Giardia And Metronidazole

[Beyond Confused]

Hello, good people.

I was just researching the treatment of using Metronidazole for Giardia, and I was hoping someone could help me out.

My kitty has been having some health issues, and the vet has been trying to rule things out one by one.

In the past 4 months, he's had some vomiting spells, sometimes once or twice, and one other time, I took him to the ER vet for Cerenia. He also had/has soft stools, at times, bordering on diarrhea.

Long story short, since I have a few threads going in the forums, after the ER visit, he has been on a few different medications to help with the nausea and diarrhea/soft stools, while the vet figures things out.

He had been on 2 different rounds of a low dose of Metronidazole, and then the vet changed it to Tylosin for a week. That didn't seem to be working, honestly, so I let the vet know. Once the blood work, fecal, and urinalysis tests all came back, they said he has Giardia. We're still looking for other things as well to be safe.
As of Friday night, they upped the Metro to 3/4 of a 250mg tablet/24 hours. Does that sound crazy? I've looked at the bottle several times to see if maybe it really say 25.0 mg, but I'm pretty sure I'm seeing it correctly. When they were filling this RX, I asked if maybe we should try a different med, since the Metro hadn't been working, and the nurse said that he was on a low dose before, but this dose is proper for Giardia. Looking online, though, it sounds like it's too high, and I've read about toxicity. Does this dose seem right? I will call them tomorrow, but I was wondering if anyone else has had experience with this.

Background: He's 9lbs, 10 yo, he's also currently on a bland rx diet, a low dose of Cerenia (5 days on/3 off), 1/4 tablet of Pepcid (1x/day), and 1 mg of Metocloprimide (2x/day).

 

[FeebysOwner]

@Kieka - do you know of any members who could help with B Beyond Confused question?

Or, perhaps, @GoldyCat, @denice??

 

[Beyond Confused]

The vet actually texted the info to me Thursday, so I was just re-reading those. She definitely says on the text 250 mg, so I read the bottle correctly.

Correction from the first post, I meant to put 1 ml of Metocloprimide (2x/day), not mg.

 

[UnderneathTheStars]

Hello, good people.

I was just researching the treatment of using Metronidazole for Giardia, and I was hoping someone could help me out.

My kitty has been having some health issues, and the vet has been trying to rule things out one by one.

In the past 4 months, he's had some vomiting spells, sometimes once or twice, and one other time, I took him to the ER vet for Cerenia. He also had/has soft stools, at times, bordering on diarrhea.

Long story short, since I have a few threads going in the forums, after the ER visit, he has been on a few different medications to help with the nausea and diarrhea/soft stools, while the vet figures things out.

He had been on 2 different rounds of a low dose of Metronidazole, and then the vet changed it to Tylosin for a week. That didn't seem to be working, honestly, so I let the vet know. Once the blood work, fecal, and urinalysis tests all came back, they said he has Giardia. We're still looking for other things as well to be safe.
As of Friday night, they upped the Metro to 3/4 of a 250mg tablet/24 hours. Does that sound crazy? I've looked at the bottle several times to see if maybe it really say 25.0 mg, but I'm pretty sure I'm seeing it correctly. When they were filling this RX, I asked if maybe we should try a different med, since the Metro hadn't been working, and the nurse said that he was on a low dose before, but this dose is proper for Giardia. Looking online, though, it sounds like it's too high, and I've read about toxicity. Does this dose seem right? I will call them tomorrow, but I was wondering if anyone else has had experience with this.

Background: He's 9lbs, 10 yo, he's also currently on a bland rx diet, a low dose of Cerenia (5 days on/3 off), 1/4 tablet of Pepcid (1x/day), and 1 mg of Metocloprimide (2x/day).

Can't give advice about dosage but thought I'd throw my two cents in about Metro and possible tests you guys could try.

We went through two treatments of Metro for our Mousse who came to us with chronic diarrhea (she is 10 years old). The vet at first assumed giardia. The first treatment did wonders. The diarrhea stopped and she was fine. But a week after the first treatment her symptoms came back. Metro does have anti-inflammatory properties so it helps with diarrhea in a lot of cases while the pet is on it. Anyway, the vet suggested another round but we didn't get through the whole treatment because this time it caused anorexia and extreme lethargy. She couldn't afford to lose more weight so we stopped. That's when I began to research and joined the IBD Cats Facebook group to ask questions. I decided to switch to raw food which helped a little but not 100%. I then asked my vet to run a B12/EPI test. It's a blood test that requires fasting, it was a little pricey ($175), and had to be sent out. It came back showing results that point towards IBD and she had low B12. So we stuck with the raw food, did s.boulardii probiotic supplements, sucralfate liquid twice a day for three weeks, and started giving weekly B12 injections from home. She is no longer the same cat. The diarrhea has stopped and she has gained over a pound. She is no longer on the sucralfate and is now maintained on the probiotics, raw diet, and B12 injections.

So, if the Metro doesn't work this time I would definitely ask for a B12 test and an EPI test to get a read of her TLI levels. I'll keep you in my thoughts!

 

[kashmir64]

If it's truly Giardia, he needs to be on Panacur as well as an antibiotic. Giardia is a protozoa parasite and antibiotics alone will not get rid of it. Also, since he's been on Met for a while, his stomach is very messed up. Give him a dose of probiotics once a day. About 2 hours after the Met. I'm not sure about the doses needed for a cat that size.
If you aren't using it already, switch to clay litter. Dump and wash the litter box every day.
Right now, I have to go deal with my pump, but I have many posts on the sterilization of Giardia. If you can't find them, I will be back to try to find one and link it here.

 

[Beyond Confused]

Can't give advice about dosage but thought I'd throw my two cents in about Metro and possible tests you guys could try.

We went through two treatments of Metro for our Mousse who came to us with chronic diarrhea (she is 10 years old). The vet at first assumed giardia. The first treatment did wonders. The diarrhea stopped and she was fine. But a week after the first treatment her symptoms came back. Metro does have anti-inflammatory properties so it helps with diarrhea in a lot of cases while the pet is on it. Anyway, the vet suggested another round but we didn't get through the whole treatment because this time it caused anorexia and extreme lethargy. She couldn't afford to lose more weight so we stopped. That's when I began to research and joined the IBD Cats Facebook group to ask questions. I decided to switch to raw food which helped a little but not 100%. I then asked my vet to run a B12/EPI test. It's a blood test that requires fasting, it was a little pricey ($175), and had to be sent out. It came back showing results that point towards IBD and she had low B12. So we stuck with the raw food, did s.boulardii probiotic supplements, sucralfate liquid twice a day for three weeks, and started giving weekly B12 injections from home. She is no longer the same cat. The diarrhea has stopped and she has gained over a pound. She is no longer on the sucralfate and is now maintained on the probiotics, raw diet, and B12 injections.

So, if the Metro doesn't work this time I would definitely ask for a B12 test and an EPI test to get a read of her TLI levels. I'll keep you in my thoughts!

Wow, you've been through just as much, if not more, than I'm going through right now!

He DID test positive for giardia, and I'm waiting to hear back on the results of his xrays. January 10th, we have an ultrasound scheduled. I'm hoping all this combined will help her figure out what's wrong.

I know raw is supposed to be the way to go, but....
Long story short - I didn't get a wink of sleep last night because I'm so worried about him. My anxiety levels were through the roof, I was having difficulty breathing, and I wasn't able to take my medication that I have on hand for that. More on that in a sec...

Early last year, when my other kitty was having a lot of vomiting episodes, I started messing with their food. I wanted so badly to get them on a natural wet food, and I tried a few. Finally, I found one that they both really liked - Nature's Variety pate. The trouble is, Duncan is on the verge of being underweight, like your kitty, and he doesn't each much. He nibbles on food here and there, and he constantly needs food to be out, or he throws up foam. I've tried scheduled feedings, and it didn't work. I guess he decides he's 10, and he wants what he wants.

Because of this, I left the wet food out, most likely, too long each day. This went on for some time. Last summer, I started noticing his fur was a little thin on one side. I had bought one of those furminator brushes, and shortly after, my groomer said "DON'T USE THAT THING! If you start noticing thinning fur, it could be from that." So, I assumed that's what was going on. A year later, and his fur continued to get thinner. I asked my previous vet, and they blew it off. Now that I'm with a new vet, she's taking his issues seriously, and she's testing for everything. One of her theories was that his raw, wet diet being left out for him to graze on may have contributed to what's going on.

So last night, I was up all night with constant worry about whether or not I have caused his problems. I have a lot of guilt, and I'm wondering if he's going to get better. I'll stop there, but I'm sure you get the point.

Thank you for sharing your story and your tips. I greatly appreciate that. For food, though, I think I'm going to stick with dry because I am so torn up about this.

I do believe IBD is one of the things she's leaning toward. The nurse also mentioned kidney issues and lymphoma, though I'm sure the list didn't end there.

He had a full blood work up (that's twice within 2.5 months), and both times, everything looked good except one kidney had slightly elevated levels. His urinalysis came back good, though, so she said she's not worried about his kidneys. The numbers were the same both times. For Christmas, I got a fountain, and he's really taken to it. Hopefully it will help keep him hydrated.

I weigh him every few days on my scale, but it's been accurate with theirs. Mine only does half pounds, but I figure it's close enough. He's been holding steady at 9# for months, so that's a blessing.

One last thing - you mentioned probiotic supplements. Which one do you give your kitty? Is it a powder? They had me try to give him the purina flora-something, and it didn't go over well. He refused to eat the food I put it on.

 

[Beyond Confused]

If it's truly Giardia, he needs to be on Panacur as well as an antibiotic. Giardia is a protozoa parasite and antibiotics alone will not get rid of it. Also, since he's been on Met for a while, his stomach is very messed up. Give him a dose of probiotics once a day. About 2 hours after the Met. I'm not sure about the doses needed for a cat that size.
If you aren't using it already, switch to clay litter. Dump and wash the litter box every day.
Right now, I have to go deal with my pump, but I have many posts on the sterilization of Giardia. If you can't find them, I will be back to try to find one and link it here.

Do you have any suggestions on how to give the probiotics? We tried the one by Purina, but he refused to eat anything with it. Funny thing is, the vet's office told me it's used as a stimulant to encourage eating.

I have used EverClean with activated charcoal for years because it's the best I've ever used. Is that clay?

 

[Beyond Confused]

Right now, I have to go deal with my pump, but I have many posts on the sterilization of Giardia. If you can't find them, I will be back to try to find one and link it here.

I did find this from you:
Giardia - Please Help An Overwhelmed Cat Mom :(

I saw a very thorough posting on here the other day about an insane list of things to do with this illness. I asked the nurse at the clinic, and she told me all that wasn't necessary.

Oh goodness, I am so confused and overwhelmed, I want to cry.

I have 2 litter boxes for him. Perhaps I should switch to using just one for now, so I'm not spending my entire life dumping and cleaning the boxes. My dad was over here Saturday night, and we completely dumped them and cleaned them with Dawn. Since then, I have scooped his box every time he's used them.
And like I said in my other post, I use EverClean with activated charcoal, and that is clay. I looked it up to confirm.

I always wash my hands after cleaning his box. The thought of not makes me ill. I've always been that way, so it's nothing new.

I'm really worried about all the meds he's on, and after reading various posts, I'm concerned he's not being given the right things, and he's being overloaded with them.

This is just awful.

 

[UnderneathTheStars]

You've been through a lot too! It's super hard when our fur babies are ill (especially if we can't figure out the treatment or diagnosis). I wish I could give giardia-specific advice but I can't since my cat ended up not having it. We never did a specific test the vet kind of just assumed and it was only after the failed second attempt at Metro that we had some stool samples sent out and there was no giardia. I'm sure others will chime in about the giardia, though.

It's good he likes the fountain! Hydration is super important. If you ever decide to go raw, try Stella and Chewy Duck Duck Goose. It's dehydrated in nuggets and you simply add water and allow it to rehydrate. My cat likes it in nugget form so I try to keep it formed but some people shred it once it has been rehydrated. I had tried frozen raw but she hated it and also wouldn't touch homemade. It took a few weeks to notice a difference but I was surprised with how much improvement she made on it. Of course, no judgement if your cat just won't take to it or if finances are an issue. We all do our best. Another thing to rule out would be food intolerance (not allergy). A lot of cats have issues with chicken or fish which is why I went with the Duck Duck Goose food.

For the probiotic, many vets prescribe FortiFlora for cats. It's like kitty-crack. Cats love the taste of it on food so I'm surprised yours didn't but every can is different. It's NOT a great probiotic as there's only one strain in it. If you go to the store and look where they sell human probiotics, there's a type called s. boulardii. Try to get just simple s.boulardii without other probiotics added for now. Try to get it with a high CPU. It has been a miracle worker. I do half a capsule (just open it and sprinkle the contents on food) twice a day but I started off smaller. It has amazing benefits. Google "S. boulardii for cat diarrhea" or join the FB group I told you about they are a wealth of information. BeneBac paste is also pretty good for cats as it contains multiple strains and it's for pets (check Petsmart, Petco, or a local pet store). Remember to start slowly. Before I got the sucralfate from the vet, I also used slippery elm powder in her food for diarrhea and you can make a syrup from the slippery elm with water and it helps with nausea if that's also an issue. The sucralfate liquid does pretty much the same thing as the slippery elm (coats the stomach and intestines and reduces inflammation) but the slippery elm is also a fiber which can help add bulk to stool. It's in the supplements section at most stores like Walgreens. It's a human supplement but completely safe for cats just make sure to wait 2 hours before or after giving meds. Since it coats the intestines, it can stop medicine absorption or lessen it if given too close together. I used to only do the slippery elm once at night because I feared she wouldn't absorb all her nutrients.

Since B12 injections are safe and any excess is excreted in urine, it might be good to bring it up to the vet as it can really help with proper absorption and reducing intestinal problems. If your kitty does have B12 problems stuff like s.boulardii and slippery elm won't help much. Some vets are willing to prescribe it without the costly B12 test although I would still eventually do it just to be safe.

Feel free to ask any other questions you may have!

 

[kashmir64]

It's not an insane list. Not only can Giardia come back since it lives in the environment for a year, but it is also not species specific which means your other animals or even you can get this. Vets or nurses may not agree with the methods, but this is the main way to control this. Your guy has been through enough, he needs to get better.
It actually doesn't take that long. Less than 5 minutes to dump and sterilize the litter box.
I realize it may seem overwhelming, but you can do this. It's for the health of your loved cat, and if you get into a routine, then it just flows and you just do it.
As far as a probiotic. I've have used Bene-Bac on all my animals. It's a paste in a tube and easy to administer.

Calm down. You will get through this. Just take one step at a time. I used to make a list and count down in my head. Something like "ok, 10 things to do" - then I do the first thing, "nine things to do" and so on. It makes the job seem not so overwhelming.

 

[Beyond Confused]

You've been through a lot too! It's super hard when our fur babies are ill (especially if we can't figure out the treatment or diagnosis). I wish I could give giardia-specific advice but I can't since my cat ended up not having it. We never did a specific test the vet kind of just assumed and it was only after the failed second attempt at Metro that we had some stool samples sent out and there was no giardia. I'm sure others will chime in about the giardia, though.

It's good he likes the fountain! Hydration is super important. If you ever decide to go raw, try Stella and Chewy Duck Duck Goose. It's dehydrated in nuggets and you simply add water and allow it to rehydrate. My cat likes it in nugget form so I try to keep it formed but some people shred it once it has been rehydrated. I had tried frozen raw but she hated it and also wouldn't touch homemade. It took a few weeks to notice a difference but I was surprised with how much improvement she made on it. Of course, no judgement if your cat just won't take to it or if finances are an issue. We all do our best. Another thing to rule out would be food intolerance (not allergy). A lot of cats have issues with chicken or fish which is why I went with the Duck Duck Goose food.

For the probiotic, many vets prescribe FortiFlora for cats. It's like kitty-crack. Cats love the taste of it on food so I'm surprised yours didn't but every can is different. It's NOT a great probiotic as there's only one strain in it. If you go to the store and look where they sell human probiotics, there's a type called s. boulardii. Try to get just simple s.boulardii without other probiotics added for now. Try to get it with a high CPU. It has been a miracle worker. I do half a capsule (just open it and sprinkle the contents on food) twice a day but I started off smaller. It has amazing benefits. Google "S. boulardii for cat diarrhea" or join the FB group I told you about they are a wealth of information. BeneBac paste is also pretty good for cats as it contains multiple strains and it's for pets (check Petsmart, Petco, or a local pet store). Remember to start slowly. Before I got the sucralfate from the vet, I also used slippery elm powder in her food for diarrhea and you can make a syrup from the slippery elm with water and it helps with nausea if that's also an issue. The sucralfate liquid does pretty much the same thing as the slippery elm (coats the stomach and intestines and reduces inflammation) but the slippery elm is also a fiber which can help add bulk to stool. It's in the supplements section at most stores like Walgreens. It's a human supplement but completely safe for cats just make sure to wait 2 hours before or after giving meds. Since it coats the intestines, it can stop medicine absorption or lessen it if given too close together. I used to only do the slippery elm once at night because I feared she wouldn't absorb all her nutrients.

Since B12 injections are safe and any excess is excreted in urine, it might be good to bring it up to the vet as it can really help with proper absorption and reducing intestinal problems. If your kitty does have B12 problems stuff like s.boulardii and slippery elm won't help much. Some vets are willing to prescribe it without the costly B12 test although I would still eventually do it just to be safe.

Feel free to ask any other questions you may have!

Thank you, I will definitely look "S. boulardii for cat diarrhea" up.

I'm one of those "weird" people - I don't have FB. I dropped it almost 3 years ago, as a birthday present to myself.

I will ask my vet about the other items you mentioned as well. Currently, the poor thing is on 3 different nausea meds and metro, until we can get the ultrasound done.

I did ask about food intolerance, but she feels like that isn't an issue, at least not yet. She wanted to check other more pressing potential issues first before going down that path. I can respect that.

 

[Beyond Confused]

It's not an insane list. Not only can Giardia come back since it lives in the environment for a year, but it is also not species specific which means your other animals or even you can get this. Vets or nurses may not agree with the methods, but this is the main way to control this. Your guy has been through enough, he needs to get better.
It actually doesn't take that long. Less than 5 minutes to dump and sterilize the litter box.
I realize it may seem overwhelming, but you can do this. It's for the health of your loved cat, and if you get into a routine, then it just flows and you just do it.
As far as a probiotic. I've have used Bene-Bac on all my animals. It's a paste in a tube and easy to administer.

Calm down. You will get through this. Just take one step at a time. I used to make a list and count down in my head. Something like "ok, 10 things to do" - then I do the first thing, "nine things to do" and so on. It makes the job seem not so overwhelming.

I definitely need to calm down, no doubt about it. My mom keeps telling me that, too. Unfortunately, I have a bit of an obsessive personality, and I will drive myself absolutely insane reading and overthinking things.

I can get into the habit of cleaning his box daily, I just think I need to take it down to one box until he gets through this. His boxes are very large and cumbersome, so dragging them downstairs to the basement, tearing them apart, cleaning them, and then putting them back together, and move in reverse is a lot with two, especially since he's never been very active in the litter box...meaning, he goes a few times a day, and there's never a whole lot to clean out.

I will have to look up Bene-bac. Do you just put it on your finger and let him lick it off? Not to be difficult, but I've tried something similar before for URI, and he wouldn't take it. He showed no interest. Why can't everything be liquid? He's a champ with that! Do you happen to know of a liquid probiotic? I can google, too, but I didn't know if you'd know right offhand.

 

[kashmir64]

It comes in a tube with a click lock. You just lock it on the dose you need and squirt it in the mouth.
I don't know of one that is liquid, but that doesn't mean there isn't one.

Edit: Can you get a smaller, less cumbersome box, just for the time being?

 

[Beyond Confused]

Perhaps I should get a smaller box. You're right.

I did find some liquid probiotics. The first link shows the S. boulardii that Underneath mentioned. Do either of you have time to look at the ingredients to see which is the best option? For whatever reason, I can't put the amazon link, but the name of the first one is below.

NutraVet Pro20 Probiotics for Dogs and Cats with Natural Digestive Enzymes an Alternative Digestive Enzyme - Pet Supplement to aide Digestion with Prebiotics for Gas, Constipation and Leaky Gut

Nutri-Vet Probiotics with Wild Alaskan Salmon Oil for Cats, 4-oz bottle - Chewy.com

(CAT) USDA Organic Liquid Probiotic for CATS by MaryRuth Organics Pet- 100% Plant Based

 

[kashmir64]

Neither of those say what the CFU count is or how many microorganisms they have. Or if they did, I didn't see it.
I personally wouldn't trust something that didn't have that info.
Here is a link for Bene-Bac. It's not from Amazon, but I would think they have it.
Bene-Bac® Plus Pet Gel | PetAg

 

[Beyond Confused]

Neither of those say what the CFU count is or how many microorganisms they have. Or if they did, I didn't see it.
I personally wouldn't trust something that didn't have that info.
Here is a link for Bene-Bac. It's not from Amazon, but I would think they have it.
Bene-Bac® Plus Pet Gel | PetAg

Thanks for checking and the link. Do you give this daily, or do you do follow the directions of 2 doses, 3 days apart?

 

[kashmir64]

I gave a dose every day for about 10-14 days (honestly can't remember which). But, you should probably follow the directions since yours will be a fresh, new tube. Mine was a few months old.

 

[Beyond Confused]

I stopped in at the vet's office, and was still not given the results of the xray done last Wednesday.

That being said, I ended up buying back the Fortiflora just to get something going here. I mixed it with enough water to fill a syringe, and I gave it to him that way. I wish they would have suggested it before when I said he wouldn't eat his food with this sprinkled on top. Anyway, I just gave it to him, and he's not even mad. Hopefully this will help to get his tummy settled from all the meds, so his stools can start to firm up.

I also picked up a small litter box, and I'll get that all set up tonight, once I have time to get some sleep. I'm beat!

 

[Beyond Confused]

I finally heard back from the vet this morning, and I'm a bit concerned. Actually, I would say I'm "really concerned," but I need to learn to take deep breaths and relax.

Of course, Duncan tested positive for Giardia, but this morning, she gave me the results of the x-ray.
She said they're "a bit questionable. It's hard to see his stomach and liver margins." She said it could be nothing, but it could also mean something is there like liver or stomach enlargement or pancreatitis or a growth. We have an ultrasound scheduled for the 10th, so we'll know more after that.

She also said that here was a small amount of blood in his urine when they did the urinalysis, no white blood cells or bacteria, though. She said that sometimes during collection, tiny blood vessels leak into the sample. She thinks that's the case here. The ultrasound should tell us more about his bladder as well.

When she did the x-ray, urinalysis, and fecal, she also did a full blood work up, and everything came back fine there. The only thing she noted was that one kidney was slightly elevated, but she thinks that was due to dehydration. He now has a water fountain, and he seems to really enjoy it. Hopefully that will help.

 

[kashmir64]

Honestly, there is nothing you can do until the ultrasound. Keep doing what your doing by giving him good food, fresh water, a warm place to lie down and plenty of love.
When it comes to organs, x-rays can be hard to read. It could be anything from not seeing it properly to all the meds aggravating his stomach and pancreas.
Calm down and take a deep breath. All you can do is wait for clearer pictures with the ultrasound.