Treatment

TREATMENT

Appropriate health care

  • Outpatient medical management unless diarrhea is severe enough to cause dehydration.

Nursing care

  • Give dehydrated patients balanced electrolyte solution with potassium, intravenously, subcutaneously, or orally.

Diet

  • Patients with acute colitis can be fasted for 24–48 h.
  • Try a hypoallergenic diet in patients with inflammatory colitis; use a commercial or home-prepared diet that contains a protein to which the dog or cat has not been exposed.
  • Fiber supplementation with poorly fermented fiber (e.g., bran and a -cellulose) is recommended to increase fecal bulk, improve colonic muscle contractility, and bind fecal water to produce formed feces.
  • Some fermentable fiber (e.g., psyllium or a diet containing beet pulp or fructooligosaccharides) may be beneficial—short-chain fatty acids produced by fermentation may help the colon heal and restore normal colonic bacterial flora.

Client education

  • Treatment may be intermittent and long-term in patients with inflammatory/immune colitis, and repeated recurrence is seen in some cases, especially those with the histiocytic and granulomatous forms.
  • Granulomatous and histiocytic colitis, pythiosis/phycomycosis, and protothecal colitis respond poorly to medical treatment; surgery may be necessary.

Surgical considerations

  • Segments of colon severely affected by fibrosis from chronic inflammation and subsequent stricture formation may need surgical excision, especially in patients with the granulomatous form of the disease; cecal inversion, ileocecocolic intussusception require surgical intervention; pythiosis/phycomycosis often requires surgical excision or debulking.

Medications - Drugs of choice

  • Antimicrobial Drugs
    • Trichuris, Ancylostoma , and Giardia—fenbendazole (50 mg/kg PO q24h for 3 days, repeat in 3 months)
    • Entamoeba, Balantidium, Giardia , and Trichomonas—metronidazole (25 mg/kg PO q12h for 5–7 days)
    • Salmonella —treatment is controversial because a carrier state can be induced; in patients with systemic involvement, choose the antibiotic on the basis of bacterial culture and sensitivity testing (e.g., enrofloxacin, chloramphenicol, or trimethoprim-sulfa).
    • Clostridium —metronidazole (10–15 mg/kg PO q12h for 5–14 days) or tylosin (10–15 mg/kg PO q12h for 7 days)
    • Campylobacter —erythromycin (30–40 mg/kg PO q24h for 5 days) or tylosin (45 mg/kg PO q24h for 5 days)
    • Yersinia and E. coli—choose the drug on the basis of bacterial culture and sensitivity testing
    • Prototheca —no known treatment
    • Histoplasma —itraconazole (dogs, 5 mg/kg PO q24h; cats, 5 mg/kg PO q12 h; several months of therapy is necessary); amphotericin B (0.25–0.5 mg/kg slow IV q48h up to cumulative dose of 4–8 mg/kg) in advanced cases
    • Pythiosis/phycomycosis—ABLC (dilute in 5% dextrose to 1 mg/mL, give 3 mg/kg IV Monday-Wednesday-Friday for 9 treatments)
  • Antiinflammatory and Immunosuppressive Drugs for Inflammatory/Immune Colitis
    • Sulfasalazine (dogs, 25–40 mg/kg PO q8h for 2–4 weeks; cats, 20 mg/kg PO q12h for 2 weeks)
    • Corticosteroids—prednisone (dogs, 1–2 mg/kg PO q24h; cats, 2–4 mg/kg PO q24h; taper dosage slowly over 4–6 months once clinical remission is achieved)
    • Azathioprine (dogs, 1 mg/kg PO q24h for 2 weeks followed by alternate-day administration; cats, 0.3 mg/kg PO q24h for 3–4 months)
    • Sulfasalazine—drug of choice for plasmacytic lymphocytic colitis
    • Prednisone and azathioprine are indicated only in eosinophilic colitis and severe plasmacytic lymphocytic colitis that does not respond to sulfasalazine
    • Reexamine the diagnosis carefully in dogs that do not respond to sulfasalazine treatment in 4 weeks; the need for chronic maintenance therapy means that an underlying cause (e.g., C. perfringens infection) may have been missed.
  • Motility Modifiers (Symptomatic Relief Only)
    • Loperamide (0.1 mg/kg PO q8–12h)
    • Diphenoxylate (0.1–0.2 mg/kg PO q8h)
    • Paregoric (0.06 mg/kg PO q8–12h)
    • Propantheline bromide (0.25–0.5 mg/kg PO q8h) if colonic spasm is contributing to clinical signs
Last modified: Wednesday, 6 October 2010, 9:30 AM