Treatment of Aseptic Dogs with Hemorrhagic Gastroenteritis with Amoxicillin/Clavulanic Acid: A Prospective Blinded Study

Abstract

Background: Antibiotics generally are recommended to treat hemorrhagic gastroenteritis (HGE). Inappropriate use of antibiotics may promote risk of antimicrobial resistance and unnecessary adverse drug reactions. The necessity of antimicrobial therapy in dogs with HGE has not been demonstrated. Objective: The purpose of this prospective, placebo‐controlled, blinded study was to evaluate whether treatment with amoxicillin/clavulanic acid improves the clinical course and outcome of HGE in dogs that show no signs of sepsis. Animals: The study included 60 dogs diagnosed with HGE between 2007 and 2009 at the Clinic of Small Animal Medicine, LMU University of Munich, Germany. The inclusion criterion was the presence of acute hemorrhagic diarrhea (<3 days). Dogs pretreated with antibiotics, with signs of sepsis, or diagnosed with any disease known to cause bloody diarrhea were excluded from the study. Methods: Patients were randomly divided into treatment (amoxicillin/clavulanic acid for 7 days) and placebo groups. To evaluate treatment efficacy, severity of clinical signs (based on a newly developed HGE index), duration of hospitalization, and mortality rate were compared between the 2 groups. Results: Fifty‐three of 60 dogs completed the study. No significant difference between treatment groups concerning mortality rate, dropout rate, duration of hospitalization, or severity of clinical signs, either on any individual day or over the course of disease, was observed. Conclusions and Clinical Importance: In some dogs with HGE that show no signs of sepsis, antibiotics may not change the case outcome or time to recovery.

Acute haemorrhagic diarrhoea syndrome in dogs: 108 cases

“…Although AHDS is typically described as acute-onset vomiting and haemorrhagic diarrhoea (Burrows 1977, Triolo and Lappin 2003, Unterer and others 2011), 20 per cent of the patients of the present study did not show vomiting at any time during disease course. If emesis occurs, this is not due to gastritis since a recent study showed that mucosal lesions associated with AHDS are restricted to the intestines (Unterer and others 2014).…”

“…In humans, acute haemorrhagic enteritis caused by certain enterotoxigenic strains of Escherichia coli has a very similar clinical presentation (Triolo and Lappin 2003). In dogs, different aetiologies have been discussed, including intestinal type 1 hypersensitivity reaction to food components or bacterial endotoxin, and enterotoxigenic clostridial strains (Cave and others 2002, Triolo and Lappin 2003, Hall and German 2010, Unterer and others 2011, 2014). A rapid clinical improvement is typically seen with symptomatic therapy—aggressive fluid therapy being the mainstay of treatment (Triolo and Lappin 2003, Unterer and Hartmann 2009, Unterer and others 2011).…”

“…In dogs, different aetiologies have been discussed, including intestinal type 1 hypersensitivity reaction to food components or bacterial endotoxin, and enterotoxigenic clostridial strains (Cave and others 2002, Triolo and Lappin 2003, Hall and German 2010, Unterer and others 2011, 2014). A rapid clinical improvement is typically seen with symptomatic therapy—aggressive fluid therapy being the mainstay of treatment (Triolo and Lappin 2003, Unterer and Hartmann 2009, Unterer and others 2011). If not treated promptly, however, the disease can rapidly progress to death (Triolo and Lappin 2003).…”

“…Four studies about AHDS have been published by the same study group in recent years, and the current study population overlaps with each of those study populations (Unterer and others 2014, 2015, 2011, Busch and others 2015). The previous studies all focus on the potential role of bacteria and antibiotics in the aetiology and treatment of this disease.…”

Endoscopically Visualized Lesions, Histologic Findings, and Bacterial Invasion in the Gastrointestinal Mucosa of Dogs with Acute Hemorrhagic Diarrhea Syndrome

“…Analgesics were administered dependent on clinical judgement of abdominal pain. The clinical assessment was performed by calculating the “canine HGE activity index.”2 This index includes the parameters attitude, appetite, vomiting, stool consistency, stool frequency, and dehydration. Each parameter was scored (0 = normal, 1 = mild, 2 = moderate, 3 = severe), and the sum of scores yielded a total cumulative score (maximum = 18).…”