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  1. #1
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    Default Metronidazole cured diarrhea- now what? UPDATE (of desperation) on pg 2

    My horse has a few doses left in the metronidazole treatment regimen, but it has so far been a fantastic success- the only thing in a long line of treatments, over 2 winters that has worked.

    My vet is cautiously optimistic it may have cured whatever causes his winter diarrhea, but it may only be masking it and we will be back to a nasty butt when he is off the meds. Fingers crossed its the former, as long-term antibiotic use is clearly a bad thing. She is suggesting a pre/probiotic supplement to help maintain gains once the treatment is done. The specific product she is suggesting I consider is Equiotic. I'm not opposed to that, but I really would prefer to use something I can include in my SmartPaks.

    And I mean, ideally I want to have no digestive supplement. But this has been SUCH a headache I also don't want to backslide if we can avoid it. Not only is it gross and unhealthy, but he's also grey. Stains are insult on injury!

    What have others done after a successful course of metronidazole for watery stool and diarrhea?
    Last edited by Jaideux; Jan. 14, 2014 at 09:39 PM.



  2. #2
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    I haven't had to deal with this in a horse but...in humans we would do the same thing. Treat with a course of metronidazole (assuming bacterial overgrowth of the gut/C.diff) and then once treatment is over recommend probiotic use. There is no known exact duration. Ideally you want to continue it at least long enough to re-establish normal flora in the gut (since metronidazole will kill all the bad...and the good) and that would take a month or so. After that - it's kind of up to you. You could trial off and see if your horse is able to maintain a normal GI balance after that or keep him on it and see if it will "prevent" reoccurance.

    Perhaps a compromise is keep him on through winter, take him off spring/summer and consider restarting it in just Fall/Winter to prevent.

    Did the vet have any idea WHY this is happening in the winter every year? Is he drinking contaminated water or something?



  3. #3
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    Our chronic squirter generally goes years between treatments. Getting soy and molasses out of his diet has prevented flare ups. We were close to losing him before we gave him Metronidazole.



  4. #4
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    Metronidazole stopped my horse's mild but chronic diarrhea in its tracks. It remains in check with a daily dose of Aloe Vera Juice -- he gets 1 cup daily mixed in with his morning grain. He's been on this for at least 4 years and any minor flare ups are now resolved with a few doses of ProBios paste.



  5. #5
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    Quote Originally Posted by rockfordbuckeye View Post

    Did the vet have any idea WHY this is happening in the winter every year? Is he drinking contaminated water or something?
    Nope, no real idea. He's always been on the looser side with his well-formed poops, but nothing real bad. Then 3 years ago he started expelling fecal water after his well-formed poops in the winter. I was very absent that winter due to school, only came out for blanket changes really, so I thought it was related to the stress of weather changes. He was also just generally anxious at this barn for really unclear reasons. I moved them back to their long-term barn (where they had lived for many years prior) in Nov 2012 and all their feet/mood/etc problems resolved practically right away. But the winter poops came back and I feel like we've tried everything. It's not ulcers. One of those power meds you give for diarrhea didn't change it (can't recall the name right now). SmartPak Ultradigest didn't change it. Omeprazole didn't help. Panacure Powerpack didn't help, nor did the Quest Plus. Fecals show low/no shedder. It resolved in the spring, he was fine all summer, and it came back around November. It actually started to turn into *real* diarrhea right before we started the metronidazole; up til that week it had always been well-formed poops with pure liquid after the fact.

    Other than the temps getting a bit colder, nothing obvious had changed in his life. The pastures still had enough grazeable grass they weren't even being thrown supplemental hay yet. Now that it's actually winter they are getting hay in the pasture. His grain hasn't changed, his water source hasn't changed, no one else in his turnout or my other horse that shares a LOT of thins with this horse has any digestive problems. I mention it goes with the colder weather but he himself does not struggle to stay warm. I generally err on the side of underblanketing him and I've only found him "cold" once... during driving rain in the high 30s, with only a sheet on. He's only 13, he is in pretty fantastic shape and health, and if you didn't look at his butt/hocks/fetlocks you'd have no idea he had a problem. But since he's grey, if you do look there, he CLEARLY has a problem.

    My vet has apparently been peddling his case in her practice, travels and conferences, trying to drum up any novel treatments in case the metronidazole isn't the cure. No one wants to be the case study, but I'm really glad she's working hard on this and turning him into one.

    And I really appreciate anyone else's input!



  6. #6
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    Quote Originally Posted by lintesia View Post
    Metronidazole stopped my horse's mild but chronic diarrhea in its tracks. It remains in check with a daily dose of Aloe Vera Juice -- he gets 1 cup daily mixed in with his morning grain. He's been on this for at least 4 years and any minor flare ups are now resolved with a few doses of ProBios paste.
    Aloe, huh? I'll go to google shortly, but do you know why it helps? What the mechanism of action and all that good stuff is?



  7. #7
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    That it responded to metronidazole and nothing else you tried is strongly suggestive of a c. difficile infection. C. diff is very nasty because it reproduces with a spore form that is impervious to antibiotics and to standard cleaning measures like alcohol. It is only vulnerable to two antibiotics and then for only part of its life cycle.

    You've basically done the equivalent now of taking a field full of noxious weeds and sterilizing it. But, you probably know from experience that if that is all you do, the weeds will be right back. You have to change the qualities of the ground so that it is more inviting to healthy bacteria. C. diff likes vacant lot conditions. The probiotics are intended to seed the gut with friendly bacteria so that the c. diff will not be able to establish itself again with more than a few token colonies.

    C. diff excretes toxins that can severely damage the intestinal lining and affect the host's ability to absorb nutrients. The purpose of something like the aloe is to try to speed healing of the intestinal lining.

    A severe or long term case of C. diff can create nutritional deficiencies - not just calories (ie weight loss) but also vitamins and minerals, which might be creating the anxiety you saw in him.

    The high end probiotics generally need to be refrigerated. It could just be marketing, but the whole idea is that they are live cultures.
    If you are allergic to a thing, it is best not to put that thing in your mouth, particularly if the thing is cats. - Lemony Snicket


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  8. #8
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    Agree with poltroon. If an antibiotic "fixed it" then the cause would be bacterial overgrowth or infection. I don't think metronidazole would fix loose stool from other causes.

    It could be C.diff (classic) or some other bacteria - metronidazole has pretty broad action against gram negative and anaerobic organisms like giardia, e. coli, klebsiella, etc.

    I don't know if horses naturally are colonized and carry C.diff in their stool (human infants do, though not adults) so I would defer to vet on how to appropriately screen/test for C. diff to rule it in/out as the cause of this issue. Their are blood PCR tests and stool sample tests that can be done for testing for C.diff. Not sure how a vet would rule in/out small intestinal bacterial overgrowth. Sorry - my knowledge is human based! Seems like you and vet are on the right track though.

    One question - is the horse on long term treatment with omeprazole or had he any recent exposure to antibiotics PRIOR to this?



  9. #9
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    Metronidazole is also effective against giardia. Horses are known carriers and I think are often asymptomatic. An overgrowth could cause disease. I had a cat that had a single incidence as a kitten which we treated with Flagyl. She lived to be about 17 years old and never had a recurrence.

    I hope your horse fully recovers and stays healthy.



  10. #10
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    Quote Originally Posted by poltroon View Post
    That it responded to metronidazole and nothing else you tried is strongly suggestive of a c. difficile infection.

    A severe or long term case of C. diff can create nutritional deficiencies - not just calories (ie weight loss) but also vitamins and minerals, which might be creating the anxiety you saw in him.

    The high end probiotics generally need to be refrigerated. It could just be marketing, but the whole idea is that they are live cultures.
    (quote is edited for specificity)

    Re: C. diff: I recall that from my clinical days in the hospital. Blech. Now, if that's the case, why wouldn't the rest of the pasture, and my other horse, be showing similiar problems? Did my horse just possibly get hit with a colony when he was particularly susceptible? To the best of my knowledge, no other horse in his turnout group at this barn or the last barn were sick.

    Your explanations for how the meds work was wonderful, thank you!

    His anxiety was only at that barn, and it resolved literally within an hour of being moved back to his current barn and had been gone for the last year even though the poops came back. My other horse had similar anxieties and no poop problems. So it's good to keep it in mind, but maybe not quite relevant to this picture?

    I'm not sure my barn can swing refridgerated supplements. I'll have to run it by the BO.

    Lastly, would C. diff be episodic? Like I said, it appears to be just a winter problem. What could be going on that makes the difference between the C. diff being a problem seasonally?

    Thanks so much for sharing your expertise with me- I really appreciate it!!



  11. #11
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    Quote Originally Posted by rockfordbuckeye View Post
    I don't think metronidazole would fix loose stool from other causes. It could be C.diff (classic) or some other bacteria.

    One question - is the horse on long term treatment with omeprazole or had he any recent exposure to antibiotics PRIOR to this?
    (quote edited for specificity)

    Hey, I'm just glad we seemed to have narrowed it down to a bacterial problem. You can't really fight the enemy until you know the enemy. It's a bit of a relief to hear that the metronidazole is unlikely to work for other causes. Yay for better differential diagnoses!!

    Definitely no antibiotics in the last 2-3 years (maybe he had them when he got stitches in 2010, but I really don't recall the specifics), and the omeprazole was about a year ago, a 2-3 month trial with no real effect. Why do you ask?



  12. #12
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    Quote Originally Posted by mswillie View Post
    Metronidazole is also effective against giardia. Horses are known carriers and I think are often asymptomatic.

    I hope your horse fully recovers and stays healthy.
    Thanks for the well-wishes Is giardia chronic, or could it be episodic? I'm no vet, but it seems weird that bacterial problems would kind of resolve themselves, or recur, based on seasons instead of treatments.

    Like I said, it's really only at *problem* in the winter, though he has always left a bit of poop on his butt cheeks under the tail so he is looser than most horses all the time. Or at least has been for the past several years that I've been paying close attention.

    Sounds like it might be worth the time investing in a really GOOD pre/probiotic for at least a month or so to repopulate his gut, then maybe look at an easier formula. It's a big barn and though my BO is committed to getting this taken care of, too, I don't want to make things unnecessarily complex for her.



  13. #13
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    Quote Originally Posted by mswillie View Post
    Metronidazole is also effective against giardia. Horses are known carriers and I think are often asymptomatic.

    I hope your horse fully recovers and stays healthy.
    Thanks for the well-wishes Is giardia chronic, or could it be episodic? I'm no vet, but it seems weird that bacterial problems would kind of resolve themselves, or recur, based on seasons instead of treatments.

    Like I said, it's really only at *problem* in the winter, though he has always left a bit of poop on his butt cheeks under the tail so he is looser than most horses all the time. Or at least has been for the past several years that I've been paying close attention.

    Sounds like it might be worth the time investing in a really GOOD pre/probiotic for at least a month or so to repopulate his gut, then maybe look at an easier formula. It's a big barn and though my BO is committed to getting this taken care of, too, I don't want to make things unnecessarily complex for her.



  14. #14
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    Metronidazole is effective against protozoans & anaerobic bacteria so I'm not sure how it was sorted that horse has a bacterial rather than a protozoan "infection"

    I'd be inclined to just follow the vet's recommendation of EquiOtic - the daily feed packets look to be very easy to dose; you might also ask SmartPak about duplicating this sort of probio level
    Each 7g administration contains 10 billion of Equine Lactobacillus reuterii and 10 billion of saccharomyces boulardii.
    EquiOtic emphasizes that they have equine sourced gut bacteria, this may/may not be a valid consideration - unless the cost is prohibitive, I'd start with the vet's recomendation & then switch over to a cheaper alternate after a couple of weeks.


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  15. #15
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    How about a poop transplant?

    Not really kidding. Seems to be working well for humans...

    http://www.mayoclinic.org/medical-pr...cent-cure-rate

    could work for c. diff or any opportunistic & chronic infection

    This was done by vets & farmers well b/f human docs. cud "transplants" for ill cattle & I do remember hearing about my mother's boss (OLD timer - died in 1985) doing this.


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  16. #16
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    Metronidazole really worked well for my ex-BO's pony's summer diarrhea. Which I think was caused by the anaerobic bacteria in her well. The pony got diarrhea one summer after they'd lived there about 5 yrs. So after treatment, he did not get diarrhea the next summer, but did the summer after that. I bought him some more metronidazole and it worked again. (Yes the horses were on Equi-Aid so it was not sand.) I bleached my horse's water buckets and trough frequently to help prevent this from happening. So check you water for anaerobic bacteria. (My BO had very frequent diarrhea. I told her to have her well checked.)
    ETA I read about the feces donation in the New York Times a while back. What a friend to have, who would donated daily his feces. And the donations worked to transfer "good" bacteria to the other guy's colon.



  17. #17
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    Quote Originally Posted by alto View Post
    Metronidazole is effective against protozoans & anaerobic bacteria so I'm not sure how it was sorted that horse has a bacterial rather than a protozoan "infection"

    I'd be inclined to just follow the vet's recommendation of EquiOtic - the daily feed packets look to be very easy to dose; you might also ask SmartPak about duplicating this sort of probio level


    EquiOtic emphasizes that they have equine sourced gut bacteria, this may/may not be a valid consideration - unless the cost is prohibitive, I'd start with the vet's recomendation & then switch over to a cheaper alternate after a couple of weeks.
    Well I did type bacterial but also listed giardia which is protozoal. Calm down The OP has a vet and no one here is making any formal diagnoses or sending a bill.

    OP - I asked about recent antibiotic exposure or omeprazole because both of those can alter natural GI flora and increase risk of acquiring C.diff (in humans - not a lot of equine studies linking except for this little one http://www.ncbi.nlm.nih.gov/pubmed/22594032).



  18. #18
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    Quote Originally Posted by rockfordbuckeye View Post
    Well I did type bacterial but also listed giardia which is protozoal. Calm down
    Not likely!
    Metronidazole was first discovered/characterized as an anti-protozoal so I hate when it gets termed an antibacterial drug foremost

    It was actually this "conclusion" that excited my protest
    Hey, I'm just glad we seemed to have narrowed it down to a bacterial problem.



  19. #19
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    Hah I <B infectious disease too so I understand. I actually didn't type protozoal b/c I wasn't sure anyone would understand what I was talking about. Sometimes I get a little excited on the boards as well. Eager to help, eager to share what I know if it can make an outcome better for a horse.



  20. #20
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    KILL ALL THE FLAGELLATES


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