Literature review and authors’ consensus recommendations for the medical management of perianal fistulae in dogs
Literature review and authors’ consensus recommendations for the medical management of perianal fistulae in dogs
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In our edition of: Aug 2025
In our categories of: small animals
our summary:
Bruet, V. et al. (2025) Literature review and authors’ consensus recommendations for the medical management of perianal fistulae in dogs. Veterinary Dermatology
The aim of this literature review and consensus recommendations was to provide primary care practitioners with practical information to assist in the management of canine perianal fistulae.
A literature review was carried out for relevant articles published between 1980 and August 2024. Recommendations are based on grading of the available evidence and voting by the advisory board composed of 16 ECVD diplomates. The quality of evidence was assessed using the three-point Strength of Recommendation Taxonomy and the level of evidence was graded on a three-point scale.
The recommendations are organised under four relevant clinical questions:
- In initial management, which treatment should be used as first-line therapy?
- Which steps should be taken if the therapeutic response is insufficient or absent?
- In the long-term phase, how can remission be maintained?
- Can diet modification to a novel or hydrolysed protein regimen be effective in the treatment of perianal fistulae?
Twenty articles were identified in the literature of which the majority concerned the efficacy of ciclosporin either alone (seven studies) or in combination with ketoconazole (four studies).
Recommendations include: that ciclosporin is the preferred first line medical treatment for perianal fistulae with the recommended starting dose when used alone of 5 mg/kg once daily; as ciclosporin treatment may take up to three months to be effective modification or discontinuation of the treatment should not be considered earlier than three months; that prednisolone or topical tacrolimus can be considered, either alone or in combination, as alternative treatments to ciclosporin; and that remission should be managed through individualised gradual tapering of treatment. There is a lack of evidence on the efficacy of dietary modification using novel or hydrolysed protein.
Limitations include a significant variability between the included studies resulting in a lack of reliable and consistent data thereby reducing the quality of the available evidence. The grading of evidence/strength of recommendations could have been set out more clearly.
These consensus recommendations provide primary care practitioners with guidance on managing cases of perianal fistulae in dogs. Further research is needed which considers treatments to optimise long-term disease management.
The following may also be of interest:
inFOCUS: Non-neoplastic anal sac disorders in UK dogs: Epidemiology and management aspects of a research-neglected syndrome [RCVS Knowledge] [online] Available from: https://infocus.rcvsknowledge.org/non-neoplastic-anal-sac-disorders-in-uk-dogs-epidemiology-and-management-aspects-of-a-research-neglected-syndrome/ [Accessed 24 August 2025]
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