How to manage feline chronic diarrhea, Part II: Treatment


How to manage feline chronic diarrhea, Part II: Treatment

Targeted drug therapy, dietary changes, prebiotics, and probiotics are some of the tools that can help you get cats with persistent diarrhea back to normal GI function.

Chronic diarrhea is best managed with targeted therapy based on a specific diagnosis. However, symptomatic or nonspecific therapies are often initially considered for patients that seem to be feeling well otherwise and when preliminary testing fails to establish a definitive diagnosis. Specific and symptomatic medical therapy may be used together to achieve greater success.

In this second part of a two-part article, we review pharmacologic and dietary interventions for treating both definitive and nonspecific chronic feline diarrheal disorders. A multimodal approach is often warranted, which may include antiprotozoal, antibacterial, dietary, immunosuppressive, and adjunctive therapy. We do not discuss the treatment of common helminth infections so we can focus on the more difficult causes of chronic diarrhea. However, we think it is certainly appropriate to administer a broad-spectrum dewormer to any patient with diarrhea, even if fecal examinations do not confirm the presence of a helminth infection.


In cats with diarrhea caused by Giardia, Cystoisospora, or Tritrichomonas species, an antiparasitic, antiprotozoal, or antimicrobial agent is indicated alone or in combination.


Fenbendazole is a benzimidazole antiparasitic that appears to be an effective option in cats with giardiasis (Table 1), without the hematologic complications associated with albendazole.1 Concern has been expressed regarding the efficacy of fenbendazole against Giardia species in certain cases.2 Although both fenbendazole and metronidazole are recommended as sole therapies for treating giardiasis, the Companion Animal Parasite Council also advocates the combination of fenbendazole at 50 mg/kg once daily with metronidazole at 25 mg/kg twice daily for 5 days.1 Fenbendazole appears to have a wide safety margin but is not FDA-approved for use in cats.3