Ehrlichi And Proper Doxy Dosage

[Guest peterpan]

Im a little confused about the proper dosage of doxycycline and treatment for Ehrlichia.

Can someone help? Ive read several articles and it seems that the higher dosage is better at treating this disease.

My vet is prescribing 250 mg twice daily(total 500mg a day) would be enough for a 80 to 90lb dog. According to several articles that I have read I have come up with 400mg twice daily for 80lbs(800mg a day) and 450 mg twice a day for 90lbs.(900mg a day). Does this seem to high?

 

Any suggestions would be very much appreciated.

Thanks

peterpans mom

[Burpdog]

Most vets dose at half dose <sigh> It should be 5mg per # of body weight twice a day.

 

bold added - we do the same in Texas and they do the same in FL re dose. The Tick List is a good list to join (very active)

 

Tick List

 

WHY ALL THE CONCERN ABOUT EHRLICHIA

IN ADOPTED GREYHOUNDS?

DIANA OF THE UPLANDS, C. W. FURSE, TATE GALLERY, LONDON ENGLAND

Suzanne Stack, DVM

Studies have shown that it can take as long as 5-7 years following a bite from an Ehrlichiacarrying

tick for a dog to show symptoms. By then, a greyhound is long gone from the tickinfested

racing kennel or farm and possibly living in an area where Ehrlichia is unheard of. The

greyhound may present with a variety of mysterious ailments, some of which can be serious

and fatal if not treated. Veterinarians working with adopted greyhounds should maintain a high

index of suspicion for Ehrlichia.

Ehrlichia canis is the most common Ehrlichia species infecting dogs, but there are others (E.

platys, E. risticii, E. equi) and researchers suspect that there are many more. E. canis is a

rickettsia (an organism somewhere between a bacteria and parasite) carried by the brown dog

tick - a common if not universal problem in racing kennels. Greyhounds from all over the

country mingle together sharing their ticks, making racing kennels a smorgasbord of tick-borne

diseases.

Acute (first few weeks) signs of Ehrlichia, such as runny eyes/nose and cough (resembling

distemper) would not be expected in adopted racers. Virtually all adopted greyhounds will be in

the chronic stage. There may be vague signs such as lethargy, fever, anorexia, and weight

loss. Greyhounds may have bleeding, bone marrow suppression, eye disease, neurologic signs,

neck/spinal pain, polyarthritis, enlarged spleen, enlarged lymph nodes, or kidney disease.

Bloodwork may show anemia, low white blood cell counts, low platelets, increased protein

(hyperglobulinemia), and increased ALT/ALKP.

Ehrlichia testing is done with antibody titers. Titers measure the body's immune response to

the bug, not the amount of bug in the dog's body. Most labs titer from 1:20 to 1:1,000,000 or

more. In general, the more chronic the infection, the higher the titer. The IDEXX in-office

"combo" test (heartworm/Lyme/Ehrlichia) catches titers over 1:100. While sick dogs usually

test positive, they might not if:

1. They have a poor immune response (the reason why a very sick dog sometimes tests

negative).

2. They carry an Ehrlichia strain other than the standard E. canis the lab tests for.

3. They have a titer <1:100 on the IDEXX test, or

4. There is variation between labs.

There is not necessarily a correlation between the severity of the disease and the titer number.

All positive titers should be treated.

Ehrlichia dogs respond dramatically and quickly (within days) to doxycycline dosed at 5 mg per

pound twice daily. For this reason, greyhounds should be started on doxycycline as soon as

Ehrlichia is suspected. If not immediately available at the veterinary office, all human

pharmacies carry doxycycline (a tetracycline family antibiotic). Often patients are vastly

improved by the time their titer results are back from the lab. This doxycycline trial can be as

useful as the titer results in determining whether to continue with treatment. The standard

regimen we use in Arizona where Ehrlichia is endemic is 5 mg per pound twice daily for 2

months. Doxycycline must always be given with food - otherwise it may upset the stomach.

Alternatively, Ehrlichia can be treated (offlabel) with Imizol, an injectable drug approved for the

treatment of Babesia, another tick-borne disease. The Imizol protocol is two injections two

weeks apart.

There is a poor correlation between resolution of infection and serum antibody titers. In

patients with high antibody titers, the antibody concentrations decline very slowly (over years)

following effective therapy. In many patients, the antibody titers persist at high concentrations

indefinitely. The PCR (polymerase chain reaction) test, which tests either positive or negative

(no numeric value) for Ehrlichia DNA in the bloodstream, may be used for follow-up testing,

but is not perfect either.

The most reliable indices of response to therapy are clinical signs, CBC changes (i.e. anemia,

platelet counts), and serum globulin concentrations. A reasonable approach is to monitor

recovered dogs with a CBC and titer at six-month intervals as long as the dog remains clinically

normal. If clinical signs develop or the CBC becomes abnormal, re-treat, using Imizol if

doxycycline was used the first time around. The majority of Ehrlichia dogs will require only one

treatment course, but owner and veterinarian should remain watchful in order to recognize a

relapse.

[Guest LynnM]

Also, remember that duration is just as important as dosage. The 2 week stint of doxy that is/was frequently recommended, results in relapse in over 60% of cases. I can't remember the full name of the study, but it's on PubMed. Imizol is the closest thing to a sure thing. Doxycycline at 5 mg/kg for a long time is the next best thing... unfortunately, nothing's been published that gives a more exact duration of treatment other than "longer than 2 weeks". If it was my dog, I'd treat 8-12 weeks, but I've dealt with a lot of resistant crud of other species (not tick borne illness) and tend to take the longest duration and add a month. That's the result of some gawdawful bone infections in dogs that just would NOT go away... makes me a little jumpy about skimping.

 

Lynn

[Burpdog]

Yes! At least 8 weeks and some people are doing 12 weeks.

[feemandvm]

OK... this is a topic that Diane and I differ GREATLY on. The standard treatment for Ehrlichiosis is generally considered to be:

 

Doxycycline 5-10 mg/kg twice daily for 21-30 days.

 

 

Diane supports the use of 5 mg/lbs. which is roughly 11 mg/kg twice daily for 8+ weeks

 

 

Now... why is there such a contrast? Honestly I can't answer that. What i can tell you is that Dr. Couto and The Ohio State University (who probably does more Greyhound work then ANY other institution) recommends 5-10 mg/kg twice daily for 21-30 days. Dr. Rick Alleman and the University of Florida recommends the same dosing and he is a TBD expert. North Carolina State's veterinary school recommends the same dosing and they have the top TBD lab in the US IMHO. Texas A&M which hosts hte veterinary school in teh state that Diane lives in uses 5-10 mg/kg twice daily for 21-30 days.

 

These recommendations are based on published data and YEARS of experience. The idea of 5 mg/lbs. twice daily for at least 8 weeks is completely random and not based on fact. Why stop at 8 weeks? Why not make it 8 months? Or even longer? I've asked if any vets that are openly recommending this protocol to join the GreytVets list group and share why they believe this and to open teh topic up for discussion. This has yet to happen.

 

So why am I making this a soap box issue? Is 5 mg/lbs. a wrong dose? No. But presenting it as the only right answer is at best misleading and is plain and simply WRONG. It should be phrased as "The commonly used dosing is 5-10 mg/kg every 12 hours for 21-30 days but I believe in using 5 mg/lbs. twice daily for 8+ weeks". That would be an honest answer... it gives medically accurate information and allows her to give her OPINION on Doxy dosing. Just remember that the 5 mg/lbs. for 8+ weeks is NOT supported by any major TBD experts yet is often listed on GT as the only right dose.

 

Is it possible that some dogs may need 5 mg/lbs. for 8+ weeks to treat an infection? It is possible... but then I would wonder if they had a concurrent bartonella infection ro something else that made it more resistant. Some urinary tract infections may require treatment with injectable only antibiotics for several weeks... but I would never dream of treating every dog this way "just in case".

 

 

[Guest peterpan]

I don't know why I am having such a hard time understanding the dosage amount as it seems so simple. The doxy treatment will also be for about 8weeks maybe longer. I have read so many articles on Ehrlichia and treating with doxy and they all seem to differ in the dosage amount.

 

I asked my vet what he thought about giving 800mg a day which is 400mg twice daily which is 5mg per lb of body weight (80lbs) He told me that was way to much. He said that he has never prescribed that much especially since we are not positive this is a tickborne illness. I won't go into a lengthy detail as why my dog can not be taken in for bloodwork. But I will say that he has recently been diagnosed with lymphoma, swollen lymph nodes in neck area. I have the report and it says Lymph node cytology consistentent with lymphosarcoma. But I highly suspect that it is NOT lymphoma but Ehrlichia. He has had swollen lymph nobes for a few years now. My vet is willing to treat with doxy without testing. I have chosen not to do chemo. Right now he is on high doses of vit E and C and seems to have more energy than ever. Very active playful, no pain, no problem swollowing. You would never know he was even sick. Just swollen lymph nodes.

 

So what do you think is 800mg of doxy a day too much for an 80lb dog?

 

Has anyone ever given this amount?

 

Am I figuring the amount wrong, should it be only 400mg a day which is 200mg twice daily?

 

Again any thoughts or suggestions would be very much appreciated.

Peterpan's Mom

 

 

 

Im a little confused about the proper dosage of doxycycline and treatment for Ehrlichia.

Can someone help? Ive read several articles and it seems that the higher dosage is better at treating this disease.

My vet is prescribing 250 mg twice daily(total 500mg a day) would be enough for a 80 to 90lb dog. According to several articles that I have read I have come up with 400mg twice daily for 80lbs(800mg a day) and 450 mg twice a day for 90lbs.(900mg a day). Does this seem to high?

 

Any suggestions would be very much appreciated.

Thanks

peterpans mom

 

[Burpdog]

Diane supports the use of 5 mg/lbs. which is roughly 11 mg/kg twice daily for 8+ weeks

 

Again, I am quoting Dr. Stack and also Dr. Beckett who both have a lot of experience in tick borne diseases.

 

Also, these figures from tick states are what works--not in text books, but in real life. If you do not do the 8-12 week dosing, you end up with problems.

 

You know I think a lot of Dr. Couto and Ohio State. However, I will debate this to the ends of the world. I have seen too many dogs with unnecessary tests and die and almost die from TBDs, and no, not all are diagnosed. As Dr. Miller here in Houston calls at least one of the unknows the "Lone Star Tick disease" after a TBD panel was done at North Carolina State, came up negative, and yet the dog was given doxy and he responded.

 

This may be a difference of opinion among veterinarians. I support the larger dose and longer duration based on the experience of veterinarians and my experience.

 

I asked my vet what he thought about giving 800mg a day which is 400mg twice daily which is 5mg per lb of body weight (80lbs) He told me that was way to much

 

Show him Dr. Stack's article. If this is a TBD, you will see results in as little as a week.

 

5 mg per # of body weight twice a day.

 

Please join the tick list

[feemandvm]

Diane supports the use of 5 mg/lbs. which is roughly 11 mg/kg twice daily for 8+ weeks

 

Again, I am quoting Dr. Stack and also Dr. Beckett who both have a lot of experience in tick borne diseases.

 

Also, these figures from tick states are what works--not in text books, but in real life. If you do not do the 8-12 week dosing, you end up with problems.

 

You know I think a lot of Dr. Couto and Ohio State. However, I will debate this to the ends of the world. I have seen too many dogs with unnecessary tests and die and almost die from TBDs, and no, not all are diagnosed. As Dr. Miller here in Houston calls at least one of the unknows the "Lone Star Tick disease" after a TBD panel was done at North Carolina State, came up negative, and yet the dog was given doxy and he responded.

 

This may be a difference of opinion among veterinarians. I support the larger dose and longer duration based on the experience of veterinarians and my experience.

 

I asked my vet what he thought about giving 800mg a day which is 400mg twice daily which is 5mg per lb of body weight (80lbs) He told me that was way to much

 

Show him Dr. Stack's article. If this is a TBD, you will see results in as little as a week.

 

5 mg per # of body weight twice a day.

 

Please join the tick list

 

Do you consider Texas a TBD state? Your own vet school does not support your recommendation. I can promise you that they see more TBDs in a year then your vet does and yet they still don't support your protocol. Don't you find that strange? Why are no other experts finding the same complications that you are? The top TBD lab in the US hasn't had a problem with lower Doxy dosing. The vet school in your own state hasn't had a problem with lower Doxy dosing. OSU and Florida who see tons of Greyhounds and have internists that also see TBDs haven't had a problem with lower dosing of Doxycycline. If we are talking about real life... then why is it that no-one else seems to have these complications? Why is it that all the experts that see more TBDs then anyone else are not seeing these same complications?

 

Again... when you post about Doxy dosing... people need to know that your Doxy dosing is your OPINION and based on zero published information or any study at all. It is based on your "real world knowledge" that is in contrast to the opinion of every top TBD expert in the US. When you only state the "correct dosing is 5 mg/lbs. BID x 8 weeks" people are going to take your word as fact when in fact it is an annecdotal opinion only.