hey again! i just have a quick question about your thoughts on metronidazole for acute diarrhea? i know it’s commonly used in practice but there were those studies that said there was no clinical befit. what are your thoughts? i’ve seen some vets not give it as a frontline but when the pt comes back they eventually do and it resolves. the dr who is basically mentoring me said they used to be hesitant but has started to give it when a patient with acute diarrhea has come in due to their experience. i guess basically the question what are your thoughts on it? i was looking into the studies and they did mention that there sample sizes were small, but it would be difficult to get a large sample size when there’s so many other factors at play (parasites, etc) and then some studies even showed that good micro flora increased after a course of it. sorry it’s a lot! i just want to see all the different views and not just the views of the drs i know
I definitely don't use it as a first line if I can help it. We were taught in school that it can actually cause more GI upset in the long run if used excessively (particularly in young animals) due to disruption of normal flora. It's also an antibiotic so I don't really want to be throwing that around if I don't have to. For me it depends on species, owner expectations, and symptoms. A puppy that is BAR, eating ok, but has loose stools? GI diet and probiotics. I would say a solid 95% of the time I have an animal with a mild-moderate episode of GI upset they improve with just that. If I have an animal that has profuse bloody diarrhea, lack of appetite, dehydration, etc I'm more likely to hit harder. Sometimes I also have owners that have been given metro before and get pretty insistent about having it sent home.
Also if I have an animal with chronic diarrhea I'm going to try looking into more diagnostics and diet trials first. If they've had diarrhea for 3 months without significant weight loss, dehydration, etc they'll be fine for another 5 days while we run a fecal and try a GI diet, TAMU GI panel, etc. I do tend to reach for it a little faster in reptiles or other less traditional species though. Ideally I want to run a fecal on reptiles before giving any kind of antiparasitic but it's not always possible. Owners can't always get a fecal and they like to wait until the animal has been sick for a long time and is now not doing well. So I will do more empirical treatment with metro and pyrantel in reptiles. Same with foxes, raccoons, etc. I can't exactly put a fox on a GI diet.
Hope that helps!
