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