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Whether you can treat pyometra in dogs with only antibiotics is a question many dog owners may have.

It's unfortunate though that while antibiotics may be helpful in many types of infections, pyometra is not one of them. 

To better understand why antibiotics alone don't typically work, it helps gaining a deeper understanding of what pyometra is and how it impacts the dog's body. 

"Don't Let the Sun Set on Pyometra"

 Pyometra is a very serious condition that you do not want to underestimate because, left untreated, it will progress and become life threatening. 

Many times, the condition is not readily recognized by dog owners. The intact female dog goes off food and starts vomiting or gets diarrhea and the symptoms are passed for just a mild indigestion. 

Fast forward a few hours or a few days, and the dog has become lethargic and is already in critical condition.

Vet offices do not take their chances when they receive phone calls from owners describing intact female dogs (especially older dogs!) displaying vague symptoms of digestive problems, loss of appetite and/or increased thirst. 

The increased thirst occurs because toxins (cytokines) are released by bacteria and these cause decreased reabsorption of water at the level of the kidneys.

 To compensate, increased diluted urine production occurs, and many dogs start drinking an excessive amount of water. Dogs can literally dehydrate themselves because of this process.

Vets therefore play it safe and recommend to take the dog immediately in to rule out this deadly condition.

Indeed, among veterinary staff there is a special saying "Don't let the sun set on a pyometra" which suggests having affected dogs seen the same day, especially when they are already quite ill and unstable, but what is it that makes dog pyometra so deadly?

The Dangers of Untreated Pyometra in Dogs 

Pyometra is the term used to depict a dog's infected uterus filling up with pus. Indeed, the term pyometra derives from the Latin word “pyo” meaning pus, and “metra” meaning uterus.

 Generally, the onset of pyometra symptoms are seen anywhere from 4 to 12 weeks following a heat cycle, explains Dr. Margaret V. Root Kustritz, a veterinarian specializing in animal reproduction in an article for DVM360.

Normally, a female dog's cervix (the lower part of the uterus) is tightly closed when the dog is not in heat, but during the heat cycle the dog's cervix remains open and this is when opportunistic bacteria may be introduced into the uterus. 

To further complicate matters, heat after heat, changes in the lining of the uterus take place (cystic endometrial hyperplasia) due to the effect of the hormone progesterone, and this contributes to making the area more hospitable to bacteria. 

Soon, there is significant inflammation which causes accumulation of pus in the uterus and significant swelling. 

Left untreated, pyometra will cause a dog to be in great discomfort or pain. The uterus will start releasing large amounts of bacteria and infected tissue into the abdomen, leading to septicemia (a serious, life-threatening infection of the bloodstream), shock and then death. 

old dog

Open Versus Closed Pyometra 

How severe the symptoms of dog pyometra become vary based on whether the dog suffers from an open or closed pyometra.

 In an open pyometra, the cervix remains open, allowing excess pus to exit. The discharge is often described as being foul-smelling and of a pale red color. 

Dogs with closed pyometra, on the other hand, have a closed cervix and therefore show more severe symptoms as the pus has no way to escape causing complications such as secondary kidney disease and an enlarged uterus. 

Treating Pyometra in Dogs With Only Antibiotics 

While with open pyometra's the risk of death is significantly lower compared to a closed pyometra, the treatment of choice remains surgery. 

With only using antibiotics to treat an open pyometra, in most cases, one is only delaying things. Sometimes, the discharge goes away while on antibiotics, but it commonly comes back as soon as the antibiotics are stopped. 

What the antibiotics may do is simply, not completely eliminate the pyometra, but at least keep the infection under control to temporary prevent septicemia. They can therefore decrease the size of the uterus and reduce the amount of pus,

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"I have seen a dog come back a month later for surgery after putting her on antibiotics for an open pyometra. It was still there, but the uterus was much smaller" remarks veterinarian Dr. John.. 

In some very few cases, medical therapy using medications may be an option in cases of very mild, early onset of open-pyometra when the dog is young and valuable for breeding (and owners do not wish to spay) and there are no signs of organ failure or toxic waste products in the blood.

Therapy in these cases consists of antibiotics along with prostaglandin injections meant to cause the dog's progesterone production to drop so to start uterine contractions and consequent expulsion of infected contents from the uterus.

Antibiotics Alone Won't Treat Pyometra in Dogs 

Antibiotics alone will therefore not treat a dog's pyometra. In order to work, antibiotics need to be given with prostaglandins so that the uterus contracts and expels the pus.

On top of that, antibiotics for dog pyometra often fail to work well because they have difficulties penetrating into the uterus when it's full of pus. "It's like trying to treat appendicitis with antibiotics", further points out veterinarian Dr. Rebecca.

Spaying Remains the Gold Standard Treatment 

There is no other ethical treatment available for female dogs affected by closed pyometra other than surgery. 

Dogs with closed pyometra are at risk for rupture of the uterus and sepsis from bacteria getting into the blood stream, explains Dr. Margaret V. Root Kustritz, a veterinarian specializing in animal reproduction in an article for DVM360.

In some very few cases, medical therapy using medications may be an option in cases of very mild, early onset of open-pyometra when the dog is young and valuable for breeding, but once again, spay surgery is needed in the majority of cases.  

Without surgery, a dog's prognosis remains very poor. 

Dog ACTH test costs

Dog emergency pyometra surgery can be costly

The Cost of Emergency Surgery for Dogs With Pyometra

Before performing surgery, it will be necessary to run several tests to confirm or rule  out pyometra. The tests often include blood work, x-rays and ultrasound. Occasionally exploratory surgery may be necessary. 

The spay surgery for pyometra isn't as an ordinary routine spay. Yes, the uterus and ovaries will need to be removed, but extra care is needed to prevent any infected contents of the uterus from spilling out and bleeding will need to controlled. 

Following surgery, the dog may need to be hospitalized for some days, and once sent home, the dog will need to continue medications such as antibiotics and pain relievers. 

 Following are several rough estimates of the cost of pyometra surgery, based on a variety of factors. 

Normal Surgery (with no complications) Range: $2,000-$2,400

In this case, the dog is stable prior to the surgery and the surgery is uneventful and therefore the dog requires no additional hospitalization. 

Cost includes physical exam, x-rays, blood work, anesthesia, surgery, surgical monitoring, IV catheter and fluids, antibiotic injection, pain injection, medications to send home and Elizabethan-collar.

Stabilization Surgery and 2 Day Hospitalization Range $3,000-$ 4,000

This higher estimate is for dogs who are too ill to undergo surgery and require some time to be stabilized and then endure follow-up hospitalization. 

Cost includes physical exam, x-rays, blood work, IV catheter placement, IV fluids, anesthesia, surgery, surgical monitoring, IV antibiotics, IV pain meds, electrolytes check, 2 day hospitalization,  recheck bloodwork, medications to send home and Elizabethan-collar.

Stabilization Surgery and 4 Day Hospitalization Range $4,500-$ 5,500

  This higher estimate is for dogs who are ill and at high risk for surgery. They need to be stabilized before surgery and are at high risk for blood loss.

Cost includes physical exam, x-rays, blood work, IV catheter placement, IV fluids, anesthesia, surgery, surgical monitoring, possible blood transfusion, hetastarch infusion (to replace blood plasma volume)IV antibiotics, IV pain meds, electrolytes check, blood pressure check, 4 day hospitalization, recheck bloodwork, medications to send home and Elizabethan-collar.

Medical Treatment (Only for Open Pyometra)  Range $500-$700

This option as mentioned is only for dogs with open pyometra who are stable or in some cases as a last-ditch effort for desperate cases where surgery is not an option.

Cost includes physical exam, x-rays, bloodwork, antibiotics, prostaglandin injections  and pain medications. 

Euthanasia (for Untreatable Cases) Range $200-500

Prices vary based on the dog's weight and choice for burial, private cremation or communal cremation. 

 Unable to Afford Dog Pyometra Surgery?

If finances are an issue, consider that Care Credit can help provide money upfront, and many vet clinics offer it as an option to qualified clients.

Another option is calling around shelters as they may have low-cost vets on call or calling a veterinary school to see if they can help. This can help provide students with an opportunity to gain hands-on surgical experience while helping pets in need. 

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