Evaluation of a structured individualised protocol as a potential cost-effective diagnostic and therapeutic approach...

Diagnostic investigation and management of chronic diarrhoea in dogs can be cost-prohibitive to many owners. The objectives of this study were to evaluate evidence-based, individualised diagnostic and therapeutic protocols for management of dogs with chronic diarrhoea, where financial constraints dictate a budget-limited approach and where more expensive approaches are deferred until simple affordable protocols are unsuccessful. Twenty-two client-owned dogs with chronic (minimum 2 weeks duration) untreated small, large or mixed small/large bowel diarrhoea were enrolled in a budget-limited step-wise management protocol (maximum expenditure $300 over 6 weeks), with diagnostic testing and therapeutic trials managed in an individualised and evidence-based fashion. Success was defined as complete resolution of diarrhoea for a minimum of 1 month. Dogs that failed to respond to a budget-limited protocol were then enrolled for complete, referral-level management. Four dogs exited the project early (one death due to caval syndrome, three lost to follow-up). Thirteen out of the remaining 18 dogs had complete resolution of diarrhoea utilising a budget-limited approach (success rate 72.2%, confidence intervals 46.5-90.3%) and five dogs were moved on to a referral-level investigation, with complete resolution of diarrhoea in four out of five. Seventeen out of the 18 dogs therefore responded to a protocol based on a budget-limited approach followed by extensive investigation only if needed, for an overall success rate of 94.4% (CI 72.7-99.9%). Comprehensive investigation of chronic diarrhoea can be deferred while simple affordable diagnostics and therapeutic trials are conducted in stable canine patients and, often, an extensive management approach will be unnecessary.