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from cats infected with one strain of the organism. In another one small study, administration of metronidazole and enrofloxacin lessened diarrhea in kittens but it is unknown if the organisms infecting those cats was T. foetus. Tinidazole may control the diarrhea but was less likely to eliminate the infection compared to ronidazole. Some puppies have recently been shown to be infected by T. foetus.
Sequential administration of clindamycin followed by tylosin blocked oocyst shedding and resolved diarrhea in one cat with chronic, clinical cryptosporidiosis. Tylosin (10-15 mg/kg, PO, twice daily) has been apparently successful in lessening diarrhea and oocyst shedding
in multiple other cats and dogs with diarrhea that were Cryptosporidium positive. However, infection is not eliminated. Unfortunately, tylosin is very bitter and usually has to be given to cats in capsules. Treatment duration may need to be weeks. In cats with naturally occurring cryptosporidiosis, response to azithromycin has been variable (Lappin MR, unpublished data). If tried, use 10 mg/kg, PO, weekly for at least 10 days. If responding, continue treatment for at least 1 week past clinical resolution. Nitazoxanide is a new drug being studied
for the treatment of Cryptosporidium and Giardia. Little information is available concerning dosages, but in
one dog study seemed safe and effective at 75 mg/kg, PO, on days 0 and 14. The drug Alinia® is available and
is labeled for both organisms in humans. The primary side-effect to date has been vomiting and so it should be given with food if used.
Cystoisospora spp. generally respond to the administration of sulfadimethoxine, other sulfa-containing drugs, macrolides, or ponazuril (or toltrazuril). Ponazuril
is superior to other drugs and should be administered at 50 mg/kg, daily for 3 days. If there are multiple puppies or kittens with diarrhea, treatment of all in contact animals should be considered.
Since many of the gastrointestinal parasites that infect dogs and cats are transmitted by carnivorism, they should not be allowed to hunt or be fed raw meats. Additionally, infection of by many parasites results from ingestion of contaminated water. Clinical disease in some parasitized animals can be lessened by eliminating stress and providing a quality diet and clean environment.
Unless signs of bacteremia are present or signs are persistent, most bacterial enteritis cases are now treated by diet change and probiotics. If antibiotics
are needed, Clostridium perfringens and bacterial overgrowth generally respond to treatment with
tylosin, metronidazole, ampicillin, amoxicillin, or tetracyclines. The drug of choice for campylobacteriosis is erythromycin; however, oral administration of tylosin or quinolones is often less likely to potentiate vomiting. Salmonellosis should only be treated parenterally due to rapid resistance that occurs following oral administration
of antibiotics. Tylosin can be administered at either 5 mg/ kg or 15 mg/kg per dose; 25 mg/kg was shown to not be needed in one study. Boxer colitis is due to E. coli and should be treated with enrofloxacin at 5 mg/kg, PO, daily for 6 – 8 weeks. Appropriate antibiotics for the empirical treatment of salmonellosis while awaiting susceptibility testing results include ampicillin or trimethoprim-sulfa; quinolones are also effective. Some animals with infectious diarrhea will respond to the administration
of a probiotic. We recently showed administration
of Enterococcus faecium SF-68 (FortiFlora, Nestle Purina PetCare) lessened diarrhea in shelter cats and to improve metronidazole responses in non-specific diarrhea in shelter dogs. The probiotic is not resistant to metronidazole and so both can be administered simultaneously.
Helicobacter spp. infections are usually treated with the combination of metronidazole, amoxicillin, and bismuth subsalicylate in dogs. Clarithromycin or azithromycin may be logical choices in cats since the species is
often difficult to treat with multiple drugs. Whether to concurrently administer an antacid like famotidine is controversial but seems to lessen vomiting in some cats.
References
Bowman D.D., Liotta J.L., Ulrich, M., et al. (2009) Treatment of naturally occurring, asymptomatic Giardia sp. in dogs with Drontal Plus flavour tablets. Parasitology Research, 105 (Suppl. 1), S125-134.
Bybee SN, Scorza AV, Lappin MR. Effect of the probiotic Enterococcus faecium SF68 on presence of diarrhea in cats and dogs housed in an animal shelter. Vet Intern Med. 2011;25:856-860.
Da Silva AS, Castro VS, Tonin AA, et al. Secnidazole for the treatment of giardiasis in naturally infected cats. Parasitol Int. 2011;60:429-432.
Litster AL, Nichols J, Hall K, et al. Use of ponazuril paste to treat coccidiosis in shelter-housed cats and dogs. Vet Parasitol. 2014;202:319-25.
Lloyd, S. & Smith, J. (2001) Activity of toltrazuril and diclazuril against Isospora species in kittens and puppies. Veterinary Record, 148(16), 509-511.
Marks SL, Rankin SC, Byrne BA, Weese JS. Enteropathogenic bacteria in dogs and cats: diagnosis, epidemiology, treatment, and control. J Vet Intern Med. 2011;25:1195-208.
Moron-Soto M, Gutierrez L, Sumano H, Tapia G, Alcala-Canto Y. Efficacy of nitazoxanide to treat natural Giardia infections in dogs. Parasit Vectors. 2017;10:52
Scorza V, Lappin MR. Metronidazole for treatment of giardiasis in cats. J Fel Med Surg 2004;6:157-160.
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