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Discussion on Metronidazole - potential side effects
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Member:
lynnland
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Posted on Tuesday, Mar 30, 2010 - 11:25 am:
Hi Dr. O (and company),
I've decided to try the metronidazole on my horse with intermittent diarrhea (and apparent abdominal discomfort under saddle). My vet is not keen on this and mentioned that she will make a note in the file that this was my idea, not hers. Although she is willing to do this and was very nice about it. She is concerned that he will get worse as a result of the changes in gut flora that she expects from this antibiotic. I have surfed the postings on this site, the web in general, and checked the drug out in the Merck Vet Manual, and can't seem to find any nasty results in horses (other than really rare cases). Any negative experiences?
Thanks again
Lynn
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Member:
pattyb
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Posted on Tuesday, Mar 30, 2010 - 11:44 am:
I had a horse on that almost 2 years ago and she felt so bad that I stopped the course early. It did help her diarrhea right away but it also made her very colicky....which she rebounded and felt much better within a day of stopping the med.
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Member:
lynnland
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Posted on Tuesday, Mar 30, 2010 - 1:01 pm:
Thanks Patty,
Glad to hear that she was fine after stopping the drugs.
Lynn
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Member:
pattyb
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Posted on Tuesday, Mar 30, 2010 - 1:24 pm:
If I remember correctly, my local small animal vet ran a "right away" stool check for me and picked up giardia.....something that you have to look for before they die....they're looking for swimmers that will die off within an hour so they had to check the sample right away. For the giardia, she was given the metronidazole. I have since learned that one of the common wormers (I forget which one) will also treat giardia and is not nearly as hard on them. My horse (33 at the time) was having a consistent problem with cow piles....
PS: You're very welcome.
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Moderator:
DrO
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Posted on Tuesday, Mar 30, 2010 - 4:57 pm:
Hello all,
Metronidazole is one of the antibiotics that is particularly good at treating gi pathogens but leaving the normal flora alone. However any antibiotic can cause GI upsets.
Concerning other treatments for Giardia fenbendazole (Panacur) is useful.
DrO
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Member:
lynnland
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Posted on Wednesday, Mar 31, 2010 - 10:12 am:
Thanks Dr. O and Pamela,
Much appreciate the info. Didn't know that fenbendazole was a treatment for giardia. Given that he has had two rounds of the power-pack version (about 1 month apart)...that likely wasn't the issue.
Lynn
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Member:
lynnland
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Posted on Wednesday, Mar 31, 2010 - 10:35 am:
Oops, sorry Patty for calling you Pamela, multi-tasking this morning!
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Member:
lynnland
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Posted on Wednesday, Apr 14, 2010 - 8:03 am:
Hi Dr O and Company,
I just finished a 7 day treatment of metronidazole on my horse (last day was Wednesday). Not an easy drug to get into a horse. One side effect I noted, and was wondering if anyone else did, was an incredibly bad smell to his DrOppings starting about late in day 2 of treatment. I generally think of that good old barn smell as aromatherapy but this was enough to make you gag the second you stepped into the barn (and good luck if he passed gas when you were behind him!). I assume it will go away shortly. I am still reserving judgement on the effectiveness until we give him a week or two. However, it did stop the mild diarrhea and he has been a pretty happy critter for the last few days (except when I was force-feeding him the drugs).
Lynn
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Moderator:
DrO
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Posted on Thursday, Apr 15, 2010 - 11:30 am:
Thanks for the update LynnL. I have not noticed the bad smell problem let us know how all this works out. Normally I do a 10 to 14 day course but if the diarrhea had resolved for 3 days before discontinuing that may work for you.
DrO
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Member:
lynnland
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Posted on Friday, May 7, 2010 - 9:47 am:
Hi DrO and Company,
Thought it might be time for an update. The awful smelling manure and gas finally went away about 2 weeks after we finished the metronidazole treatment (thank goodness). The horse is doing great since the treatment. Normal amount and consistency of manure and much less gassy. As this has been a long road (about 1.5 years) I am keeping my fingers and toes crossed. I will reserve a final judgement until late summer as his issues tend to be much worse from late summer to early spring. However, he is doing much better than he ever has. Maybe he just heard that we were moving from the hunter ring to the small jumper division! Thanks for all the helpful input and ideas.
Lynn
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Moderator:
DrO
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Posted on Saturday, May 8, 2010 - 10:17 am:
Delighted to hear of the good outcome (so far) and look forward to that late summer posting.
DrO
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Member:
lynnland
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Posted on Tuesday, Jul 13, 2010 - 8:35 am:
Hi All,
Just thought I would post an update. The stomach discomfort returned after about 2 months of treating with metronidazole. My vet and I have decided to give it another go with a higher dosage (20mg/kg vs 13mg/kg)and a longer duration (14 days vs 7). Found a compounding company that got it into liquid format to 300mg/ml so that should make drugging him easier. Will keep you posted.
Cheers
Lynn
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Moderator:
DrO
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Posted on Wednesday, Jul 14, 2010 - 7:08 am:
Thanks for the update Lynn. Can you give us an idea of what this cost, and which salt of Metronidazole was used? Also has the diarrhea returned also?
DrO
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Member:
lynnland
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Posted on Wednesday, Jul 14, 2010 - 7:45 am:
Hi Dr. O,
Unfortunately, it looks like my vet was not paying much attention when I said I did not want the benzoate version. I have 1400 ml of metronidazole benzoate liquid (apple flavoured). It is supposed to be at 300mg/ml of metronidazole. So, that is 14 days worth of drug at 20mg/kg (horse is about 500kg) and she said the cost was ~$350 canadian before taxes. The compounding pharmacy is call Chiron (easy to find on the internet). My vet seems to think this is all hopeless but...I hate to retire a sound 7 yr old that that moves great and has lots of scope (my profile pictures is his typical jumping form). If this doesn't work then it will be the 8 hour drive to one of the big clinics down south.
Cheers
Lynn
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Moderator:
DrO
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Posted on Thursday, Jul 15, 2010 - 2:44 pm:
Bummer about the salt. Has the chronic diarrhea returned?
DrO
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Member:
lynnland
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Posted on Monday, Jul 19, 2010 - 7:18 am:
Hi Dr. O,
The diarrhea cleared up on day two. Seeing same side effects as last time: really bad smelling manure, picking at his food, a little lethargic. This seems to suggest that the metronidazole benzoate is acting the same as the base. Unfortunately he came in with a really thick, hard and hot left hind yesterday so I will need to deal with this. The last day of treatment with the antibiotic will be July 17. Will provide an update then.
Cheers
Lynn
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Moderator:
DrO
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Posted on Monday, Jul 19, 2010 - 7:33 pm:
Thanks Lynn, this continues to be interesting.
DrO
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Member:
lynnland
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Posted on Tuesday, Jul 20, 2010 - 7:16 am:
Hi Dr. O,
As luck would have it, it appears the leg swelling may be cellulitis. Although he is lame, not anywhere near as lame as I have seen in other horses; he is still bearing weight on it and will trot and canter in the field. However, the swelling sure looks like it and his temp last night was 104F. So, we got ahold of our southern vet (ours it out of town and the one on call is 2 hours away) and have stopped the metronidazole. We are giving him some bute and TMP-SMZ and are trying to get ahold of some Excenel. All stuff I would have normally avoided with this horse but, a chronic cellulitis is real scary. So...you may find me posted under lymphangitis in the near future.
Lynn
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Member:
lynnland
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Posted on Tuesday, Jul 20, 2010 - 7:18 am:
Oops,
I noticed that a few posts up (July 19 posting) the last date of metronidazole benzoate treatment was supposed to go until July 27 (to make 14 days) not July 17.
Lynn
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Member:
dsibley
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Posted on Tuesday, Jul 20, 2010 - 11:12 pm:
I have a 3-y/o QH/paint gelding who had chronic diarrhea. He was being fed oats top-dressed with a ration-balancer. After numerous testing, which was all non-conclusive, I switched him from oats to Purina Strategy. His stools got remarkably better, and he was kept on Strategy for a year. He still had bouts with periodic cow-pie stools, and it was recommended that I switch him again, this time to Ultium. It has rice bran, which should help with the problem. Since I made the very slow switch, his stools have been excellent. I even trailered him to a show and exposed him to the warm-up pen and all the excitement of the show experience. He never had a loose stool the entire time.
I also start the show horses on Neigh-Lox about two weeks prior to a show, just for preventative measures. I have noticed a marked difference in colicky behavior since I have put them on this regimen.
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Member:
lynnland
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Posted on Wednesday, Jul 21, 2010 - 7:33 am:
Hi Dieliz,
Thanks for the suggestions. I have actually been dealing with this stomach issue my horse Peety has for some time now. He gets very little feed other than hay and I actually tried pulling his grain mix completely with no success (not to mention a ton of other ideas including omeprazole for ulcers). The metronidazole is a last ditch effort before I pull out the really big $$. If you are feeling brave, the entire history can be found under the following post: "HorseAdvice.com » Diseases of Horses » Colic, Diarrhea, GI Tract » Gastric Ulcers » Gastric Ulcers in Adult Horses » Sucralfate - treatment duration". Any ideas/suggestions much appreciated.
Thanks
Lynn
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Member:
rtrotter
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Posted on Wednesday, Jul 21, 2010 - 10:06 pm:
Hi Lynn,
Do you have a Triple Crown distributor in your neighborhood. Triple Crown puts out a product called Triple Crown Safe Starch Forage. It has everything a horse needs in it( including pre-biotics and probiotics) and is meant to be a complete forage based diet, meaning you do not have to feed any grain with it at all. It is chopped up hay, sort of like a dengie mixture. Very nutritionally balanced.
You would feed it as if you were feeding grain in a feed tub or bucket, 2 or 3 times a day. I put my race mare on this last year when she was having a chronic diarrhea problem and the diarrhea cleared up in two days. In her case, I think it rested her gut and put back all the good bacteria.
Because she was racing, she was also being grained at the same time, so I only used it to replace the hay portion of her rations (10-12 lbs). Unfortunately, very expensive at $18.00 a bag. But when I think of the alternative (Ulcergard or Gastroguard), this is cheap by comparison.
Rachelle
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Member:
lynnland
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Posted on Thursday, Jul 22, 2010 - 7:35 am:
Hi Rachelle,
I am having some sort of deja-vue. I think you and I have had this discussion before? See the link in my previous post. I board this horse at a private barn which precludes my removing his hay or feeding him lunch. I would also expect that removing his hay would result in a ton of behavioural issues. In addition, in the winter they get free access to a round hay bale in their turnout paddock, as they are out all day. So...if hay is the the problem then it is one I cannot solve and keep him sane and usable. Thanks much for the idea! A great suggestion for horses managed in a different fashion than this one.
Lynn
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Member:
lynnland
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Posted on Thursday, Jul 22, 2010 - 7:45 am:
Rachelle,
Forgot one other thing. I did remove his grain mix entirely for a few weeks without any improvement, so...it would seem that if it is an issue with what he is being fed then it would be the hay.
Lynn
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Member:
rtrotter
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Posted on Thursday, Jul 22, 2010 - 6:21 pm:
Lynn,
The Safe Starch forage is hay, just chopped up and complete with everything in it, so no extra anything, no supplements etc. If your horse normally gets 15 lbs of hay, this replaces it. If you think its the hay causing it can you try him on a pelleted complete feed ( wet down a bit so there is no choke)and no hay.
Another thing, find out if the hay that is currently being fed is being cured with preservatives, some horses are very sensitive to the preservatives used and exhibit a variety of symptoms ranging from colic to diarrhea. Sometime's I think some horse's have intermittent diarrhea because the different batches of hay do or don't have preservatives. This last statement is conjecture on my part, don't have any proof to back it up.
Good luck and I hope all your problems get better.
Rachelle
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Member:
lynnland
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Posted on Saturday, Jul 31, 2010 - 4:07 pm:
Hi Dr O,
Managed to get the infection in the leg under control and he has been off all drugs for one week. Would you consider it worth while to go ahead and give him the remaining 8 days of liquid metronidazole?
thanks
Lynn
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Moderator:
DrO
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Posted on Sunday, Aug 1, 2010 - 9:16 am:
Considering the aim of the consistent prolonged treatment, to remove some organism that may be responsible for the the diarrhea, but that all the recent antibiotic therapy may have upset the bowel environment, I would say it makes more sense to me to wait and see if the diarrhea returns give it a few weeks more then start over again.
DrO
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Member:
lynnland
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Posted on Tuesday, Sep 28, 2010 - 7:47 am:
Hi Dr. O,
Just looking for a little more advice. Because of the expiry date on the liquid metronidazole I had, I ended up feeding the remaining week's worth, which ended August 9th. The effect last until this week. So...my plan is to give him a week or so to let this progress a bit more then ship him down to one of the bigger clinics. The vet university is one of the furthest away so I was wondering what type of diagnostic tests and equipment I would be looking for if I considered a closer clinic. Obviously a scope for stomach ulcers but what else would you suggest. Is there some way to tell if his intestine is swollen or damaged?
If you need a reminder of what the issue was with this horse, the location of the original description is listed in one of my replies above, and ignore the seasonality, as that no longer seems to apply.
Thanks again for the help
Lynn
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Moderator:
DrO
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Posted on Tuesday, Sep 28, 2010 - 5:59 pm:
Hello LynnL,
Mainly you want a clinic that has a good internal medicine clinician with an interest in diarrhea of the horse. His findings will direct what tests should be run. Some possibilities are an ultrasound with suitable frequencies for abdominal views, rectal/colonic mucosa biopsy, and laboratory for assessing cultures, blood work, cytology, and histopath.
DrO
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Member:
lynnland
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Posted on Wednesday, Sep 29, 2010 - 7:05 am:
Thanks Dr O.
Lynn
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