Metronidazole in the Treatment of Stress Colitis in Shelter / Rescued Dogs

Traditional Chinese Veterinary Medicine (TCVM), which can include treatment with Chinese herbal medicine, is being used increasingly in Western medicine to treat a variety of diseases in dogs. With the increased interest in Chinese herbal medicines, evidence-based research to prove efficacy and safety of these traditional medicines is necessary. The objective of this research was to compare the effectiveness of the Chinese herbal medicine, Da Xiang Lian Wan (DXLW), to the Western pharmaceutical, metronidazole, in the treatment of stress colitis in sheltered/rescued dogs utilizing a randomized controlled study with a hypothesis that successful treatment with DXLW would not be less than metronidazole. Fifty-six dogs were randomly assigned to either metronidazole treatment group or DXLW treatment group. Each medication was administered orally twice daily at recommended clinical doses for a maximum of 10 doses. The results indicate that dogs in the metronidazole treatment group had an 89% response rate (normal stools) within the 10 dose protocol while the DXLW group had a 97% positive response rate (p < 0.05, non-inferiority test). This study demonstrates that DXLW is as effective as metronidazole in resolving stress colitis in sheltered dogs and can be an effective alternative treatment for patients that do not respond to metronidazole or cannot tolerate it. key words: colitis, dog, stress, traditional Chinese veterinary medicine, Da Xiang Lian Wan, Coptis, Saussurea, Huang Lian, Mu Xiang, Great Saussurea Coptis From: Acupuncture & Holistic Veterinary Services of Northwest Florida, Panama City Beach, Florida (Fowler); Chi Institute, Reddick, Florida, and Optima Neuroscience, Inc., Alachua, Florida (Shiau); Chi Institute, Reddick, Florida (Xie). ABBREVIATIONS TCVM Traditional Chinese Veterinary Medicine DXLW Da Xiang Lian Wan BID twice daily TID three times daily Stress colitis is a common problem in rescued or sheltered dogs housed in a kennel type environment and in the case of kill shelters, can result in euthanasia of affected dogs.1 Colitis is defined as a high frequency of defecation with small fecal volume. Affected dogs often display prolonged tenesmus after defecation and the loose stools typically contain mucus and/or blood.2 The syndrome may be multi-factorial involving gastrointestinal parasites, bacterial or viral infections, diet changes, anxiety and stress. Abandoned dogs in kennel type facilities are particularly under a high degree of psychological stress from fear, anxiety and sometimes over-crowding. Their gastrointestinal tract is also physiologically stressed from diet changes. While no medical literature could be found discussing the role of stress in dogs with colitis, in humans a higher perceived level of stress in patients appeared to be a contributing factor in ulcerative colitis and Crohn’s disease and experimental work with mice demonstrated that stress aggravated existing colitis. 3,4 Colitis and ulcerative colitis in dogs and other species have been well discussed in veterinary journals. Several conventional medications have been used as a treatment addition or alternative to metronidazole, including tylosin, fluoroquinolones, azathioprine, sulfasalazine, amoxicillin and prednisone. Often no one single agent such as metronidazole is effective and combinations of medications can be required. 5 The role of bacteria in the development of colitis has been discussed and demonstrated along with the failure of antibiotics such as metronidazole in the treatment of canine colitis due to antibiotic resistance. 5,6,7 Metronidazole is listed as the drug of choice for Inflammatory Bowel Disease and Large Bowel Diarrhea