VetMedFaecal microbiota transplantation in acute diarrhoea of young dogs: does it shorten time to formed stools vs standard supportive care? — MAYBE (weak evidence)
In puppies and shelter dogs with acute diarrhoea, does faecal microbiota transplantation vs standard supportive care shorten time to formed stools?
Shelf #390 · gate-verified and approved by the developer
MAYBE (weak evidence): The evidence conflicts by subpopulation, and only one carded trial is in the puppies this shelf is about. In Pereira 2018 (PMID: 29460302; randomised clinical trial, 66 puppies with canine parvovirus infection at 2 veterinary hospitals in Brazil), standard treatment plus faecal microbiota transplantation (FMT) was associated with much faster resolution of diarrhoea than standard treatment alone among survivors: diarrhoea had resolved within 48 hours in 61.5% (16/26) of FMT puppies vs 4.8% (1/21) of standard-treatment puppies (P < .001), and median hospitalisation was 3 days with FMT vs 6 days without (abstract P = .001); mortality was 21.2% (7/33) with FMT vs 36.4% (12/33) without, a difference that was not statistically significant (P = .174). Against that, two trials in client-owned dogs with acute haemorrhagic diarrhoea syndrome (AHDS) — an acute diarrhoea population, but not puppies, shelter dogs or parvovirus cases — found no clinical benefit: Gal 2021 (PMID: 33872339; randomised, placebo-controlled, open-label pilot, 8 AHDS dogs, 4 per group) found no significant difference in median AHDS clinical scores at admission (P = 0.22) or discharge (P = 0.41) between FMT and sham-treated controls, and Reisinger 2024 (PMID: 39094622; 32 client-owned AHDS dogs: symptomatic treatment n = 12, FMT n = 12, antibiotic n = 8) detected no significant differences in clinical scores between treatment groups over time except on day 2 (higher AHDS index in the antibiotic group than the FMT group; P = .046), concluding that neither FMT nor antibiotic treatment resulted in faster clinical improvement. Design class (b): randomisation is established by carded records answering this shelf's own comparison (Pereira 2018 and Gal 2021 both state randomised allocation), but blinding is not established for clinical outcomes — Pereira's full text states it was not possible to fulfil blinding or placebo treatment, and Gal 2021 was open-label (only the reviewing pathologist was blinded) — so this shelf is not class (a). The stamp is MAYBE (weak evidence), not higher, because the one positive trial is unblinded, analysed diarrhoea resolution only among survivors, and had a significant age imbalance favouring the FMT group (mean 5.18 vs 3.67 months; P = .004, PMC full text), while the two AHDS trials were null and one of them had only 8 dogs; no carded record at all studies shelter dogs, so the shelter part of the question is unanswered. Tier C is not engaged: mortality in Pereira 2018 appears only as a non-significant secondary outcome with no mortality benefit claimed by the record, and this pack makes no mortality or survival claim — that call is recorded here on the pack's face. One-home cross-points: FMT in chronic enteropathy is shelf #389's home (its trials are not re-carded here, and its null result in chronic disease is a different question from acute diarrhoea); metronidazole, amoxicillin-clavulanate and probiotics in acute diarrhoea home on shelves #163, #161/#162 and #164 respectively and are not re-carded. Chaitman 2020 (PMID: 32363202), a non-randomised pilot comparing FMT with metronidazole in 18 dogs with acute diarrhoea, is documented on the synthesis card as a near-miss and is not carded, because its comparator is metronidazole, not standard supportive care, and its full text states there was no randomisation and no placebo group. Drafted Nov 10, 2026 (VetMed build, topic #390); figures from the abstracts and, for Pereira 2018 and Gal 2021, the PMC full text, fetched and verified at drafting.
Pereira 2018: in parvovirus puppies, adding FMT to standard treatment was associated with diarrhoea resolution within 48 hours in 61.5% of survivors vs 4.8% on standard treatment alone, and median hospitalisation of 3 vs 6 days
Randomised clinical trial, NOT blinded and with no placebo treatment (PMC full text's own admission, quoted in the watchOut; publication types: Journal Article, Randomized Controlled Trial)
Who: Dogs: 66 puppies with canine parvovirus infection (all PCR-positive for strain CPV-2b) evaluated at 2 veterinary hospitals in Brazil (PMC full text: in Londrina, Paraná state), in a randomised clinical trial. Puppies were randomly distributed to standard treatment alone (STD; n = 33; IV fluids and antimicrobials) or standard treatment plus FMT (STD + FMT; n = 33). For FMT, 10 g of faeces from a healthy dog diluted in 10 mL of saline were administered rectally 6–12 hours post-admission, repeated every 48 hours until resolution of diarrhoea or a total of 5 applications (PMC full text: mean 1.82 procedures per dog, range 1–3).
Result: Among survivors, FMT was associated with faster resolution of diarrhoea (P < .001) and shorter hospitalisation (median 3 days in STD + FMT vs 6 days in STD; abstract P = .001). By time interval (PMC full text), diarrhoea resolved within 48 hours in 61.5% (16/26) of surviving FMT puppies vs 4.8% (1/21) of surviving standard-treatment puppies (P < .001); between 48 and 96 hours in 30.8% (8/26) vs 43% (9/21) (P = .3912); and after 96 hours in 7.7% (2/26) vs 52.38% (11/21) (P < .001). Hospitalisation in the full text was median 3.00 days (range 1–6; mean 3.31) with FMT vs median 6.00 days (range 2–15; mean 5.57) without. Mortality was 36.4% (12/33) on standard treatment vs 21.2% (7/33) with FMT, with no statistical difference between groups (P = .174). No puppy in the FMT group developed clinical abnormalities attributable to the procedure (PMC full text).
Watch out: The resolution percentages are calculated only among survivors (26 FMT and 21 standard-treatment puppies), so puppies who died — numerically more in the standard group — are excluded from the headline comparison. The trial was not blinded: the full text states 'It was not possible to fulfill all of the clinical trials standard guidelines (eg, blinding, placebo treatment) in our study.' The FMT group was also significantly older at admission (mean 5.18 vs 3.67 months; P = .004, PMC full text), which the authors acknowledge could have affected recovery, though they judge a 1.5-month average difference unlikely to explain the result. Minor reporting discrepancy: the abstract gives hospitalisation P = .001 while the PMC full-text results text gives P < .001 for the same comparison; the medians (3 vs 6 days) agree. This is parvovirus diarrhoea in hospitalised puppies only — it does not by itself answer FMT in shelter dogs or in non-parvovirus acute diarrhoea.
Pereira GQ, Gomes LA, Santos IS, Alfieri AF, Weese JS, Costa MC. Fecal microbiota transplantation in puppies with canine parvovirus infection. J Vet Intern Med. 2018;32(2):707-711. PMID: 29460302. Registry ID: none in the record. MeSH: Animals · Diarrhea/therapy/veterinary* · Dog Diseases/therapy*/virology · Dogs · Fecal Microbiota Transplantation/veterinary* · Gastrointestinal Hemorrhage/therapy/veterinary · Parvoviridae Infections/microbiology/therapy/veterinary* · Parvovirus, Canine/classification · Treatment Outcome
Reisinger 2024: in 32 dogs with acute haemorrhagic diarrhoea syndrome, FMT did not improve clinical scores faster than symptomatic treatment (no significant group differences over time except day 2 vs the antibiotic group)
Prospective, double-anonymized clinical trial (abstract's own wording; publication types: Clinical Trial, Veterinary, Comparative Study, Journal Article)
Who: Dogs: 32 client-owned dogs with acute hemorrhagic diarrhea syndrome (AHDS) in a prospective, double-anonymized clinical trial with 3 groups: symptomatic treatment (n = 12), FMT treatment (n = 12) and antibiotic treatment (n = 8). Clinical improvement was determined from the AHDS index, microbiome changes from the dysbiosis index, and PCR results for clostridial strains.
Result: Overall, no significant differences in clinical scores between the treatment groups over time were detected except on day 2, when the AHDS index was higher in the antibiotic group than in the FMT group (P = .046). The dysbiosis index increased and Peptacetobacter hiranonis decreased on day 1 in some dogs, but these changes were transient in the symptomatic-treatment and FMT groups; in the antibiotic group the dysbiosis index was persistently elevated and 4 of 8 dogs showed reduced P hiranonis abundance on day 42. NetF-encoding Clostridium perfringens was detected in 67% of dogs on day 1 and enterotoxin-encoding strains increased, but these changes were transient in all dogs regardless of therapy. The authors conclude that in dogs with AHDS, neither FMT nor antibiotic treatment resulted in faster clinical improvement, and that the C perfringens changes are self-limiting and do not require antibiotic therapy.
Watch out: The abstract does not state how dogs were allocated to the three groups, so randomisation is not established from this record, and 'double-anonymized' is the record's own term — this pack does not translate it into a claim of blinded outcome assessment. These are client-owned dogs with AHDS, not puppies, shelter dogs or parvovirus cases, and the abstract reports no time-to-formed-stools outcome, only AHDS index scores over time. The single significant contrast (day 2) was antibiotic vs FMT, not FMT vs symptomatic treatment.
Reisinger A, Stübing H, Suchodolski JS, Pilla R, Unterer S, Busch K. Comparing treatment effects on dogs with acute hemorrhagic diarrhea syndrome: fecal microbiota transplantation, symptomatic therapy, or antibiotic treatment. J Am Vet Med Assoc. 2024;262(12):1657-1665. PMID: 39094622. Registry ID: none in the record. MeSH: Animals · Dogs · Female · Male · Anti-Bacterial Agents*/therapeutic use · Diarrhea*/complications/therapy/veterinary · Dog Diseases*/therapy/microbiology · Fecal Microbiota Transplantation*/veterinary · Prospective Studies · Hemorrhage*/complications/therapy/veterinary
Gal 2021: in a randomised open-label pilot of 8 dogs with acute haemorrhagic diarrhoea syndrome, a single FMT gave no clinical benefit over sham treatment (AHDS scores P = 0.22 at admission, P = 0.41 at discharge)
Randomised, placebo-controlled, OPEN-LABEL pilot trial (PMC full text's own wording; the only blinded assessment stated in the full text is the reviewing pathologist, blinded to group allocation; publication types: Journal Article, Randomized Controlled Trial, Veterinary, Research Support, Non-U.S. Gov't)
Who: Dogs: 8 client-owned dogs with acute hemorrhagic diarrhea syndrome (AHDS) — 7 enrolled at Onderstepoort Veterinary Academic Hospital, South Africa, and 1 at Massey University Teaching Hospital, New Zealand (PMC full text) — randomised to FMT (n = 4) or sham-treated control (n = 4), with 4 clinically healthy donor dogs (3 and 1 from the same hospitals). Faecal 16S rRNA sequencing was performed in FMT recipients, sham-treated controls and donors at admission, discharge and 30 days post-discharge. The full text describes the design as a randomized, placebo-controlled, open-label, longitudinal, prospective trial, with randomisation by a premade randomisation table.
Result: There were no significant differences in median AHDS clinical scores between FMT recipients and sham-treated controls at admission (P = 0.22) or discharge (P = 0.41); in the PMC full text, the admission-to-discharge change in median (IQR) AHDS score was −1.5 (3.5) in FMT dogs vs −5.5 (4.5) in sham controls (P = 0.08; n = 4 per group). The Shannon diversity index (SDI) was lower in AHDS dogs than healthy donors at admission (P = 0.002); SDI did not change from admission to 30 days in sham-treated dogs, but increased in FMT recipients from admission to discharge (P = 0.04) to levels not different from donors (P = 0.33) and significantly higher than sham-treated controls at discharge (P = 0.002); at 30 days SDI did not differ between FMT recipients, sham controls and donors (P = 0.88). The authors conclude that in this small pilot study FMT did not have any clinical benefit, although a single FMT increased bacterial communities of short-chain-fatty-acid-producing genera for up to 30 days.
Watch out: Only 8 AHDS dogs in total (4 per group), so this pilot cannot exclude a modest clinical effect in either direction — its null is a statement about a single FMT in these 8 dogs. The trial was open-label, so clinical AHDS scoring was not blinded; do not describe it as a blinded trial. These are adult client-owned AHDS dogs from two referral hospitals, not puppies, shelter dogs or parvovirus cases.
Gal A, Barko PC, Biggs PJ, Gedye KR, Midwinter AC, Williams DA, Burchell RK, Pazzi P. One dog's waste is another dog's wealth: A pilot study of fecal microbiota transplantation in dogs with acute hemorrhagic diarrhea syndrome. PLoS One. 2021;16(4):e0250344. PMID: 33872339. Registry ID: none in the record. MeSH: Actinobacteria/genetics/growth & development/isolation & purification · Animals · Bacteroidetes/genetics/growth & development/isolation & purification · Clostridioides/genetics/growth & development/pathogenicity* · Clostridium Infections/microbiology/pathology/therapy*/veterinary · Diarrhea/microbiology/pathology/therapy*/veterinary · Dogs · Fatty Acids, Volatile/biosynthesis · Fecal Microbiota Transplantation/veterinary* · Feces/microbiology* · Female · Bacillota/genetics/growth & development/isolation & purification · Fusobacteria/genetics/growth & development/isolation & purification · Gastrointestinal Hemorrhage/microbiology/pathology/therapy*/veterinary · Gastrointestinal Microbiome/physiology* · Intestinal Mucosa/microbiology · Male · New Zealand · Pilot Projects · Prospective Studies · Proteobacteria/genetics/growth & development/isolation & purification · RNA, Ribosomal, 16S/genetics · South Africa
Synthesis: one unblinded parvovirus-puppy trial found much faster diarrhoea resolution with added FMT; two AHDS trials found no clinical benefit — MAYBE (weak evidence)
Synthesis
Who: Synthesis of the three cards above (Pereira 2018, 66 parvovirus puppies; Reisinger 2024, 32 AHDS dogs; Gal 2021, 8 AHDS dogs) and of the near-miss record documented in the result, fetched at drafting and deliberately not carded as a claim-carrier.
Result: (1) Puppies with parvovirus: Pereira 2018 is the only carded record in the young-dog population named in this shelf's question, and it is positive on its own terms — resolution within 48 hours in 61.5% (16/26) vs 4.8% (1/21) of survivors and median hospitalisation 3 vs 6 days — but it is unblinded, has no placebo arm, analyses resolution among survivors only, and its FMT group was significantly older (mean 5.18 vs 3.67 months; P = .004). (2) AHDS: both controlled AHDS records are null on clinical scores — Gal 2021 (P = 0.22 at admission, P = 0.41 at discharge; n = 4 per group) and Reisinger 2024 (no significant clinical-score differences over time except day 2 for antibiotic vs FMT, P = .046) — while both show microbiome changes after FMT, so a microbiome shift is not evidence of faster clinical recovery. (3) Shelter dogs: no carded or near-miss record studies FMT in shelter dogs with acute diarrhoea; that part of the question has no direct evidence at all. (4) Near-miss not carded: Chaitman 2020 (PMID: 32363202) compared FMT as enema (n = 11) with oral metronidazole for 7 days (n = 7) in dogs with acute diarrhoea — faecal consistency improved significantly in both groups by day 7 and day 28 (p < 0.01 vs day 0) and was significantly better with FMT than metronidazole at day 28 (p = 0.040) — but its comparator is metronidazole, not standard supportive care, and its PMC full text states the study had no randomisation, no placebo group and unblinded faecal scoring, so it cannot carry this shelf's claim. (5) Design class (b): randomisation is established by Pereira 2018 and Gal 2021 for this shelf's own comparison; blinding of clinical outcomes is not established in any carded record (Pereira explicitly unblinded, Gal open-label), so the class is not (a).
Watch out: One-home check at drafting: none of PMIDs 29460302, 39094622, 33872339 or 32363202 appears in any other pack on disk. Boundaries honoured: FMT in chronic enteropathy homes on shelf #389 and none of its records is re-carded here; acute-diarrhoea drug and probiotic comparisons home on shelves #161, #162, #163 and #164. Do not quote Pereira's 61.5% vs 4.8% without its survivors-only denominator and age imbalance beside it, and do not transport the parvovirus-puppy result to shelter dogs, for which no record was found.
Synthesis of Pereira GQ et al. PMID: 29460302; Reisinger A et al. PMID: 39094622; Gal A et al. PMID: 33872339; Chaitman J et al. PMID: 32363202. Registry IDs as on the individual cards (none in the records).
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