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The following parameters should be used as an indication for antibiotic treatment in dogs with AHDS:
• rectal temperature > 39.5°C
• tachycardia after rehydration and pain management > 120/min
• WBC < 4 or > 25 x 109/l
• band neutrophils > 1.5 x 109/l
Besides these criteria, evaluation of the clinical course and response to  uid therapy is important in detecting low numbers of patients that require antibiotic treatment. With adequate  uid therapy (crystalloids;  uid amount depending on dehydration, maintenance demands,
and ongoing losses) a rapid improvement of clinical signs can typically be observed during the  rst 48 hours without antibiotic treatment. Dogs that do not adequately respond to  uid therapy after 4 hours
(i. e. alert mental status, heart and respiratory rate dropping into normal range, adequate production of urine) should be categorized as “complicated AHDS” patients. That should prompt the clinician to look for other underlying causes (e.g. acute pancreatitis, viral enteritis). In patients with suspected bacterial infection with an enteropathogen or bacterial translocation from the intestinal tract resulting in sepsis, bacterial cultures from blood, aspirated material from enlarged abdominal lymph nodes, bile or even feces might help to isolate
the responsible pathogen and to select an appropriate antibiotic. Until sensitivity testing is available, suspect septic patients should be treated with intravenously administered antibiotics effective primarily against Gram- negative and anaerobic bacteria (e. g.  ouroqinolones and metronidazole).
In summary, several studies demonstrated an apparent association between C. perfringens and the occurrence of acute hemorrhagic diarrhea. There is strong supportive evidence regarding clostridial toxins as a cause for the intestinal epithelial necrosis in dogs with AHDS. Most dogs with acute hemorrhagic diarrhea are signi cantly dehydrated and show a rapid clinical improvement with adequate  uid therapy. Septic events are uncommon, and prognosis is good even in patients without antibiotic treatment. Close patient monitoring is essential to identify dogs requiring antibiotic treatment.
An Urban Experience

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