. For dogs that are reasonably stable (for example Bartonella polyarthritis) try starting oneantibiotic (for example doxycycline at 5 mg/kg every 12 hours) and then add the secondantibiotic 5-7 days later. The reason to not start both antibiotics simultaneously is associated witha Jarisch Herxheimer-like reaction, which is a common occurrence in cats and dogs during theinitial treatment for this infection. The reaction (lethargy, fever, potentially vomiting) tends tooccur 4-7 days after starting antibiotics (but is even more delayed in some animals) and is aresult of bacterial injury/death and cytokine release, presumably after achieving high intracellularantibiotic concentrations. Because the patient’s condition can be worse than before startingantibiotics, the clinician often suspects an adverse drug reaction and either stops or switchesantibiotics. This reaction (lethargy, fever, vomiting) generally lasts only a couple of days. Givinganti-inflammatory steroids for a few days may help dogs through this period. Unless clinicaldeterioration continues to progress, it is best to continue the antibiotics that were initially started.The fact that the antibiotics induced a reaction is most likely a reflection of adequate intracellularand intravascular drug concentrations resulting in bacterial death.Originally Posted by skip11
very interesting
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