You can use the cyclosporine along with tacrilimus (Protopic) ointment that is as effective. Unfortunately no all dogs can stomach ketokonazole and will lose appetite. Anti biotics will never work. Some vets will use high doses of steroids which again will bandaid but not heal...will only remove inflammation. I totally cured a male with cyclosporine and ointment and they never returned. But it took close to 6 months of due diligence and a fair bit of money Molly Trillia GSD's bokenkampgsd1@xxxxxxx Member GSDCC, GSDCA, GSDC of Beaumont, Life member CKC ---- Original Message ---- From: Suzanne Jambe <suzannejambe@xxxxxxxxxxx> To: marhaven <marhaven@xxxxxxxxxxxxxx> Cc: SHOW LIST <Showgsd-l@xxxxxxxxxxxxx> Sent: Tue, Mar 10, 2015 11:45 am Subject: [ SHOWGSD-L ] Re: Fistula Treatment? Cyclosporin and ketokonazole. Many years ago had experience with this, and at the time it was cutting edge treatment. Now I think it's the standard. The use of anti-rejection drugs as are used in transplant patients has been very effective, it was very expensive at one time, but I believe may have been authorized for veterinary use and priced lower now. Sent from my iPad On Mar 10, 2015, at 11:22 AM, "Carolyn Martello" < marhaven@xxxxxxxxxxxxxx> wrote: I have a friend in Canada that has an older dog that recently developed fistula. The Vet gave her metronidazole and an ointment ....and the dog is not improving at all. She is a bit isolated and has no internet.....and hoped I would know someone that has experience with this. I don't. Is this the current treatment for this problem? Any advice for her? Carolyn marhaven@xxxxxxxxxxxxxx www.marhaven.com