Table 1.
Summary of clinical problems with associated action steps
| Clinical Finding | Source | Action |
|---|---|---|
| Thrombocytopenia | ||
| 0 plt/µL | RDVM | Begin prednisone 2.2 mg/kg/day PO |
| 156,000 plt/µL | RDVM | Decrease prednisone by 25 % |
| 117,000 plt/µL | RDVM |
Increase prednisone to 2.2 mg/kg/day PO; begin azathioprine 2.4 mg/kg PO daily |
| 23,000 plt/µL | RDVM | Refer to TAMU-VMTH |
| 171,000 plt/µL | TAMU-VMTH |
Discontinue azathioprine; decrease prednisone by 50 % |
| 102,000 plt/µL | TAMU-VMTH |
Begin cyclosporine at 4.7 mg/kg/day PO; begin Yunnan Baiyao 0.5 g PO BID; increase prednisone by 25 % |
| 160,000 plt/µL | TAMU-VMTH |
Taper cyclosporine to discontinuation; discontinue Yunnan Baiyao |
| Vector-borne diseases | ||
| Ehrlichia spp. antibody seropositivity | RDVM | Begin doxycycline 5.7 mg/kg PO BID |
| Anaplasma spp. antibody seropositivity | RDVM | Begin doxycycline 5.7 mg/kg PO BID |
| D. immitis antigen seropositivity | RDVM | Begin doxycycline 5.7 mg/kg PO BID |
| Echocardiographic confirmation of heartworm infestation | TAMU-VMTH | Administer melarsomine three-dose protocol (2.5 mg/kg/dose) |
| Urinary tract infection | ||
| 6–20 WBC/hpf on UA | RDVM | Begin empiric sulfamethoxazole- trimethoprim 27.3 mg/kg PO daily x 14d |
|
bacteriuria / pyuria on UA |
RDVM | Begin empiric amoxicillin/clavulanic acid 13.8 mg/kg PO BID |
| > 100,000 organisms/mL of Salmonella spp. from urine culture | RDVM |
Discontinue amoxicillin/clavulanic acid; begin amoxicillin 25.3 mg/kg PO BID x 28d |
| 4 colonies of Salmonella spp. from prostatic wash culture and susceptibility | TAMU-VMTH |
Begin enrofloxacin 10.6 mg/kg PO daily x 28d; begin doxycycline 10.1 mg/kg PO BID x 28d; initiate zoonosis precautions in the home |
| Negative urine culture after 14 days of enrofloxacin / doxycycline | TAMU-VMTH | No action |
| > 100,000 organisms/mL of Salmonella spp. from prostatic wash culture | TAMU-VMTH | Begin marbofloxacin 3 mg/kg PO daily through 2 weeks post-castration |
| Negative prostatic wash culture 10 d after stopping marbofloxacin | TAMU-VMTH | |
Clinical data and action steps are in chronological order within each problem category
RDVM referring veterinarian. TAMU-VMTH Texas A&M University Veterinary Medical Teaching Hospital