Diarrhoea after Ronidazole

Our 2 Bengal kittens have had stomach troubles since the day we brought them home from the breeder. Diarrhoea every day, frequent movements, truly foul smell, wind, constant accidents, leaking slime & blood etc etc.

After months of testing for worms, standard parasites etc with no joy, as well as all the diet advice under the sun, we finally got them diagnosed with Tritrichomonas foetus.

Despite the vets trying to advise against using it, we decided to try Ronidazole after doing lots of research online. The vet ordered a dosage of 10mg/kg for each kitten.

We had a few troubles with the administration of the tablets originally but gradually they got used to it and - low and behold - they both began to show drastic signs of improvement within the first 3-4 days.

The diarrhoea eased, they became more lively - even more loopy than normal - but we witnessed none of the neurological side effects we'd read about, so we continued with the treatment.

We reached the end of the 14 day treatment period 2 days ago and whilst Lily, the female, seems to now be absolutely fine, Tiger (her brother) has suddenly descended into the worst bout of diarrhoea we've ever witnessed. It's just leaking out of him to the extent that we've had to shut him in the bathroom this evening as he's covered the lounge, sofa & bed with it.

The poor love clearly can't help it though so he's not being punished. We're just making a vague attempt to keep things clean!

I'm all ready to take him to the emergency vets tomorrow if he's no better.

Does anyone have any advice on this? Could this additional diarrhoea simply be a side effect of the ronidazole? Do you think we'll need to try it again with a dose of 30mg/kg?

The vets don't seem to know much about it all so I'm hoping you guys will!

Many thanks, Claire

There is one long discussion thread from another year that might interest you.  Perhaps your boy had more than one parasite active, and killing off one has made the other stronger?  I have no experience with this parasite (fortunately!) but maybe you can find some help through this thread.

http://www.thecatsite.com/t/167565/need-advice-about-ronidazole-please

while i don't have experience with Tritrichomonis foetus, i'd just recently done some research into this.

from this article --  http://icatcare.org/advice/cat-health/tritrichomonas-foetus-infection-cats

Initial studies suggested that a dose of 30-50mg/kg once to twice daily for two weeks is capable of both resolving clinical signs and potentially eradicating T. foetus but it can also be associated with neurological side effects, plus occasional lethargy and/or vomiting. Therefore, we now recommend 20-30mg/kg once daily for two weeks, which should be reduced for young kittens or cats with hepatopathy to 10mg/kg once daily for two weeks. To ensure that each kitten receives the correct dose, and so reduce the risk of side effects, it is important to weigh the kittens prior to ordering the reformulated capsules.

and,

also, may i ask -- what are your kittens eating, what type/kind of food? i'm asking because this kind of gastro upset can be caused by simply that the cat(s) don't tolerate/do well with a particular type of food or even a particular brand of food. this may not be the case with your Lily and Tiger, but i feel it's something that we might at least bear in mind. bengals sometimes don't do well with the same diet or proteins (or other additives in canned or dry cat foods) that more common domestic cats do.

has your vet done a PCR diarrhea panel, using some of the diarrhea (that the vet retrieves a sample of)?

Hi everyone, thank you so much for your helpful responses. 

I've read through the other thread that you linked to Red Top Rescue, and a few people on there mentioned that it could be because the  antibiotics have killed the good flora in their gut, and it takes a while for these to grow back once the antibiotics are stopped.

I've ordered some more Purina FortiFlora probiotics to help speed things along. I'm thinking I should have been using these throughout the treatment period, but I didn't bother because we got some before and it made no difference whatsoever, so I didn't think it was working. Hopefully it will ease the problem now though! 

Tiger is a bit better now, in that the diarrhoea isn't constant - he is still having some accidents straight after eating though. I'm just hoping beyond hope that it's not still the Tritrich, as that will mean another £400-500 in re-testing fees, more Ronidazole, then more testing! We've already spent an absolute fortune on them trying to get this sorted and we're running out of savings! None of it's covered by insurance of course, because they've had it from day 1. 

In response to the points raised about dosage - they were on 10mg/kg because they are still kittens. They're currently 8 months old. I'm hoping we don't have to do it again at 30mg/kg as the lower dosage was tough enough to administer. 

In response to your question mickNsnicks2mom, they are eating James Wellbeloved grain free turkey pouches, for kittens, along with some Wainright's white fish biscuits (again for kittens). All hypo-allergenic. We've tried them on a few different brands over the months (again, all hypo-allergenic, stomach sensitive etc) but the James Wellbeloved seemed to cause the least problems for them (plus they like it best). The very worst reaction was to the Royal Canin wet food, which is supposed to be the most stomach-gentle! 

I've also tried them on boiled chicken breast a few times, but to be honest, while they had the Tritrich everything just went straight through them and actually changing the food seemed to make things even worse, so we're trying to just keep them on the same thing now. 

I'll let you know how things go over the next few days and whether the probiotics help, but if you have any other ideas in the meantime please do let me know.

Many thanks again for your help with this matter. 

Claire

Oh, also I forgot to mention - they did have a full faecal screening before the vets tested for TF, which came back negative for everything, so I don't think it's another parasite. 

The vets didn't really know much about TF at all though and only tested for it because I specifically asked them to do so, after doing my research!

Lily was found to have a tapeworm when she recently went in to be spayed. We've treated them both for that - but from what I've read online, I don't think it would cause diarrhoea. 

Do let me know if you know any different though!

I look forward to the day when we can get these poor babies completely well for the first time in their little lives. 

Many thanks again,

Claire

Sorry, I've just realised I was mistaken - they WERE on a dose of 30mg/kg after all. So it can't be due to the dosage being too low either!

I've just spoken to the vet & they've said to try them on a probiotic gut-healing paste, which i'll go and pick up this afternoon.

I'll let you know how it goes!

Hi everyone, just wanted to update you on the situation and reach out for help again!

After this incident, things did get a little bit better for a while, but both cats are still doing very sloppy stools - more like a squidgy cow pat than the normal poop you'd expect from a cat, and it still smells really bad. Perhaps not quite as horrendous as before but still pretty unpleasant and I can't leave it in the litter tray for any time at all as it just stinks out the house.

We've been giving them 1 or 2 sachets each per day of Purina Proplan Forti Flora probiotic powder as well, but I don't think it's made any noticeable difference.

Then tonight again they seem to have taken another turn for the worse - dripping mucusy bloody blobs on the floor.

I have just put them onto a new hypo-allergenic, grain free, super-sensitive food so I'm guessing it may just be the diet change that's sparked it but I thought once we'd got rid of the tritrich they wouldn't react like this anymore.

Tiger also seems to have started peeing all over the place now for some reason so we generally live in a cesspit and it's really beginning to put a strain on our household. My other half has talked seriously about getting rid of them, saying he can't live like this anymore and whilst I don't blame him - I can't begin to imagine giving them away as I just love them so much, despite all their problems. As I'm writing this Tiger has jumped into my lap and curled up upside down like big soft fur baby. How can you give away a cat as affectionate as that?

I let the breeder know about it and she actually refunded us £400 of the £950 we paid for them, to help with all the vets bills. She said she hadn't had any problems at her house and none of the other kittens of the same litter had had any issues. She did decide to get all her adult cats tested though, as a precaution. I sent her a message to find out the result of that but she never replied - so I'm guessing she may have had a positive result but didn't want to admit it to me! 

I'm really at a loss to know what to do now - and my other half has pretty much set winter as the deadline for getting them sorted, as by then it'll be too cold to keep opening the windows wide to let out the smell. At that point I think he's pretty serious about giving them to someone else.

I've suggested we get Tiger neutered to see if that helps with the peeing situation. It's also been suggested that we get them re-tested for tritrich and then possibly treated again - but we just can't afford it! We've already spent about £600 on trying to sort these problems, on top of the £950 initial purchase price. It'll be another £400-500 for re-testing, re-treatment and another re-test and none of it is covered by insurance because they've had gut issues from day one.

If you guys or anyone else on this forum can offer me some sort of lifeline of advice here I'd be really really grateful. I don't want to lose my fur babies but it seems to be heading that way rapidly

Many thanks,

Claire

i'm so sorry your two furbabies are continuing to have the diarrhea.

i'm going to see if i can attract the attention of a couple very knowledgeable members -- @LDG, @missmimz   may i request your knowledge and expertise for the OP (original poster)?

i'm thinking it might very well be appropriate to suggest a raw or home cooked diet for your two babies. i'd also suggest a better probiotic -- like a human-grade probiotic, but in an appropriate cat/kitten dosage. forti-flora is actually not a very good probiotic, but does have a very good use -- as an 'enticer', to help cats eat foods (like a special diet that they need to stay on for medical reasons, but that they don't care for the taste of).

two things i'd like to bring up again (?) are:  i did read that tritrichomonas foetus can, in some cats, never completely be cured. i believe that in these cases, the focus must be on managing the symptoms. and, that bengals sometimes don't do well with the same diet or proteins (or other additives in canned or dry cat foods) that more common domestic cats do.

we're here for you, and we'll see what our members suggest.

a question for you -- with the diet changes for your two kittens, have the kittens stayed on any of the diet(s) for a solid month or more? i don't think this has been asked yet. sometimes, with these kind of serious gastro upsets, it can be a very good thing to stick with one diet for at least a full month (or longer). this gives the kitty's gastro system time to both adjust to the new diet and calm down. it also can take (i wanna say) 6-8 weeks for their good gut bacteria to become replenished.

Forti flora is a useless probiotic. You need to get your hands on a good quality human grade probiotic. It seems like you're in the UK? I'm not really sure what's available there, but look through this list of them and see which ones you can get. Follow the instructions for dosage and mix in their food AM and PM. You ideally want to use one that contains s boulardii, which helps control that diarrhea. Here's more info on using good bacteria like a good quality probiotic to control that infection. 

http://www.rawfeedingforibdcats.org/probiotics-for-cats---why-and-which-ones.html

http://www.littlebigcat.com/health/giardia-natural-treatment-protocol/

LDG isn't active here anymore, but here's her response to a thread about this issue from a few years ago. She's active on FB, and she runs the Raw feeding for IBD website and FB group.

"But if you want to try another approach to treating the giardia or potential co-infections (like T. foetus) this is worth the shot: it's safe and easy and doesn't keep subjecting her body to toxins that can impair her immune system.

http://www.littlebigcat.com/health/giardia-natural-treatment-protocol/

If she still has diarrhea, you might want to consider using S. boulardii. If this works, then you know the problem isn't giardia, but side-effects from it or the meds. And to restore the healthy bacteria in her gut, a good L. acidophilus probiotic is a good idea. FYI, if you're going to continue using the metro, the S boulardii can be given with it: it is a yeast-based probiotic and not killed by the antibiotics the way a traditional bacterial probiotic is. Instructions for use are here: http://www.ibdkitties.net/Probiotics.html" 

I'd absolutely suggest switching to a raw or homecooked diet as well, it's the easiest to digest for cats and will cause the least interference. I don't know what's available where you are, though, but you may want to consider ordering EZcomplete, or even Better in the Raw for cats to mix with boneless meat. 

http://www.foodfurlife.com/ (has a 20% off coupon until Sept 30th too)

https://www.knowbetterpetfood.com/products?region=international

I pulled this info from the Raw feeding IBD group from people in the UK.

A good digestive enzyme (I use this one for my cats )


For probiotic available in the UK

Probiotic is BIOGLAN Biotic Balance Ultimate Flora - the dosage is Kittens Daily Use for “Maintenance”: 1/4 capsule twice daily; Kittens Therapeutic use: 1/2 capsule twice daily

And here's s. Boulardii-


Here are the dosages for S Boulardii: Daily Use for “Maintenance”:
1/8 capsule twice daily Kittens Therapeutic use: 1/4 capsule twice daily. 

I'd get all three, and start giving it to them ASAP.

Wow thanks so much for all your help and support guys - it really means a lot to me.

I will certainly read up on the raw/home cooked food plan missmimz  and get them onto that along with some decent probiotics.

I'll let you know in a few weeks how they're getting on.

Just to reply to your question mickNsnicks2mom  - they've been on James Wellbeloved grain free kitten food for most of their lives (except it was the turkey one). This has been the most consistent food for them and they've certainly had that for more than 6 weeks in a row. Probably a good few months in a row in fact.

We've also tried Wainrights  (which is supposed to be easily digested, hypo-allergenic and wheat free), plain boiled chicken breast, and I'm currently giving them AVA "Vetinary Approved" kitten food  (which is free from wheat, gluten, soya, pork and dairy contains vitamins & minerals, pre-biotics, +Imuvita immune boosting ingredients etc etc.)

Combined with the wet food we've tried a few varieties of biscuits of the same brands - all grain free as well. 

I know this is a fair amount of chopping and changing, which probably hasn't helped settle their tummies but with their stools being so runny from the beginning, with little-to-no change each time I changed the food, I wanted to try out a few to see if anything helped.

They do usually have a bad 1 or 2 days (drops of slimy mucus/blood etc) just after I change the food type, which is what I think happened yesterday, but they soon settle into their "normal" digestive patterns. By "normal" I mean normal for them - i.e. very soft, smelly splats

I will certainly take this advice on board though and start them on a home cooked diet with proper probiotics - and stick with that for a few months to see how it goes.

Many thanks again for your support!

Claire

(Leeds, UK)

again, we're here for you -- for support, and encouragement, as well as should you have any questions or need some help with a raw/home cooked food plan.