QUARTERLY BEAT / DECEMBER 2022 ///
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Treatment of Canine Parvovirus
B (Oral)
Give dogs the ” happy vaccine experience ” with fast, one-and-done protection
KRISTIN ZERSEN , DVM, DACVECC Colorado State University Veterinary Teaching Hospital
ampicillin-sulbactam (Unasyn™) is frequently used at a dose of 30-50 mg/kg IV q8hr. Alternatively, cefoxitin may be administered at 22 mg/kg IV q8h. NUTRITION The importance of early nutritional support cannot be underestimated in critically ill patients. Early enteral nutrition has been associated with improved clinical outcome and weight gain in dogs with CPV (Mohr 2003). One study found that dogs receiving early enteral nutrition had a more rapid normalization of attitude and appetite as well as a quicker resolution of vomiting and diarrhea. The most practical method to ensure enteral nutrition is by placement of a nasoesophageal (NE) or nasogastric (NG) tube. An added benefit of NG tubes is the ability to intermittently suction gastric contents, which may also help reduce nausea in these patients. Enteral nutrition is preferred as it is the only way to deliver nutrition directly to the enterocytes and promote healing. Enteral nutrition prevents villous atrophy and helps maintain the GI barrier functions. Parenteral nutrition can be considered in situations when enteral nutrition is not tolerated, but it is technically demanding and includes risks of metabolic, catheter, and formulation complications. OTHER TREATMENT CONSIDERATIONS GI parasitic disease is common in puppies with CPV, so a fecal examination should be performed. Alternatively, prophylactic administration of anthelminthics can be considered. N-acetylcysteine (NAC) is an antioxidant used to treat oxidative stress. A recent study looked at the use of NAC in CPV puppies. They had 2 groups – one group received supportive care and one group received supportive care plus NAC at 70mg/kg IV once daily for 5 days. In this study, the NAC treated group had lower markers of oxidative stress and improved leukocyte counts as compared to the group not treated with NAC, so they concluded that NAC could be considered in CPV puppies.
debilitated nature of most CPV cases, reversible opioids are preferred as titratable CRIs. For cases of mild visceral pain, the partial mu-receptor opioid agonist, buprenorphine, may be considered. Lidocaine can be administered as an IV CRI to enhance visceral analgesia. NMDA receptor antagonists, such as ketamine, help reverse wind-up pain and an exaggerated central response to painful stimuli. The use of a multimodal approach enhances overall analgesia and allows for a relatively low dose of each drug to be used, mitigating the likelihood of unwanted side effects. Due to a compromised gastrointestinal tract and concerns regarding hypovolemia, nonsteroidal anti-inflammatory drugs are contraindicated in the treatment of CPV. Likewise, 2-adrenergic agonists should be used with caution due to their adverse cardiovascular effects. Potential analgesics and doses are listed below: • Fentanyl: bolus 2-4 mcg/kg IV; CRI 2-5 mcg/kg/hr IV • Hydromorphone: 0.05-0.1 mg/kg IV q6hrs; CRI 0.005-0.04 mg/kg/hr IV • Methadone: 0.1-0.5 mg/kg IV q4-6hrs • Buprenorphine: 0.01-0.02 mg/kg IV q6-8hrs • Lidocaine (2%): bolus prior to CRI 0.25-0.5 mg/kg IV; CRI 10-30 mcg/kg/min IV • Ketamine: bolus 0.25-0.5 mg/kg IV; CRI 2-10 mcg/kg/min IV ANTIBIOTICS Intravenous antibiotics are only indicated in leukopenic puppies with CPV; if the puppy has a normal WBC count, antibiotics are not indicated. The author recommends performing a WBC count daily to determine if antibiotics should be prescribed. It is recommended to use the narrowest antimicrobial spectrum and shortest treatment duration possible. Single agent antibiotic options include extended spectrum beta lactams and second-generation cephalosporins. In the author’s hospital, single-agent
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