treatment

Doxycycline

A semisynthetic tetracycline, doxy is the drug of choice for ehrlichiosis, Lyme Disease and Rocky Mountain Spotted Fever. 

The dosage we recommend on Tick List is an aggressive one:  5 mg. of doxy per pound of body weight given every 12 hours for 8 weeks.  For those who prefer to figure body weight in kilograms, this is approximately the same as 10 mg per kg, the difference being not enough to mention.

This is twice as high as the dose that is generally recommended - and here I should probably remind you that I am not a veterinarian or a medical professional.  Well, that's true.  At the same time, I should tell you that your vet is the one to decide what dosage to use.  I can't do that. 

In my opinion and that of everyone on Tick List, ehrlichiosis and Lyme must be hit hard the first time out and lower doses and/or shorter treatment times all too often mean recurrence.  Unless your dog is one of the few that cannot take doxycycline or take it in this higher dose, my best advice to you is to insist on it.  Each time ehrlichiosis or Lyme recurs, it's harder to stop or contain it. 

According to the University of Georgia, the common dosage of doxy for Rocky Mountain Spotted Fever (RMSF) can be as high as 20 mg/kg by body weight given twice a day.  That may be because this is a fast-acting disease that a dog without treatment will either recover from or die from, but the slower acting ehrlichiae are just as capable of killing and half that 20 mg/kg amount of doxy as an aggressive dose to combat them decisively, which is the key word here, is surely warranted when so many dogs may suffer all their lives from the effects of ehrlichiosis even if they don't succumb to it.

Caution:  Do not give out-of-date doxycycline!  Tetracycline drugs can cause kidney damage if given after their expiration dates.

When giving doxycycline, be sure to give it with food, just before a meal or with it.  Unlike other tetracyclines, doxy is not greatly affected by the calcium in dairy products; so, while you should err on the safe side and not feed a lot of them, it's not necessary to worry about poking a tablet in a small amount of cheese or slipping a capsule in a spoonful of yogurt if that will help get it down your dog. 

Tablets appear to be easier on the dog.  Capsules may stick in the esophagus and cause irritation if they dissolve and release the doxy there instead of in the stomach so, if you use capsules, butter them or coat them in grease to make them go down easily.

Opening capsules or breaking tablets may also irritate the esophagus.

If your dog is nauseated by being given the dose for a 12 hour period all at once, you can divide the dose and give half that amount twice in 12 hours, 4 half doses in 24 hours;  as long as he gets all he needs in a day, that's all that counts.  Always, however, give it with food.

Tetracyclines, including doxycycline, can sometimes cause yellowing of the teeth that are still being formed in the gums.  The teeth of pups six months or older shouldn't be affected.  Amoxicillin at 20 mg/kg PO (by mouth) for eight weeks can be used instead for Lyme disease but it is useless in the treatment of ehrlichiosis. 

Since doxy is the most effective of the drugs you can use to fight ehrlichiosis, most forms of which are very dangerous, you have to ask yourself, in the case of a very young pup, if you really care that much about yellowed teeth.

Doxycycline is an antibiotic.  All antibiotics destroy or inhibit bacteria and don't differentiate "good" from "bad";  they wipe out beneficial bacteria in the dog's gut right along with the disease-causing organisms.  It's a wise idea, then, to give the dog probiotics as long as he's taking doxycycline and for several weeks afterward to avoid the gastrointestinal problems that can develop if he's left without this help for eight weeks or more.

Probiotics such as lactobacillus acidophilus are available in capsules in health food stores.  Plain yogurt with active cultures is also useful but probably not as effective.  Stoneyfield is one of the most recommended brands of yogurt.  Be sure there is no flavoring or sugar in the kind you buy.

Important!   Give probiotics two hours "after" doxycycline.  

Because doxy will curtail reproduction of the beneficial bacteria you've given your dog in the form of probiotics, you have to keep giving them after every dose.  If you give probiotics before the doxy has cleared the dog's digestive system, you may as well not bother.  So stick to the two hour delay and keep it up after every dose of the antibiotic until a few weeks after your dog's treatment is over.

One last note on doxycycline.  It is processed mainly through the liver and a dog with a damaged liver may not be able to take it.  Amoxicillin, on the other hand, leaves through the kidneys and is an acceptable alternative to doxy as a treatment for Lyme as long as the dog doesn't have renal disease.  (Amoxicillin is not effective against ehrlichiosis.)  More than likely, your vet will have done a CBC and serum chemistry before putting your dog on any treatment for TBD and will have identified any problem areas to take into account, so this is just a heads up.

If the dog still has problems with nausea, you can ask your vet about giving him Reglan (metaclopromide).  Pepcid AC has also been said to help a lot with nausea.

October 2007 update:  There have been reports on Tick List of dogs which react badly to doxycycline.  Until now, only a few people have reported that doxycycline caused their dogs to have serious problems with the liver and have had strong evidence to back up their assertions.  Recently, however, a number of Standard Poodles infected with A. phagocytophilum (E. equi) showed an alarming rise in levels of ALT on bloodtests, levels which began to fall when the doxy was stopped.  Whether this is a peculiarity restricted mostly to that breed, or a few lines in that breed, is unknown. 

This points up the wisdom, however, of doing regular bloodtests throughout a dog's treatment and at wider intervals afterward. 

In the event that your dog has a similar reaction, stopping or reducing the amount of doxycycline is an obvious first step.  You can then determine whether or not to try one of the alternatives to this antibiotic.  One of the other tetracyclines, minocycline, for instance, may be just different enough not to cause this odd reaction.  Chloramphenicol might be used, though the precautions for the human giver "must" be followed carefully. 

If you consider Imizol, which carries a caution about its use in dogs with compromised livers, lungs or kidneys, be certain your vet has read the product label and follow his or her advice.

In this instance, as always, your best resource is a vet who is thoroughly conversant with tick-borne disease.

Imizol

Imizol (Imidocarb dipropionate) is used in the treatment of Babesiosis canis and off-label to treat E. canis.  It is usually administered in a series of two shots given two weeks apart.  Cautions on the label about its use for dogs with impaired lungs, liver or kidneys should be noted and taken into account.  There is no body of evidence so far to indicate that Imizol is effective against any strain of ehrlichiosis other than E. canis but it's certainly worth a try if time is of the essence or the dog cannot take doxycycline.

Imizol is given either sub-Q (under the skin) or intramuscularly.  Note, however, it burns.  Vets who have not used it should be aware that the dog will have an easier time of it if the needle is changed after the Imizol is drawn up into the syringe so that there is no Imizol on the needle to touch and burn the skin.

Most dogs have no problem with it beyond a little drooling and an initial yelp of outrage as the shot is given.

One advantage to the use of Imizol, either with or instead of doxycycline, is that it may take care of a cross infection with babesiosis. 

Cross infections of one TBD with another are unfortunately common.

Treatment for Bartonellosis - see also here for links 

According to the University of Georgia, College of Veterinary Medicine, "Currently, there is no set treatment protocol for B. vinsonii subsp. berkhoffii because the appropriate antibiotic and duration of administration has not yet been established. However, an antibiotic capable of crossing lipid membranes and reaching high intracellular concentrations would be indicated, such as azithromycin, doxycycline, and enrofloxacin. Macrolides, like azithromycin, have shown the most therapeutic promise. Treatment of several weeks duration may be needed to eliminate Bartonella infections.

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