persistent antibiotic-associated diarrhea

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E.coli was found in my boy's urine after C&S and the vet prescribed cephalexin for 14 days. He threw up on day 2 and I gave him an antinauseant once then. The vet told me to observe him for another day and he hasn't vomited since with daily mosapride citrate and an antidiarrhea med. The issue now is his diarrhea which started on day 3. It's day 9 and has had diarrhea daily for the last 7 days. We have tried two different antidiarrhea meds but his diarrhea just won't go away. He has been getting Jarrow's saccharomyces boulardii as well. He takes his meds right after meal. Previously, he had diarrhea with clavulox. Is there anything we can try to stop his diarrhea? In-house urinalysis on day 8 at another clinic didn't find any bacteria or wbc. The regular vet is on holiday until next Monday, day 13, when we go in for another C&S. Do we just have to persevere for another 5 days? I don't think stopping the course of this treatment now is a good idea.
 

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Imo, I would reach out to the vet office and see if you can speak with one of the other vets on staff to ask if it's ok to stop the antibiotics. Keflex (brand name) is a pretty heavy duty antibiotic. If he has had consistent diarrhea on it but his urine looked ok on last check, I would advocate to the vet clinic that this is occurring and the reason why you are asking if it's ok to stop.

Casper had felines herpes and would get kitty colds fairly often; he would have to take antibiotics for it. Vet would always prescribe 12-14 days, but by day 10 his BMS would be so bad I'd call and say he's had the runs for a while, can we stop? He's feeling better, no symptoms, yadda yadda. At some point the vet decided to just go with 7 days to avoid prolonging the poopy issues.

If they say it's ok to stop the antibiotics, keep up with the S. Boulardi. You'll certainly see some improvement then.

Good luck, let us know how it goes!
 
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stephanietx

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You can ask the vet for a different antibiotic if possible. You could also ask for Metronidazole, which helps stop diarrhea. If you want to try something natural, make slippery elm bark syrup and add to wet food or syringe into your kitty's mouth.
 

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Hi. This information (see link below) is from a raw feeding website but can be used for any situation involving diarrhea. The bottom line is that you don't limit, but actually even increase, the amount of s. boulardii that you use until you see results. It explains why this is not dangerous in any way.

After that, make sure your cat doesn't get the same antibiotics that you are using now for down the road. And, start your cat on pure D-Mannose, it helps to rid the bladder of not only e coli, but many other bacteria as well. I started giving this to my cat after she had gone through repeated UTIs and after she started taking it she only had one other UTI thereafter - in a 3 year span. It not only helps to rid the bladder of bacteria, but many folks use it for overall bladder health.
How to Use S boulardii for diarrhea - Raw Feeding for IBD Cats

Btw - my cat was consistently on 14 day regimens with the antibiotics in order to ensure the UTI was eradicated. Taking a new C&S in mid stream of an antibiotic can be misleading in that it can appear the UTI has been eradicated when it actually has not.
 
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Imo, I would reach out to the vet office and see if you can speak with one of the other vets on staff to ask if it's ok to stop the antibiotics. Keflex (brand name) is a pretty heavy duty antibiotic. If he has had consistent diarrhea on it but his urine looked ok on last check, I would advocate to the vet clinic that this is occurring and the reason why you are asking if it's ok to stop.

Casper had felines herpes and would get kitty colds fairly often; he would have to take antibiotics for it. Vet would always prescribe 12-14 days, but by day 10 his BMS would be so bad I'd call and say he's had the runs for a while, can we stop? He's feeling better, no symptoms, yadda yadda. At some point the vet decided to just go with 7 days to avoid prolonging the poopy issues.

If they say it's ok to stop the antibiotics, keep up with the S. Boulardi. You'll certainly see some improvement then.

Good luck, let us know how it goes!
Unfortunately, the hospital is closed this week...  When I went to another clinic for his urinalysis yesterday, I told them about his diarrhea and asked for a different antidiarrhea med that was previously effective but so far I don't see improvement.
 
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Hi. This information (see link below) is from a raw feeding website but can be used for any situation involving diarrhea. The bottom line is that you don't limit, but actually even increase, the amount of s. boulardii that you use until you see results. It explains why this is not dangerous in any way.

After that, make sure your cat doesn't get the same antibiotics that you are using now for down the road. And, start your cat on pure D-Mannose, it helps to rid the bladder of not only e coli, but many other bacteria as well. I started giving this to my cat after she had gone through repeated UTIs and after she started taking it she only had one other UTI thereafter - in a 3 year span. It not only helps to rid the bladder of bacteria, but many folks use it for overall bladder health.
How to Use S boulardii for diarrhea - Raw Feeding for IBD Cats

Btw - my cat was consistently on 14 day regimens with the antibiotics in order to ensure the UTI was eradicated. Taking a new C&S in mid stream of an antibiotic can be misleading in that it can appear the UTI has been eradicated when it actually has not.
My understanding is that d-mannose works with a certain strain of e.coli only. Are you sure it works with other bacteria as well?
I put him on the heavy dose of d-mannose initially before starting the antibiotic but that didn't get rid of his e.coli.

I didn't do C&S on day 8. It was just to see if the bacteria was still present in large numbers, which meant the med was not working. I will do C&S on Monday and again 10 days after that.

I also followed the S boulardii emergency stop instructions which didn't work for him but I'll increase the amount to 1 capsule every 2 hours now.
 
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You can ask the vet for a different antibiotic if possible. You could also ask for Metronidazole, which helps stop diarrhea. If you want to try something natural, make slippery elm bark syrup and add to wet food or syringe into your kitty's mouth.
I don't want to put him on a different antibiotic to start over again. Chances are he will have diarrhea with different antibiotics and the choices for different antibiotics are rather limited at this stage and some come with an increased risk to the kidneys. Vet didn't want to prescribe Metronidazole to stop diarrhea in the past, saying it's the practice of the past. I should've bought slippery elm bark.... if I order it now, it won't be delivered before next week. I only have cornsilk, marshmallow root, and hawthorn berry.
 

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My understanding is that d-mannose works with a certain strain of e.coli only. Are you sure it works with other bacteria as well? I put him on the heavy dose of d-mannose initially before starting the antibiotic but that didn't get rid of his e.coli.
D-Mannose will not get rid of an infection once it has started. It is merely used to rid the bladder of bacteria than can lead to an infection, because the bacteria are allowed to colonize. I am having trouble finding the original article I had about d-mannose, but the bottom line is that d-mannose will adhere to any bacteria that are not smoothed-surfaced cells. E coli and many others are not smoothed surfaced and the d-mannose adheres to them and they are flushed out of the bladder with urination. I will continue to look for that article, it explains it better than I can.
 
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D-Mannose will not get rid of an infection once it has started. It is merely used to rid the bladder of bacteria than can lead to an infection, because the bacteria are allowed to colonize. I am having trouble finding the original article I had about d-mannose, but the bottom line is that d-mannose will adhere to any bacteria that are not smoothed-surfaced cells. E coli and many others are not smoothed surfaced and the d-mannose adheres to them and they are flushed out of the bladder with urination. I will continue to look for that article, it explains it better than I can.
Then d-mannose should only be used as a prevention measure, not treatment of e.coli infection. I think lots of people believe d-mannose will treat the infection because many papers still say d-mannose is as effective as antibiotics in treating UTIs.
 
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Helpful read on d-mannose https://www.ahvma.org/wp-content/uploads/D-mannose-Volume-67-Summer-2022.pdf
- Gram-negative rods in the Enterobacteriaceae family (e.coli is one) that contain fimbriae can bind to d-mannose​
- "One factor in bacterial susceptibility to D-mannose is the presence of the FimH receptor; not all members of the Enterobacteriaceae, or even some strains within a species which tend to have the FimH receptors, actually possess them"​
- Not all species of bacteria bear the mannose-binding capacity​
- "If the bacterial species present is mannose resistant, there will be no benefit to administering D-mannose to a patient. If there is no improvement in clinical signs within 24 hours, alternative treatments must be pursued. D-mannose will also be ineffective if the pathogenic bacteria are protected in a biofilm on the bladder mucosa "​
- "Although there is less information to support the treatment of acute infections, there is support for its use to help decrease colonization and therefore reduce bacterial numbers available for induction of disease"​

I would consider giving him d-mannose daily but am worried about the effect of the long-term use on his kidneys.
 

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Then d-mannose should only be used as a prevention measure, not treatment of e.coli infection. I think lots of people believe d-mannose will treat the infection because many papers still say d-mannose is as effective as antibiotics in treating UTIs.... I would consider giving him d-mannose daily but am worried about the effect of the long-term use on his kidneys.
There may be people who think d-mannose can cure an infection, and I have read some misleading stuff alluding to that. But, as you now know, that is not the case. And the data you found was a much more precise way of saying what I originally said.

However, what information did you read that suggested to you that it is harmful to the kidneys? Is that in some part of the article that you did not quote (I didn't read the entire article)? I never came across that when I researched its use. I do know that repeated UTIs can't be any better for a cat's urinary tract. From what I have read, some studies suggest that d-mannose, when used in appropriate doses, may actually be beneficial for urinary tract health, which indirectly supports kidney health.

It also kept my cat off of repeated antibiotic treatments.
 
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The article actually says that even with e.coli, not all strains of that can bind to d-mannose, certainly not all other bacteria even if they are rod shaped since they don't all possess the FimH receptors.
Also, I didn't copy the links to other studies but many of them suggest that d-mannose could clear up certain bacterial infection in humans. One study is titled "Why d-Mannose May Be as Efficient as Antibiotics in the Treatment of Acute Uncomplicated Lower Urinary Tract Infections"

There's not enough evidence or research to support how d-mannose actually works with cats, so there's no way of knowing how that affects their kidneys in the long term, but I've also read that in theory d-mannose indirectly supports kidney health by preventing UTIs and reduces the need for antibiotic treatments.
So it seems as long as your cat's kidneys are healthy and they are not immunocompromised or suffer from diabetes, appropriate doses of d-mannose use outweighs the risks, but it's important to understand that it can't inhibit adhesion of all strains of rod-shaped bacteria and that there's not enough evidence to support the treatment of acute infections in cats.

I gave him 10 capsules of Jarrow's s.boulardii throughout the day and night and that has made his diarrhea more frequent. It's possible that this is the initial reaction to the probiotics but I will reduce the dose if I don't see improvement in the next few days.
 

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All any of can do is do our own research and make our own conclusions as to what is best for our cat(s), and then act accordingly. Not all meds/supplements work the same on all cats, and some can cause issues in some cats when they don't in others.

I hope when your boy gets the antibiotics out of his system that the diarrhea will subside, and that regardless of how you choose to treat him that he stays free of further UTIs.

Let us know how he is doing as time passes.
 
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I have given him 10 capsules of s.boulardii daily for 3 days but his diarrhea isn’t getting any better. If anything he now has twice daily diarrhea instead of just once a day, and he also starts leaking while digging in the litter box. I had high hopes for this probiotic.
 

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Hey there,
Have you looked into Animal Biome's GMP? It uses bacteria phages to target both E Coli and Clostridium Diff. KittyBiome™ GMP – AnimalBiome You can also speak to someone who works there and ask about using to stop diarrhea. I've used it with one of my cats who had an overgrowth of E Coli in his colon last year and it worked. It's also worth asking them about their Gut Restore as well since the diarrhea is getting worse and he was on antibiotics. The Gut Restore will give him good bacteria from healthy cats to repopulate what was decimated by the antibiotics and bring things back in balance. KittyBiome™ Gut Restore Supplement – AnimalBiome
 
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I came across AnimalBiome while looking for probiotics the other day. I'm looking for multi-strain probiotics to use after his antibiotic treatment, so maybe order some from them. Incidentally, it has occurred to me that Jarrow's didn't work because I was opening capsules and they got killed off in his acidic stomach before reaching the intestines...
 

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Incidentally, it has occurred to me that Jarrow's didn't work because I was opening capsules and they got killed off in his acidic stomach before reaching the intestines...
Hmmm... Oddly enough, every set of instructions I've seen said the capsules can be opened and sprinkled on food. So, I don't know...
 

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Too much s. boulardii can cause diarrhea. You shouldn't need to give 10 capsules a day. I would give no more than 1 a day.
 

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I want to mention, it is also possible that the antibiotic set something in motion that may have been underlying. I had a cat with numerous health issues end up with a severe UTI. He was on a harsh antibiotic, which caused persistent bad diarrhea. At first they indicated his flora was off balance which caused bacteria to grow. But after treatment for that, the diarrhea still continued. S. Boulardi was only slightly helpful, as we're some other standard treatments.
After additional tests, we discovered he had IBD that had gotten out of control by the above. The end result was placing him on budesonide (since he was a diabetic) to help stop the inflammation.
It may be worth discussing the benefits of a steroid with your vet if nothing seems to be working in your kitty's case.
Keeping you both in my thoughts, I hope he gets better soon. 🙏🏼
 

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Proviable DC is a good probiotic for cats. You can also use Nexabiotic. If your kitty has GI problems, some probiotics can aggravate things and actually exacerbate issues. You might look at the Adored Beast products for a probiotic.
 
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