Canine Respiratory Disease Complex: Diagnostic and Therapeutic Approach

By Dr. Zubair Khalid, DVM, MS, PhD · 2026-08-11

Key Takeaways

• Canine Respiratory Disease Complex (CIRDC) is a multifactorial syndrome caused by a variety of viral (e.g., CPIV, CAV-2, CRCoV, CIV, CDV, CHV) and bacterial (e.g., B. bronchiseptica, M. cynos, S. equi subsp. zooepidemicus) pathogens, frequently presenting with overlapping clinical signs and high rates of coinfection, particularly in high-density dog populations.
• Multiplex PCR on nasal, oropharyngeal, or conjunctival swabs is the diagnostic test of choice for identifying causative agents, but positive results must be interpreted cautiously due to common subclinical shedding, meaning a positive test does not definitively prove causation.
• Disease severity stratification is critical for triage, with mild cases managed supportively, moderate cases warranting thoracic radiography to rule out pneumonia, and severe cases requiring hospitalization, aggressive diagnostics, and potentially intravenous fluid therapy and supplemental oxygen.
• Antimicrobial therapy is reserved for suspected or confirmed bacterial pneumonia (evidenced by fever, lethargy, anorexia, abnormal lung sounds, or radiographic alveolar patterns) or severe, progressive disease where bacterial coinfection cannot be excluded, with empirical choices targeting Bordetella bronchiseptica and common secondary invaders.
• Supportive care, including rest, hydration, nutritional support, and airway clearance techniques like nebulization and coupage, forms the cornerstone of CIRDC management, with cough suppressants used judiciously only after pneumonia has been ruled out.
• Progression to pneumonia, coinfection amplifying disease severity, and chronic cough are recognized complications; failure to improve within 7-10 days or worsening signs necessitate re-evaluation for secondary bacterial pneumonia, aspiration, or non-infectious differentials.

Canine infectious respiratory disease complex (CIRDC) is an endemic, worldwide syndrome involving multiple viral and bacterial pathogens that cause clinical signs ranging from mild, self-limiting cough to severe pneumonia Reagan and Sykes on canine infectious respiratory disease. The syndrome is frequently encountered in kennels, shelters, and boarding facilities, where high population density and pathogen shedding amplify transmission. This article provides a diagnostic reasoning framework for the practicing veterinarian, covering etiologic agents, clinical presentation, diagnostic test selection and interpretation, and therapeutic decision-making. It does not address vaccination protocols.

The clinical challenge in CIRDC lies in the overlap of clinical signs among causative agents, the high prevalence of subclinical infection, and the frequency of coinfection Day et al. on the aetiology of CIRDC in Europe. A diagnosis based solely on history and physical examination is often insufficient to identify the etiologic agent, yet routine diagnostic testing in mild, self-limiting cases may not alter management Reagan and Sykes on canine infectious respiratory disease. The clinician must therefore weigh the cost and turnaround time of molecular testing against the likelihood that results will change therapeutic decisions, particularly in outbreak settings where identifying a novel or highly pathogenic agent has public health and population-level implications.

At a Glance

Pathogen Biology and Epidemiology

Viral Pathogens

Canine respiratory coronavirus (CRCoV), a betacoronavirus first identified in 2003, is a major cause of CIRDC and is highly infectious, with the highest prevalence reported in rehoming shelters worldwide Priestnall on canine respiratory coronavirus. The virus is genetically and antigenically distinct from enteric canine coronavirus, so specific diagnostic assays are required Erles and Brownlie on canine respiratory coronavirus as an emerging pathogen. Clinical signs are typically mild, consisting of persistent cough and nasal discharge, but the virus is frequently detected in mixed infections.

Canine parainfluenza virus (CPIV) and canine adenovirus type 2 (CAV-2) remain classic CIRDC agents, although recovery rates from healthy and diseased dogs are low in Europe, likely reflecting widespread vaccination Day et al. on the aetiology of CIRDC in Europe. Canine distemper virus (CDV) causes systemic disease with respiratory signs as one component, and its detection should prompt evaluation for neurologic and ocular involvement. Canine herpesvirus (CHV) seroconversion can be demonstrated following outbreaks, and the virus has been detected in the lower respiratory tract of diseased dogs, though its role as a primary respiratory pathogen remains less clearly defined Day et al. on the aetiology of CIRDC in Europe. Canine influenza virus (CIV) is an emerging agent with outbreak potential in dense dog populations.

Bacterial Pathogens

Bordetella bronchiseptica is a gram-negative coccobacillus that colonizes ciliated respiratory epithelium and is a primary cause of CIRDC. Evidence of exposure is found frequently in both healthy and diseased dogs, and client-owned dogs are as likely to be infected as kennelled dogs Day et al. on the aetiology of CIRDC in Europe. The organizm can evade and modulate host immune responses to support persistence, which complicates both diagnosis and clearance Miguelena Chamorro et al. on Bordetella bronchiseptica and Bordetella pertussis. Mycoplasma cynos and Streptococcus equi subsp. zooepidemicus are increasingly recognized as contributors to CIRDC, with the latter capable of causing severe, sometimes fatal, hemorrhagic pneumonia.

Pathophysiology and Host Factors

The respiratory tract of the dog is protected by multiple innate defenses, including mucociliary clearance, secretory immunoglobulin A, and resident alveolar macrophages. Viral pathogens such as CPIV and CAV-2 damage the ciliated epithelium, impairing mucociliary clearance and creating a permissive environment for secondary bacterial colonization. B. bronchiseptica exploits this damage through adhesins and toxins that further suppress local immune responses Miguelena Chamorro et al. on Bordetella bronchiseptica and Bordetella pertussis.

Coinfection is the rule instead of the exception. Multiplex PCR testing of dogs with respiratory illness frequently detects multiple viruses in individual animals Piewbang et al. on multiplex PCR for virus-induced respiratory disease complex in dogs. The clinical consequence of coinfection is variable, but some combinations, particularly viral-bacterial pairings, are associated with more severe disease. Host factors that increase the risk of progression include age extremes, immunosuppression, poor vaccination status, and underlying bronchial or cardiac disease.

Diagnostic Reasoning Framework

When to Test

The decision to pursue etiologic diagnosis should be guided by disease severity, outbreak context, and the potential for zoonotic or novel pathogen involvement. Mild, self-limiting cough in an otherwise healthy, vaccinated dog with known kennel exposure may not require laboratory confirmation Reagan and Sykes on canine infectious respiratory disease. Testing is indicated when clinical signs are severe, when cough persists beyond 10 to 14 days, when multiple dogs in a household or facility are affected, or when a novel pathogen such as CIV is suspected.

Sample Collection and Test Selection

Nasal, oropharyngeal, or conjunctival swabs are suitable for molecular testing. Multiplex PCR assays can simultaneously detect the principal viral pathogens, including CIV, CPIV, CDV, CRCoV, CAV-2, and CHV, with reported sensitivity above 87 percent and specificity of 100 percent compared with simplex PCR Piewbang et al. on multiplex PCR for virus-induced respiratory disease complex in dogs. Bacterial culture for B. bronchiseptica and Mycoplasma species can be performed on the same samples, though the clinical significance of a positive culture must be interpreted in light of the high prevalence of subclinical carriage Day et al. on the aetiology of CIRDC in Europe.

Interpreting Results

A positive PCR result confirms the presence of the pathogen's nucleic acid but does not prove that the pathogen is the cause of the current illness. Subclinical shedding of CIRDC pathogens is well documented, and a positive result in a dog with respiratory signs may represent incidental carriage Reagan and Sykes on canine infectious respiratory disease. Conversely, a negative PCR result does not exclude infection if sampling was performed late in the disease course or if the pathogen is present in the lower respiratory tract but not the sampled site. The clinician should integrate PCR results with cytology, imaging, and response to therapy when available.

Clinical Assessment and Physical Examination

The physical examination should proceed systematically, with attention to localizing the disease process within the respiratory tract. Dogs with CIRDC typically present with a paroxysmal, honking cough that may be elicited by tracheal palpation. Nasal discharge, ocular discharge, and sneezing suggest upper airway involvement, whereas tachypnoea, increased respiratory effort, and abnormal lung sounds indicate lower airway or parenchymal disease. Fever is variable and does not reliably distinguish viral from bacterial aetiology.

A complete examination includes assessment of hydration status, mucous membrane color, capillary refill time, and thoracic auscultation. The clinician should specifically evaluate for increased bronchovesicular sounds, crackles, or wheezes, and should note whether these are localized or generalized. Thoracic auscultation alone is insensitive for detecting early pneumonia, and normal lung sounds do not exclude lower respiratory tract disease.

The examination should also include palpation of the submandibular and prescapular lymph nodes, assessment of pharyngeal tone, and evaluation for evidence of systemic illness such as depression, anorexia, or weight loss. The presence of these systemic signs, particularly in combination with tachypnoea or fever, should raise suspicion for bacterial bronchopneumonia or a more severe viral infection such as canine distemper virus. As noted in the ACVIM consensus statement collection, the diagnostic approach should be guided by the severity and progression of clinical signs instead of by the presence of a cough alone.

Severity Stratification and Triage Decisions

The clinical spectrum of CIRDC ranges from mild, self-limiting tracheobronchitis to severe, life-threatening pneumonia. Triage decisions should be based on objective parameters instead of on the duration of cough alone.

Dogs with mild disease can typically be managed as outpatients with supportive care and monitoring. Dogs with moderate disease warrant closer observation, and thoracic radiography should be performed to exclude pneumonia. Dogs with severe disease require hospitalization, intravenous fluid therapy, supplemental oxygen if hypoxemic, and aggressive diagnostic testing. The MSD Veterinary Manual emphasizes that progression from mild to severe disease can occur rapidly, particularly in young puppies, geriatric dogs, and immunocompromised patients.

Diagnostic Imaging and Point-of-Care Testing

Thoracic radiographs should be obtained in any dog with fever, tachypnoea, increased respiratory effort, or abnormal lung sounds. Three views, right lateral, left lateral, and ventrodorsal, are preferred to avoid missing focal lesions. The radiographic pattern helps narrow the differential diagnosis. A bronchial pattern is most consistent with uncomplicated tracheobronchitis or chronic bronchitis. An alveolar pattern, particularly in the cranioventral lung lobes, supports bacterial bronchopneumonia. An interstitial pattern is less specific and may be seen with viral pneumonia, fungal disease, or non-infectious inflammatory conditions.

The distribution of radiographic changes is also informative. Cranioventral alveolar disease is typical of aspiration pneumonia or Bordetella bronchiseptica infection. Diffuse or caudodorsal interstitial patterns raise concern for canine distemper virus, canine influenza virus, or non-infectious causes such as pulmonary edema or hemorrhage. Radiographic changes may lag behind clinical signs by 24 to 72 hours, so a normal thoracic radiograph does not exclude pneumonia in a dog with acute onset of signs.

Point-of-care testing includes pulse oximetry and blood gas analysis. Pulse oximetry provides a rapid, non-invasive estimate of arterial oxygen saturation. Values below 94% at sea level warrant further investigation and supplemental oxygen. Venous blood gas analysis can assess ventilation through carbon dioxide measurement and can identify metabolic derangements in severely affected dogs. These parameters should be monitored serially in hospitalized patients, with the frequency determined by clinical stability.

Pathogen-Specific Diagnostic Decision Table

The decision to pursue specific pathogen testing should be guided by the clinical presentation, the epidemiological context, and the potential for management changes. The following table summarizes the clinical scenarios in which testing for specific pathogens is most likely to alter case management.

The European prevalence data on CIRDC pathogens demonstrate that Bordetella bronchiseptica is frequently detected in both healthy and diseased dogs, and that co-infections with viral pathogens are common. This finding has direct clinical relevance: a positive PCR result for a single pathogen does not exclude concurrent infection with another agent, and the absence of a detectable pathogen does not exclude CIRDC as a diagnosis.

Treatment Algorithm and Antimicrobial Stewardship

The treatment approach should be stratified by disease severity and by the likelihood of bacterial involvement. Antimicrobial therapy is not indicated for every dog with CIRDC. Many viral infections are self-limiting, and the review of canine respiratory coronavirus notes that clinical signs are generally mild and resolve without specific antiviral therapy.

Antimicrobial therapy is indicated when there is evidence of bacterial pneumonia, including fever, lethargy, anorexia, abnormal lung sounds, or radiographic evidence of alveolar disease. Antimicrobial therapy is also reasonable in dogs with severe or progressive disease in which bacterial co-infection cannot be excluded. The choice of antimicrobial should be guided by culture and susceptibility testing whenever possible, particularly in dogs with severe disease, in dogs that have failed empirical therapy, or in populations where antimicrobial resistance is a concern.

Empirical therapy, when required before culture results are available, should target Bordetella bronchiseptica and common secondary invaders. The comparative review of Bordetella species highlights that B. bronchiseptica can evade and modulate host immune responses, which supports the use of antimicrobials that achieve adequate tissue concentrations and that are active against intracellular organizms. Current formulary and label references must be consulted for specific doses, durations, and withdrawal periods, as these vary by drug, formulation, and jurisdiction.

Supportive care is the foundation of management for all dogs with CIRDC. This includes rest, adequate hydration, nutritional support, and nursing care to maintain airway clearance. Cough suppressants are controversial and should be used with caution. Suppressing a productive cough may impair clearance of exudate and worsen pneumonia. Antitussive therapy may be considered in dogs with a non-productive, paroxysmal cough that interferes with rest or feeding, but only after pneumonia has been excluded.

Nebulisation and coupage may aid in airway hydration and clearance in hospitalized dogs with pneumonia. These techniques are most useful in dogs with copious airway secretions and should be combined with regular assessment of respiratory status. Oxygen supplementation is indicated for dogs with hypoxemia, and the fraction of inspired oxygen should be titrated to maintain oxygen saturation above 94%.

Monitoring and Documentation

Hospitalized dogs should be monitored at least twice daily, with more frequent assessment in severely affected patients. The monitoring plan should include respiratory rate and effort, heart rate, temperature, mucous membrane color, capillary refill time, appetite, and body weight. Pulse oximetry should be repeated at intervals determined by clinical stability, and thoracic radiographs should be repeated if there is clinical deterioration or failure to improve within 48 to 72 hours of initiating therapy.

Documentation should record the initial severity score, the diagnostic tests performed, the results obtained, the treatment administered, and the response to therapy. Serial documentation of respiratory parameters allows objective assessment of treatment response and early identification of deterioration. The WOAH terrestrial animal health standards provide guidance on disease surveillance and reporting that is relevant when CIRDC occurs in group-housed populations, particularly in shelters or breeding facilities where outbreak investigation may be required.

The decision to discharge a dog from hospital should be based on objective criteria instead of on a fixed duration of therapy. Discharge is appropriate when the dog is normothermic, eating, maintaining hydration, and has stable or improving respiratory parameters. Owners should be counselled on the contagious nature of CIRDC and on the need for isolation from other dogs for a period that reflects the likely pathogen involved. The duration of contagiousness varies by pathogen and is not always well defined, so a conservative approach to isolation is warranted in multi-dog households.

Recognized Complications and Early Detection

Progression from mild tracheobronchitis to pneumonia is the most consequential complication in CIRDC. Dogs that deteriorate typically do so within 48 to 72 hours of initial presentation. Early indicators include a change from a dry, honking cough to a productive cough with mucopurulent exudate, increased respiratory effort, and auscultatory findings of crackles or bronchial lung sounds. Serial temperature measurement and respiratory rate assessment at rest, performed twice daily in hospitalized patients, identify decompensation before overt respiratory distress develops. Pulse oximetry below 94% on room air warrants immediate re-evaluation and thoracic imaging.

Coinfection is a recognized amplifier of disease severity. Multiple viral and bacterial pathogens frequently circulate simultaneously in kennelled populations, and detection of one agent does not exclude others Canine Infectious Respiratory Disease. Dogs infected with canine respiratory coronavirus and Bordetella bronchiseptica together may show more pronounced clinical signs than dogs infected with either pathogen alone Canine respiratory coronavirus: an emerging pathogen in the canine infectious respiratory disease complex. When a dog fails to improve within five to seven days of supportive care, repeat sampling for additional pathogens is indicated instead of assuming treatment failure.

Chronic or recurrent cough after apparent recovery suggests structural airway damage, secondary bacterial bronchitis, or an underlying non-infectious process such as collapsing trachea or bronchomalacia. Persistence of cough beyond three weeks after resolution of other signs should prompt bronchoscopy or advanced imaging instead of repeated empirical antimicrobial courses.

Common Diagnostic and Therapeutic Errors

The most frequent error is treating every coughing dog with antimicrobials. Bordetella bronchiseptica is frequently isolated from healthy dogs, and many viral infections are self-limiting Aetiology of Canine Infectious Respiratory Disease Complex and Prevalence of its Pathogens in Europe. Antimicrobial therapy is reserved for dogs with fever, mucopurulent nasal discharge, pulmonary auscultatory changes, or radiographic evidence of pneumonia. A second common error is interpreting a single positive PCR result as proof of causation. Subclinical shedding is widespread, so a positive result must be correlated with clinical signs and temporal exposure history Canine Infectious Respiratory Disease.

Sampling errors also undermine diagnostic accuracy. Oropharyngeal swabs miss lower respiratory pathogens, while nasal swabs may only reflect surface colonisation. Deep nasal or tracheal washes, or bronchoalveolar lavage in pneumonic dogs, provide more representative material. Multiplex PCR panels offer high sensitivity for viral detection, but results depend on sample quality and timing relative to shedding Development and application of multiplex PCR assays for detection of virus-induced respiratory disease complex in dogs.

A third error is failing to reassess the diagnosis when the clinical course diverges from expectations. Foreign body aspiration, fungal pneumonia, and neoplasia can mimic CIRDC. Dogs that worsen despite appropriate therapy, or that present with unilateral nasal discharge, facial deformity, or hemoptysis, require a broader differential list.

Troubleshooting Table

Evidence Limitations and Areas of Disagreement

The evidence base for CIRDC is constrained by several factors. Most prevalence studies rely on convenience sampling from shelters or referral populations, which may not reflect general practice caseloads. Subclinical infection rates are high for nearly all recognized pathogens, making attribution of disease to a specific agent difficult Canine Infectious Respiratory Disease. Seroprevalence studies show widespread exposure to canine respiratory coronavirus in kennelled populations, but the clinical significance of infection in individual dogs remains uncertain Canine Respiratory Coronavirus: A Naturally Occurring Model of COVID-19?.

Expert opinion diverges on the role of Mycoplasma cynos and Streptococcus equi subspecies zooepidemicus as primary pathogens versus opportunistic invaders. Some authorities recommend routine antimicrobial coverage for these organizms in severe cases, while others reserve treatment for cytologically or culturally confirmed infection. The protective immune response to Bordetella bronchiseptica involves both mucosal and systemic components, and the duration of protective immunity after natural infection is not well defined Bordetella bronchiseptica and Bordetella pertussis: Similarities and Differences in Infection, Immuno-Modulation, and Vaccine Considerations. This uncertainty complicates decisions about re-exposure risk in multi-dog households.

Referral and Reporting Indications

Referral for specialist evaluation is warranted when pneumonia is severe or refractory, when hypoxemia persists despite oxygen supplementation, when bronchoscopy or advanced imaging is required, or when the diagnosis remains uncertain after a complete primary workup. Dogs with suspected canine influenza virus should be managed with heightened biosecurity, and clinicians should consult current regional guidance from professional bodies such as the American Veterinary Medical Association practice resources for outbreak reporting expectations. Canine distemper virus is reportable in many jurisdictions, and clinicians should verify local requirements through WOAH terrestrial animal health standards and national authorities. Laboratory consultation is appropriate when cytology or histopathology interpretation is uncertain, when culture results show unusual resistance patterns, or when PCR results conflict with clinical findings.

Frequently Asked Questions

How Should I Manage a Suspected CIRDC Case When PCR Panels Are Unavailable or Unaffordable?

When molecular testing is not feasible, base initial decisions on severity stratification and signalment. For mild disease in an otherwise healthy, vaccinated adult dog, a working diagnosis of uncomplicated CIRDC is reasonable after physical examination excludes lower respiratory tract involvement. Collect a deep nasal or oropharyngeal swab for bacterial culture if a mucopurulent discharge is present, since Bordetella bronchiseptica remains an important cause of CIRDC in Europe. Reserve radiography for patients with fever, tachypnoea, or abnormal lung sounds. Document the testing limitation in the medical record and revisit the diagnosis if signs fail to improve within 10 days or worsen at any point.

What Is the Minimum Isolation Protocol for a Kennel or Shelter After a CIRDC Outbreak?

Coughing dogs should be separated from the general population immediately, and ideally housed in a dedicated isolation area with independent air handling. Use dedicated personnel or strict hand hygiene and footbath protocols between groups. Because canine respiratory coronavirus is highly infectious and endemic in rehoming shelters, assume viral shedding precedes clinical signs by several days. Discontinue intake of new animals for a minimum of 14 days after the last cough resolves. Clean and disinfect all surfaces with products active against non-enveloped viruses, since adenovirus and herpesvirus are less susceptible to simple quaternary ammonium compounds. Maintain cohort housing for newly arrived animals throughout the quarantine period.

How Do I Distinguish CIRDC From Primary Bacterial Pneumonia in a Dog That Is Not Improving?

Failure to improve within 7 to 10 days, or deterioration after initial stabilization, should prompt re-evaluation for bacterial pneumonia, aspiration, or a non-infectious differential such as eosinophilic bronchopneumopathy or neoplasia. Perform thoracic radiography and consider bronchoalveolar lavage for cytology and aerobic culture. Coinfections are common in CIRDC, so a single positive PCR result does not exclude a second bacterial pathogen. Neutrophilic inflammation with intracellular bacteria supports primary bacterial pneumonia and justifies targeted antimicrobial therapy based on culture and susceptibility. If cytology shows eosinophilic or lymphocytic inflammation, revisit the diagnostic plan before escalating antimicrobials.

What Should I Tell an Owner Whose Dog Has a Mild Cough but Is Otherwise Well?

Explain that CIRDC is a syndrome caused by several viruses and bacteria, that most cases resolve without specific treatment, and that the cough can persist for 1 to 3 weeks even after the infection clears. Advise rest, avoidance of dog parks and group classes, and a harness instead of a collar to reduce tracheal irritation. Warn that the dog remains contagious to other dogs for up to 2 weeks after clinical signs resolve. Instruct the owner to monitor respiratory rate at rest and to seek recheck if coughing worsens, appetite drops, or breathing effort increases. Clinical signs are frequently mild and self-limiting, but some cases progress to severe disease, so provide clear criteria for urgent re-evaluation.

When Should I Notify Public Health Authorities or Report a Case?

Most CIRDC cases are not reportable, but two situations warrant attention. First, canine influenza virus is a notifiable disease in some jurisdictions, and a confirmed or suspected case should be reported according to local requirements. Second, Bordetella bronchiseptica is increasingly implicated in human infections, particularly in immunocompromised individuals. If an owner or household contact is immunocompromised, advise them to discuss exposure with their physician and to minimize close contact with the coughing dog. Consult WOAH terrestrial animal health standards for international reporting obligations and your national veterinary authority for local requirements.

How Should I Document a CIRDC Case in the Medical Record for Medicolegal Protection?

Record the date of onset, exposure history, vaccination status, and all examination findings including temperature, respiratory rate, lung auscultation, and hydration status. Document the severity classification and the rationale for each diagnostic test performed or declined. If antimicrobials are prescribed, note the suspected or confirmed pathogen, the drug selected, and the planned duration. Record owner instructions verbatim in summary form, including isolation advice and recheck criteria. If the owner declines recommended testing, document that discussion and the informed decision. Clinical diagnosis is often based on history and physical examination, but determining the etiologic agent requires specific diagnostic tests, so record explicitly when testing was deferred and why.

Related Clinical & Scientific Guides

• Feline Hepatic Lipidosis: Nutritional and Medical Management
• Canine Respiratory Infection: Diagnostic Approach and Treatment
• Canine Respiratory Virus: Diagnostic and Management Considerations

References and Further Reading

• Canine Infectious Respiratory Disease.. 2020.
• Canine Respiratory Coronavirus: A Naturally Occurring Model of COVID-19?. 2020.
• Canine respiratory coronavirus: an emerging pathogen in the canine infectious respiratory disease complex.. 2008.
• Aetiology of Canine Infectious Respiratory Disease Complex and Prevalence of its Pathogens in Europe.. 2020.
• <i>Bordetella bronchiseptica</i> and <i>Bordetella pertussis</i>: Similarities and Differences in Infection, Immuno-Modulation, and Vaccine Considerations.. 2023.
• Development and application of multiplex PCR assays for detection of virus-induced respiratory disease complex in dogs.. 2017.
• ACVIM Consensus Statements. Journal of Veterinary Internal Medicine.
• MSD Veterinary Manual, Professional Edition. MSD Veterinary Manual.
• American Veterinary Medical Association Practice Resources. American Veterinary Medical Association.

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This article is educational professional reference material for veterinary audiences. It is not a substitute for veterinary diagnosis, individual clinical judgment, current product labeling, or applicable regulatory requirements.