Abstract
BackgroundDespite limited evidence of efficacy, antibiotic treatment is still frequently prescribed in dogs with uncomplicated acute diarrhea (AD).ObjectiveTo assess whether amoxicillin‐clavulanic acid has a clinical benefit, an effect on the fecal microbiome, and the proportion of amoxicillin‐resistant Escherichia coli in dogs with AD.AnimalsSixteen dogs with AD of <3 days duration.MethodsProspective, placebo‐controlled, double‐blinded study. Clinical scores were compared between client‐owned dogs randomly assigned to an antibiotic (AG) or a placebo (PG) group. The intestinal microbiome was analyzed using quantitative PCR assays. Amoxicillin‐resistant fecal E. coli were assessed semiquantitatively with microbiological methods.ResultsThere was no difference in clinical recovery between treated dogs or controls (CADS index day 10: AG group median: 2 (range: 1‐3; CI [1.4; 2.6]); PG group median: 1.6 (range: 1‐3; CI [1.1; 2.4]); P > .99). All dogs gained normal clinical scores (CADS index ≤3) after 1 to 6 days (median 2 days) after presentation. There was no significant difference in the fecal dysbiosis index (during treatment: AG mean −2.6 (SD 3.0; CI [−5.1; 0.0]); PG mean −0.8 (SD 4.0; CI [−4.2; 2.5]; P > .99) or its bacterial taxa. The proportion of resistant fecal E. coli increased (to median: 100%; range: 35%‐100%) during treatment with amoxicillin‐clavulanic acid and was still increased (median: 10%; range 2%‐67%) 3 weeks after treatment, both of which were significantly higher proportions than in the placebo group for both time points (during treatment AG median 100% versus PG median 0.2% (P < .001); after treatment AG median 10% versus PG median 0.0% (P = .002)).Conclusions and Clinical ImportanceOur study suggests that treatment with amoxicillin‐clavulanic acid confers no clinical benefit to dogs with AD, but predisposes the development of amoxicillin‐resistant E. coli, which persist for as long as 3 weeks after treatment. These findings support international guideline recommendations that dogs with diarrhea should not be treated with antimicrobials unless there are signs of sepsis.
Highlights
Diarrhea is a common reason for dogs being presented for veterinary care with approximately 7% of the dogs presented in small animal practice showing diarrhea.[1]
At the day of presentation and inclusion into the study, defined as day 0, all dogs were evaluated with the canine acute diarrhea severity (CADS) index (Table 1)
On day 0, before the antibiotic treatment was started, the median percentage of ampicillin-resistant E. coli was 0.2% in the amoxicillin-clavulanic acid group (AG) group and 0.1% in the placebo group (PG) group with no significant difference between groups (P = .94)
Summary
Diarrhea is a common reason for dogs being presented for veterinary care with approximately 7% of the dogs presented in small animal practice showing diarrhea.[1] Uncomplicated acute diarrhea (AD) in dogs is most frequently associated with dietary indiscretion, adverse reactions to food, endoparasites, or transient uncomplicated bacterial/viral infections.[2,3,4,5,6] In many cases the etiology cannot be identified This is usually not a problem, because clinical signs typically resolve spontaneously and usually do not recur.[2,4,7,8,9] International guidelines recommend that in dogs with diarrhea, antimicrobials should only be administered to dogs manifesting systemic signs of illness.[10,11,12,13,14] Despite these recommendations, it is common that dogs with AD receive an untargeted, short-term antibiotic course as first-line medication. The proportion of resistant fecal E. coli increased (to median: 100%; range: 35%100%) during treatment with amoxicillin-clavulanic acid and was still increased (median: 10%; range 2%-67%) 3 weeks after treatment, both of which were
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