Birdie’s Case: Probiotics in the Management of Acute Travel-Induced Diarrhea

Sponsored by Nutramax Laboratories Veterinary Sciences, Inc.

Acute diarrhea is one of the most common reasons dogs are presented to the veterinary clinic, with most cases being managed without identification of the exact etiology.¹ Stress (eg, travel) may be one such cause of acute diarrhea.²

Studies have shown that probiotics can have positive results in dogs receiving supportive care for diarrhea, speeding time to resolution of acute diarrhea, improving stool quality, and, in some cases, improving appetite. ³

Birdie’s Case

Birdie, a 4-year-old spayed female Labrador retriever crossbreed, was presented for acute diarrhea. Birdie’s family had recently moved from several states away, and during the drive, she was kept in a crate in the vehicle. Her owners reported that she seemed stressed, often panting and whimpering during the trip. After arriving at their new home, Birdie’s owners noted that she started having diarrhea. Birdie was up to date on preventive care, including vaccinations and monthly parasite prevention. She had not had any recent dietary changes.

Physical examination abnormalities included a BCS of 6/9, mild dental calculus, mild abdominal discomfort on palpation, and loose stool noted during rectal examination. She was not notably dehydrated during examination and was bright, alert, and responsive, with pink mucous membranes and a capillary refill time of <2 seconds.

To evaluate for an underlying cause of acute diarrhea, abdominal radiography, CBC, serum chemistry, fecal flotation, and Giardia spp SNAP test were recommended. Radiography and blood work were declined. No ova or parasites were appreciated on fecal flotation, and Giardia spp SNAP test was negative. Given the patient’s history, examination findings, and diagnostic results, stress was suspected as the most likely cause of the acute diarrhea.

Birdie’s owners were interested in conservative management to save on costs due to their recent move. Because an infectious cause was not suspected or identified on completed diagnostics, Birdie’s veterinarian did not recommend antibiotics or parasiticides and discussed temporary use of a prescription GI diet and probiotics. Birdie was sent home with a Proviable®-Forte (multistrain probiotic supplement with prebiotics [synbiotic]) kit, including a paste and sprinkle capsules.

Probiotics in the Multimodal Management of Acute Diarrhea

Historically a commonly selected management option for acute diarrhea, antibiotics—including metronidazole—can cause dysbiosis in dogs.^1,4-7 In fact, in one study of healthy dogs, diarrhea occurred in ≈56% of dogs treated with metronidazole.⁶ In addition, most studies do not show clinically significant improvement in dogs with acute diarrhea treated with metronidazole.¹ The use of antibiotics in cases of noninfectious acute diarrhea also raises concerns in light of increasing antimicrobial resistance.⁷

In dogs with acute diarrhea, probiotics have been shown to offer benefits such as improved stool consistency, improved food intake, and decreased time to resolution of diarrhea by supporting gut health through various mechanisms.^1,2

Proviable-Forte contains 7 strains of beneficial bacteria, including Enterococcus faecium, Streptococcus thermophilus, Lactobacillus helveticus, Lactobacillus delbrueckii, Lactobacillus casei, Bifidobacterium bifidum, and Lactobacillus plantarum. It contains prebiotics to encourage the growth of beneficial probiotics in the gut and ≥10 billion CFUs of probiotics per capsule. Proviable has been evaluated in 7 published studies in cats and dogs.^4,5,8-12

Back to Birdie

Birdie’s owners gave the probiotic kit as directed by the veterinarian, with improvement observed over the following days. Birdie was also fed a GI diet until her stools improved. No antibiotics were necessary in her management plan, as an infectious cause was not identified and Birdie’s signs were mild and responded to the management plan.

Conclusion

With metronidazole considered an essential antibiotic for humans, it is important that veterinarians not overprescribe this medication in cases of noninfectious acute diarrhea, especially considering that it may not result in clinically significant improvement.¹ Probiotics provide an option for patients with acute, stress-related diarrhea without compromising the antibiotic stewardship expected of veterinarians.