OUTPATIENT PARVOVIRUS: DOES IT WORK? DR. JUSTINE A. LEE, DVM, DACVECC, DABT
(cont)
6 PROGNOSIS The prognosis for canine parvovirus infection is fair to good with treatment, with recent reports of 80-90% survival with various modalities of treatment. 9 When financial limitations exist, one can consider the outpatient protocol. This outpatient protocol can be successful, with a survival only slightly lower in outpatients. 9 A modified outpatient protocol may be a good alternative for less severely affected cases or those with financial limitations. 7 PREVENTION While vaccination against parvovirus is highly effective, failure of passive transfer, early weaning, lack of vaccination, inappropriate client education (e.g., frequency of veterinary visits), or maternal antibody interference can result in disease. Parvovirus can be easily prevented by appropriate client education and vaccination. As DHPP is considered a core vaccine, puppies should be vaccinated frequently while maternal antibodies are waning. In high-risk areas (e.g., shelters), a vaccine every 2 weeks is indicated until 16-22 weeks of age (depending on if the breed is at risk) to prevent outbreaks. Pet owners should be educated on the importance of preventative medicine. LEARN MORE References available upon request. NOTE: When in doubt, all drug dosages should be confirmed and cross-referenced with a reference guide such as Plumb’s Veterinary Drug Handbook.
Gastrointestinal support Anti-emetics (e.g., maropitant, ondansetron, dolasetron) should be implemented for patient comfort and to treat nausea. As for the use of gastric pH-altering medication, it is not necessarily warranted in the CPV patient. Outpatient protocol Earlier last year, Venn et al out of Colorado State University published “Evaluation of an outpatient protocol in the treatment of canine parvoviral enteritis” in the Journal of Veterinary Emergency Critical Care . 9 In this prospective, randomized study, 20 inpatient puppies were compared to 20 modified “outpatient” puppies. Both groups of dogs received IV fluid resuscitation on presentation, venous blood gas and blood glucose monitoring and initial treatment for hypoglycemia. 9 The inpatient group was treated with continued IV fluids, cefoxitin (22 mg/kg, IV, q 8), maropitant (1 mg/kg, IV, q 24), dextrose and potassium supplementation, and nutritional support (e.g., syringe fed 1 ml/kg, PO, q 6). 9 The modified outpatient group was treated in- hospital (for monitoring purposes, as to mimic outpatient care) with subcutaneous fluids (30 ml/kg, SQ, q 6), cefovecin sodium (Convenia™) (8 mg/kg, SQ, once), maropitant (1 mg/ kg, SQ, q 24), and nutritional support (e.g., syringe fed 1 ml/kg, PO, q 6). 9 In the in-patient group, 90% survived to discharge, with a median duration of hospitalization being 4.6 days + 2
days. 9 In the modified outpatient group, a similar survival was seen (80%), with a median duration of hospitalization being 3.8 days + 1.8 days. 9 The outpatient group did have more frequent electrolyte disturbances, with approximately 50% requiring dextrose supplementation and 60% requiring potassium supplementation. 9 Non- survivors in the study (of the outpatient group) were also more likely to have a lower body weight < 4 kg and were more likely to be younger < 4 months of age. 9 Based on this study, veterinary professionals can consider this potential modified outpatient therapy. Keep in mind that young, smaller puppies (< 4 kgs, < 4 months) had a poorer survival outcome and may need more aggressive in-hospital therapy. 9 Also, in the author’s opinion, modification to this protocol could include the use of aggressive IV fluid therapy for 24 hours, followed by attempts at outpatient therapy once the patient is more hydrated and stabilized. Likewise, for the modified outpatient group, the use of a larger amount of SQ fluid administration (e.g., 50-60 ml/kg, SQ, q 8) to help minimize stress to the patient. Most importantly, client communication and compliance is imperative to prevent patients from dying at home; humane euthanasia should be considered if patients fail to respond to outpatient therapy. More importantly, appropriate pet owner education on preventative medicine (e.g., vaccination) is necessary.
15
vetgirlontherun.com
Made with FlippingBook - Online Brochure Maker