 ].…”

Gut microbes in healthy dogs have individualized responses to synbiotic supplementation that lead to increased abundances of probiotic strains: A randomized controlled trial

“…Information on age, sex, body condition score (BCS), ideal body weight, physical activity level, neutered status, stool quality scale [23] , and defecation and flatulence frequency was obtained through an online survey at baseline. Written descriptions and images were provided for the stool quality scale in the survey.…”