What is the recommended treatment protocol for canine colitis?

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Canine colitis treatment follows a stepwise approach: dietary management is first-line, with antimicrobial and immunosuppressive therapy reserved for specific indications. Dietary therapy is the recommended initial intervention for both acute and chronic colitis. For acute noninfectious colitis, dietary management with complete and balanced, highly digestible diets — with or without psyllium fiber enhancement — is superior to metronidazole treatment, producing faster treatment response times and a healthier gastrointestinal microbiome profile.2 For chronic colitis, dietary modification is considered an adequate therapeutic starting point, as most dogs with inflammatory bowel disease (IBD) respond positively to dietary management alone.5 In cats with chronic colitis, long-term management with diet alone is achievable in some patients.1 Metronidazole should not be prescribed for acute canine colitis. Metronidazole treatment is associated with slower treatment response times and a significant negative impact on gastrointestinal health, including an abnormal canine dysbiosis index in treated patients.2 Dietary management alone is the preferred approach for noninfectious acute colitis in dogs that are eating voluntarily; if inappetence is persistent, assisted enteral nutrition should be considered.2 Fluoroquinolones are indicated when an infectious etiology responsive to this drug class is identified. Fluoroquinolone (FQ) use in canine colitis requires rigorous qualification to confirm an FQ-responsive infectious agent is contributing to the clinical presentation.3 Histiocytic ulcerative colitis (HUC) in young Boxer dogs, in which an FQ-responsive infectious agent plays an integral role, is a specific indication supporting FQ use.38 Historically, granulomatous colitis in Boxers was treated with immunosuppression with usually fatal outcomes; identification of its infectious etiology made it largely curable with antimicrobials.8 Immunosuppressive therapy is indicated for I