C09999453 / invoice 10000

Plan for Sully:•	Continue strict diet trial•	Continue sulfasalazine 1 tablet SID •	Start cyclosporine 5 mg/kg SID- prescription for owner to source from chemist - will taper •	Resume antibiotic course and add in amoxyclav alongside metronidazole  for 3 weeks  given previous culture** consider budesonideCyclosporineDuration:4–6 weeks minimumGoal during this phase:resolve clinical signsstabilise rectal inflammationstop recurrent anal sac infectionMany clinicians will not taper before 6 weeks, even if the dog looks better earlier.2. First taper (reduce frequency)Once stable for 2–4 weeks with no relapse:Reduce to 5 mg/kg every 48 hours for 4-6 weeks Monitor for recurrence of:rectal bleedingmucusanal gland dischargescooting or discomfortIf relapse occurs ? return to daily dosing.3. Second taperIf still stable after the EOD phase reduce to 5 mg/kg every 72 hoursContinue for 4–8 weeksSome dogs remain stable here long term.4. Long-term maintenance optionsDepending on the dog’s response, maintenance may be every 72 hours vs twice weekly or occasionally discontinuedMany chronic colitis dogs remain stable on low-frequency cyclosporine.5. Practical example protocolA common timeline:Weeks 0–6? 5 mg/kg SIDWeeks 6–12? 5 mg/kg EODWeeks 12–20? 5 mg/kg every 72 hrThen reassess whether ongoing therapy is needed.6. Drugs often continued alongside cyclosporineSulfasalazine during inductionstrict diet trial (e.g. Hill's Prescription Diet z/d)Sulfasalazine is sometimes tapered after cyclosporine is stabilised.7. Monitoring while on cyclosporineMost clinicians check:Baseline then periodic:CBCbiochemistryurinalysisWatch for:GI upset (most common early effect)gingival hyperplasiapapillomasopportunistic infectionsClinical improvement usually appears within 2–4 weeksFull mucosal stabilisation may take 6–8 weeks    Vital Signs