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Oseltamivir in dogs with acute parvovirus infection

Clinical Scenario

You work in a busy charity hospital and see a lot of parvovirus in dogs less than 6 months of age. Even though the mortality due to CPV is low in your hospital, dogs with parvovirus are a big burden to both veterinary and nursing staff. You have recently been to an evening CPD meeting where the use of Tamiflu was described in dogs in the acute stage of infection. It was suggested that this drug may reduce the severity of clinical signs and possibly survival. You wonder if there is any evidence to support the use of Tamiflu in affected dogs...

3-Part Question (PICO)

In [dogs with acute parvovirus infection] does [the use of oseltamivir in combination with supportive therapy compared to supportive therapy alone] decrease [the severity of clinical signs in the affected dogs]?

Search Strategy and Summary of Evidence

Search Strategy

MEDLINE(R) In-Process & Other Non-Indexed Citations and MEDLINE(R) 1946 to Present using the OVID interface

(dog.mp. OR dogs.mp. OR canine.mp. OR canines.mp. OR canid.mp. OR exp Dogs/)

AND

(parvo$.mp. OR viral diarrhoea.mp. OR viral diarrhea.mp. OR viral enteritis.mp. OR exp Parvovirus, Canine/)

AND

(oseltamivir.mp. OR tamiflu.mp. OR anti viral.mp. OR anti virals.mp. OR antiviral.mp. OR antivirals.mp. OR neuraminidase inhibitor.mp. OR neuraminidase inhibitors.mp.)

CAB Abstracts 1910 to Present using the OVID interface

(dog.mp. OR dogs.mp. OR canine.mp. OR canines.mp. OR canid.mp. OR exp Dogs/)

AND

(parvo$.mp. OR viral diarrhoea.mp. OR viral diarrhea.mp. OR viral enteritis.mp. OR exp canine parvovirus/)

AND

(oseltamivir.mp. OR tamiflu.mp. OR anti viral.mp. OR anti virals.mp. OR antiviral.mp. OR antivirals.mp. OR neuraminidase inhibitor.mp. OR neuraminidase inhibitors.mp.)

Search Outcome

MEDLINE

  • 38 papers found in MEDLINE search
  • 26 papers excluded as they don't meet the PICO question
  • 0 papers excluded as they are in a foreign language
  • 1 papers excluded as they are review articles/in vitro research/conference proceedings
  • 1 total relevant papers from MEDLINE

CAB Abstracts

  • 38 papers found in CAB search
  • 33 papers excluded as they don't meet the PICO question
  • 0 papers excluded as they are in a foreign language
  • 4 papers excluded as they are review articles/in vitro research/conference proceedings
  • 1 total relevant papers from CAB

Total relevant papers

1 relevant papers from both MEDLINE and CAB Abstracts

Summary of Evidence

Savigny & Macintire (2011) Canada

Title:

Use of oseltamivir in the treatment of canine parvoviral enteritis.

Patient group:

35 dogs presenting with canine parvovirus (CPV) for treatment at Auburn University Veterinary Hospital (not clear whether primary care patients or referrals)

Study Type:

Randomised controlled trial

Outcomes:
  • Clinical score (encompassing attitude, appetite, vomiting and diarrhoea)
  • Biochemistry values (CBC, total protein, electrolytes, glucose)
  • Haematology—PCV, total white cells (WBC), neutrophils (NEUT) and lymphocytes (LYMPH); nadir values of cell counts and when nadir occurred; number of days where a “clinically relevant decrease” in white cells was noted
  • Body weight
  • Percentage days where “systemic inflammatory response syndrome (SIRS) criteria” (fever, elevated HR and RR, elevated WBC) were fulfilled
  • Need for ancillary therapy (colloids, transfusion, chlorpromazine)
  • Duration of hospitalisation
  • Mortality
Key Results:
  • Clinical scores had no significant differences between groups (no p value given), except on day 6 when the treatment group scores were significantly better (p=0.02)
  • Biochemistry values were not reported in the results
  • No significant differences for WBC, NEUT and LYMPH values were found between groups at any point (no p value given). However, control group dogs’ counts did drop significantly as compared to their day 1 values, whereas those of the treatment group did not
  • There was no significant difference in body weight between the two groups at entry (p=0.21) or at discharge (p=0.42). However, the body weight of the control group did drop significantly (median -0.21 kg) as compared to the day 1 value, whereas the weight of those in the treatment group did not (median +0.07 kg)
  • No differences in % SIRS days (52% in control group, 54% in treatment group)
  • No significant difference in requirement for colloids (p=0.5), chlorpromazine (no p value given) or transfusion (p=0.5)
  • There was no significant difference (p=1.0) in duration of hospitalisation between control (mean 5.9 d) and treatment (mean 6 d groups)
  • 100% of the treated group survived, compared to 81% of the control group (3 deaths, p = 0.09, no statistically significant difference)
Study Weaknesses:
  • Sample size inadequate – 19 in treated group and 16 in placebo (the post hoc power analysis suggested that 94 dogs, 47 in each group, were needed.)
  • Some lack of clarity around how cases were recruited
  • Although many of the outcome measures were clinically relevant, these generally showed the treatment to be the same as the control group. The study appears to focus on those few measures of questionable clinical relevance which provided a positive outcome
  • No statistical compensation for the multiple comparisons made
Attachment:
No attachments.

Comments

There are important ethical problems with this study, including the fact that owners of dogs with an expensive, acute, life-threatening illness were given a financial incentive to enrol them in a clinical trial. In addition, oseltamivir is reserved for human use in the event of a catastrophic influenza pandemic, so there are questions over the use of this drug for veterinary patients, particularly without having a clear biological rationale for its use.
There is strong potential for bias in the reporting of this trial. For example, multiple biochemistry tests are described but the results are not reported; excessive importance is attached to values of dubious clinical significance (e.g. appetite on a particular day), and overall negative results are discussed with an unduly positive slant.
Overall, this does not provide convincing evidence in favour of the use of CPV. However, further studies may offer more insights, as the number of animals in this trial was small.

Bottom line

At the present time, the use of oseltamivir in canine parvovirus cannot be justified.

Disclaimer

The BETs on this website are a summary of the evidence found on a topic and are not clinical guidelines. It is the responsibility of the individual veterinary surgeon to ensure appropriate decisions are made based on the specific circumstances of patients under their care, taking into account other factors such as local licensing regulations. Read small print

References

Savigny MR and Macintire DK (2010) Use of oseltamivir in the treatment of canine parvoviral enteritis. Journal of Veterinary Emergency and Critical Care 20: 132–142.

About this BET

First author:
Jenny Stavisky
Second author:
Rachel Dean
Institution:

CEVM, University of Nottingham

Search last performed:
2016-03-02 09:59:28
Original publication date:
2013-09-13 09:59:28
Last updated:
2016-03-02 09:59:28
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