Chronic inflammatory enteropathy (CIE) has historically been divided into food-responsive chronic inflammatory enteropathy (CIE-FR), immunosuppressant-responsive chronic inflammatory enteropathy (CIE-IR), non-responsive chronic inflammatory enteropathy (CIE-NR) and antibiotic-responsive chronic inflammatory enteropathy (CIE-AR). Given the rising concern for antimicrobial resistance (AMR) and the effects of antibiotics on the microbiome, replacement of CIE-AR with microbiota-modulation-responsive enteropathy (MrMRE) has been suggested, and antibiotic use questioned. The objective of this study was to assess the prescribing habits of antibiotics for dogs with CIE prior to referral. This was a single-centre retrospective study of cases between 2020 and 2024 assessing antibiotic prescription for CIE in the six months prior to referral. Data including signalment, clinical signs, diagnosis, antibiotic administration and the antibiotics used were recorded. A total of 144 dogs with chronic inflammatory enteropathy were included, of which 128 had CIE without protein-losing enteropathy (PLE) and 16 had PLE. Overall, 57.6% of dogs with CIE referred for investigation were prescribed antibiotics in the six months prior to referral. Of the dogs prescribed antibiotics, metronidazole was the most prescribed (74.7%), followed by amoxicillin-clavulanate (36.1%). Dogs with diarrhoea were more likely to be prescribed antibiotics overall and were also more likely to receive metronidazole. Antibiotic use differed across the years, with the lowest rate prescribed in 2024 (26/46 [56.5%] in 2020/2021, 24/33 [72.7%] in 2022, 22/35 [62.9%] in 2023, and 11/30 [36.7%] in 2024; p = 0.031). Further work is required to understand continued antibiotic use in CIE and inform antimicrobial stewardship strategies.

Omeprazole, a proton pump inhibitor, is widely used in veterinary medicine, although it may be frequently prescribed for conditions in which evidence of benefit is limited. This retrospective observational single-centre study evaluated omeprazole exposure before referral in dogs subsequently diagnosed with chronic inflammatory enteropathy. Medical records from 151 dogs were reviewed, including omeprazole exposure during the six months preceding referral, documented indication, dose and administration frequency. Indications were classified according to American College of Veterinary Internal Medicine consensus recommendations. Overall, 83/151 dogs (55.0%; 95% CI, 47.0–62.7%) had documented omeprazole exposure within six months of referral. Of these, 30/83 (36.1%; 95% CI, 26.6–46.9%) had a documented consensus-consistent indication, whereas 53/83 (63.9%; 95% CI, 53.1–73.4%) did not. Non-specific gastrointestinal signs were the most common documented indication (42/83; 50.6%), followed by suspected gastrointestinal bleeding or gastrointestinal ulceration or erosion (21/83; 25.3%) and suspected gastro-oesophageal reflux or reflux-associated oesophagitis (9/83; 10.8%). Among dogs with a clearly documented once or twice daily oral dosing regimen, once daily administration was more common than twice daily administration (38/65; 58.5% versus 27/65; 41.5%). Omeprazole exposure was common before referral, and a substantial proportion of exposed dogs had no documented indication consistent with ACVIM consensus recommendations. Interpretation was limited by the retrospective design and dependence on the completeness of referring veterinary clinical records.

Fungal urinary tract infections (UTIs) are uncommon in dogs and are typically associated with immunocompromised patients or those with other predisposing factors. Fungal hepatobiliary disease is rarely reported in the veterinary literature. This case report describes a dog on dual immunosuppressive therapy for suspected immune-mediated polyarthritis that developed a hepatopathy suspected to represent bacterial hepatobiliary disease and was subsequently treated with prolonged amoxicillin–clavulanate therapy. Following treatment, the dog developed marked hepatocellular enzyme elevations together with a Candida albicans UTI. Given the patient’s progressive hepatocellular injury, clinical signs, history of immunosuppression and antibiotic therapy, concurrent fungal hepatobiliary involvement was suspected. Following initiation of oral fluconazole, the fungal UTI resolved, and there was marked improvement, with subsequent normalisation of ALT and ALP activities. Although the temporal association between antifungal treatment and clinical and biochemical improvement raised suspicion of concurrent fungal hepatobiliary involvement, simultaneous discontinuation of amoxicillin–clavulanate, substantial reduction in prednisolone dose, and continuation of hepatoprotective therapy precluded attribution of the improvement specifically to antifungal treatment. This case highlights the potential for opportunistic fungal disease in immunosuppressed dogs, particularly following prolonged antimicrobial exposure, and illustrates the diagnostic challenges associated with suspected hepatobiliary involvement.