Recommendations for approaches to meticillin-resistant staphylococcal infections of small animals: diagnosis, therapeutic considerations and preventative measures: Clinical Consensus Guidelines of the World Association for Veterinary Dermatology. Crusted skin 5. To prevent the unnecessary use of systemic antimicrobials, topical therapy should always be recommended in cases of superficial pyoderma before systemic therapy is considered. Pustules are quite short lived and not always identified during examination. Generalized or deep cases are usually best treated with a combination of oral antibiotics and topical antibacterial therapies (Table 2). Using the correct dose, frequency of administration, and duration of antimicrobials is crucial for a successful outcome when treating any infection. Ciprofloxacin should not be used because of its reported poor absorption and bioavailability in dogs. If selected properly, systemic antimicrobial therapy is very effective in cases of canine superficial pyoderma. It is currently recommended by veterinary dermatologists to treat superficial pyoderma until 1 week after complete clinical resolution of the infection. 2. 7. Virbac South Africa: Canine Bacterial Pyoderma, Western Veterinary Conference: using Antibiotics Wisely for Pyoderma in the Age of Methicillin Resistance, Dr. Robert Hilton: Bacterial Infections of the Skin, Delaware Valley Academy of Veterinary Medicine: Tips for the Treatment of Canine Pyoderma. to help veterinarians adequately diagnose and treat pyoderma, using judicious antimicrobial therapy to prevent bacterial resistance. Successively, scaling, crusts, and epidermal collarettes (. ) Bacterial culture and susceptibility testing is a very important diagnostic tool for identification of the bacteria involved and selection of appropriate antimicrobial therapy (Box 1), especially when considering systemic antibiotics. Superficial pyoderma in dogs is a mild pyoderma infection that’s limited to the skin’s surface, while deep pyoderma affects all layers of the dog’s skin and can be more difficult to deal with. The author considers cefovecin and cefpodoxime to be second-tier antimicrobials because they are third-generation cephalosporins, with a broader spectrum than other cephalosporins such as cephalexin and cefadroxil. This skin infection can be superficial, which is the most common form of pyoderma in canines, or deep. Recommended doses of systemic drugs for canine superficial pyoderma have been published in the ISCAID guidelines. Mucocutaneous pyoderma is a local disorder that often develops alongside other dermatological health issues in dogs. (A) Dog with superficial pyoderma along the dorsum before topical therapy with chlorhexidine shampoo and mousse. Baths should be given 2 to 3 times per week during the first 2 weeks of treatment and then 1 to 2 times per week until the infection clears. First-generation cephalosporins (e.g., cephalexin), Third-generation cephalosporins (e.g., cefpodoxime, cefovecin), Aminoglycosides (e.g., gentamicin, amikacin), Fluoroquinolones (e.g., enrofloxacin, marbofloxacin, difloxacin, orbifloxacin, pradofloxacin), Do not use ciprofloxacin (poor bioavailability in dogs). Owner adherence to the recommended treatment regimen is crucial for treatment success and prevention of bacterial resistance. In one study, treatment with topical 4% chlorhexidine products showed resolution of clinical signs in all dogs and was found to be as effective in treating superficial pyoderma as systemic therapy with amoxicillin-clavulanic acid. Straining to Eliminate: First Aid. Subsequently, she obtained her master’s degree and completed her residency in veterinary dermatology at the University of Minnesota College of Veterinary Medicine. It is a staph or other bacterial infection that targets wounds on your dog's skin, resulting in deep or superficial … Figure 3. Third-tier antimicrobials (fluoroquinolones) should only be used when in vitro susceptibility is demonstrated and first- and second-tier antimicrobials are not effective.7 The author considers these antimicrobials as last options for treating canine pyoderma, unless they need to be selected for safety reasons for the patient. Topical antimicrobials were used in most cases. Skin cytology is the most important diagnostic test for canine pyoderma; however, it is still underused. Treatment can be done with relative ease … Currently, she is a professor of veterinary dermatology at the University of Minnesota. Antibiotics used for deep pyoderma are similar to those used for superficial infections of the skin. Staphylococcus aureus phage lysate is a vaccine indicated for the treatment of recurrent canine pyoderma and related Staphylococcal hypersensitivity, or polymicrobial skin infections with a Staphylococcal component. (B) Same dog with complete resolution of the pyoderma after topical therapy. Antimicrobials given only once daily (e.g., enrofloxacin, marbofloxacin) are called dose dependent. 2. Many diseases have the potential to predispose dogs to the development of superficial pyoderma. In dogs, superficial bacterial folliculitis (SBF) is the commonest form of canine pyoderma, which is in turn, the principal reason for antimicrobial use in small animal practice. The classifications above help determine the treatment regimen for each case of pyoderma: 1. Skin infections associated with significant inflammation may benefit from short, limited courses of topicals containing glucocorticoids such as hydrocortisone, betamethasone, mometasone, or triamcinolone; however, care should be taken with these products, as chronic use of topical glucocorticoids can induce adverse cutaneous reactions (e.g., atrophic skin, wounds). Pet owners can choose between Clavamox pills or oral drops. Generalized pemphigus foliaceus mimicking superficial pyoderma in a dog. Poor nutrition, high stress levels and other general health factors can also leave your pet vulnerable to skin infections. Canine pyoderma is a group of various skin diseases and an accurate diagnosis is mandatory. -lactam antimicrobials, including all cephalosporins, penicillins (including potentiated amoxicillin), and carbapenem antimicrobials. Each dog’s case is different because it could be chronic or recurrent. Before antimicrobials are administered, the diagnosis of superficial pyoderma needs to be supported by cytologic findings demonstrating coccoid bacteria, often associated with inflammatory cells (typically degenerate neutrophils) and, when present, bacteria phagocytosis (Figure 5). Superﬁcial pyoderma is a superﬁcial bacterial infection involving hair follicles and the adjacent epidermis. Vet Dermatol 2014;25(3):163-175. Guidelines for antimicrobial use in dogs and cats. Canine superficial pyoderma, also called bacterial folliculitis, is one of the most common problems veterinarians face, and the increasing prevalence of staphylococcal antimicrobial resistance poses a new challenge to treatment.Failure to recognize staphylococcal antimicrobial resistance frequently results in ineffective empiric therapeutic choices and protracted clinical disease. Superficial bacterial pyoderma is one of the most common disorders in the dog. Using the correct dose, frequency of administration, and duration of antimicrobials is crucial for a successful outcome when treating any infection. Treatment of superficial pyoderma involves administration of appropriate antibiotics, topical therapy, and addressing underlying factors. ), but it can also assist in more rapid resolution of lesions and reduce the duration of systemic antimicrobial use. 3 The median age of the nine beagles was 2.3 years (range 1.4–5 years), and the median weight was 9.2 kg (range 7.6–11.3 kg). British Veterinary Association. Topical therapy is usually safer and reaches higher concentration in the skin compared with systemic antimicrobials. For these antimicrobials, increasing the dose increases efficacy but increasing the frequency of administration does not. 7. In the author’s opinion, topical fluoroquinolones should not be used empirically and should also be saved for more resistant cases if other topicals are not effective. Other less commonly identified gram-positive bacteria include Staphylococcus schleiferi, Staphylococcus aureus, Staphylococcus xylosus, Staphylococcus epidermitis, and Streptococcus species. 1 When a diagnosis of pyoderma … Mucocutaneous pyoderma is considered a surface condition, so topical treatments can be applied to most or all of the affected area. A small scraping of skin is all a vet needs to check for pathogens. These dogs have the appearance of circular patches of alopecia with some scaling, little erythema, and rarely papules. 6. Mucocutaneous pyoderma is a local disorder that often develops alongside other dermatological health issues in dogs. Specific antimicrobial guidelines and clinical consensus on treating bacterial skin infections have been developed by the International Society for Companion Animal Infectious Diseases (ISCAID, iscaid.org) and the World Association for Veterinary Dermatology (WAVD, wavd.org) to help veterinarians adequately diagnose and treat pyoderma, using judicious antimicrobial therapy to prevent bacterial resistance.1,2 To treat canine pyoderma successfully, it is important to recognize its clinical signs, confirm the infection, and identify and treat any underlying cause to help prevent pyoderma recurrence. ), and sterile neutrophilic or eosinophilic pustulosis. Guardabassi L, Houser GA, Frank LA, et al. Itchiness 2. Six dogs already had been used to establish the canine model of superficial pyoderma. Treatment for Pyoderma consists of antibiotic therapy for a minimum of 3 – 4 weeks. The basic principles of successful systemic antimicrobial therapy include proper antimicrobial selection, establishment of an effective dosage, and long enough duration of treatment to ensure complete resolution of the infection. Pyoderma is a skin infection caused by bacteria, fungi, or parasites. To avoid the side effects of commercial drugs, you can always use coconut oil and apple cider vinegar to clear bacterial infections in dogs. Vet Record Your veterinarian will also instruct you regarding continuing bathing routines that are required to clear the inf… Hillier A, Lloyd DH, Weese JS, et al. 8. What Is Pyoderma? Superficial bacterial infections are usually to blame, but many additional sources of skin irritation should be considered. The diagnosis includes recognition of the typical clinical signs, the exclusion of other similar conditions, and confirmation via skin cytology, plus or minus bacterial culture and susceptibility testing.3 This approach helps prevent inappropriate use of antimicrobial therapy for skin diseases that are not associated with pyoderma. Clinical signs of canine superficial pyoderma typically include erythematous papules and pustules (Figure 1), which are usually associated with hair follicles. Guardabassi L, Houser GA, Frank LA, et al. Using antibiotics responsibly in companion animals. Suggested guidelines for using systemic antimicrobials in bacterial skin infections (2): antimicrobial choice, treatment regimens and compliance. bsava.com/Resources/Veterinary-resources/Position-statements/Responsible-use-of-antibacterials. Skin cytology from a dog with superficial pyoderma demonstrating degenerate neutrophils and intracellular (blue arrow) and extracellular (orange arrow) cocci bacteria. The typical treatment time is three to four weeks but can be extended to eight to twelve weeks if necessary. How is Pyoderma Treated? Gold RM, Lawhon SD. If pustules are not present, samples may be collected from exudate beneath crusts, epidermal collarettes, and, if needed, from papules (by rupturing the papules with a 22-gauge needle). There is no current indication that use of antimicrobials affects isolation of causative bacteria in canine superficial pyoderma; therefore, samples may be collected for culture whenever indicated, regardless of administration of antimicrobials. Pyothorax in Dogs and Cats. is how much their concentration at the infection site is above the bacterial MIC. Follow-up visits are very important for evaluation of the response to therapy and to decide when to discontinue the antimicrobial. Recommended doses of systemic drugs for canine superficial pyoderma have been published in the ISCAID guidelines1 and elsewhere. Vets often supplement systemic antibiotics with ointments and shampoos to expedite recovery. Underlying causes such as allergies or hormonal imbalances may predispose your dog to recurrent issues. Chloramphenicol and rifampin can be used safely in most dogs; however, close monitoring for potential aplastic anemia and liver toxicity, respectively, is needed. Topical therapy is usually safer and reaches higher concentration in the skin compared with systemic antimicrobials. Fourth-tier antimicrobials should not be used in veterinary medicine, particularly with regard to routine cases of superficial pyoderma. Antibiotics must be selected carefully and used with appropriate dosage and duration of treatment. In dogs, superficial pyoderma is the most common form of pyoderma, and it is also the most common reason for antimicrobial use in small animal practice. Pyoderma is not an uncommon condition among dogs. Moth-eaten alopecia on the dorsum of a dog. Mucocutaneous pyoderma creates crusted lesions and fissures in sensitive areas, so bathing helps reduce the unsightly skin damage, odor and greasy fur associated with the disorder, according to the 2013 Western Veterinary Conference. ), especially when considering systemic antibiotics. Many dermatologists first select cephalexin or cefadroxil for empiric treatment of superficial pyoderma, with the second choice typically being amoxicillin clavulanate. The choice of systemic antimicrobial may be empiric in first-time, nonrecurrent pyoderma cases and in dogs that have not been exposed to multiple courses of systemic antimicrobials. ). Figure 1. Ideally, samples should be taken from pustules. De Lucia M, Bardagi M, Fabbri E, et al. The type of therapy selected should be based on the nature of the disease, the severity and extent of the lesions, concurrent diseases, any other administered drugs, the ability of the owner to administer topical and systemic therapy, and the owner’s compliance and financial situation, in addition to any known or expected antimicrobial resistance. Pythiosis (Oomycosis, Lagenidiosis, Swamp Cancer, Bursatti, Leeches) in Dogs, Cats and Horses ... Snake Bite Prevention and Treatment for Dogs. The author considers cefovecin and cefpodoxime to be second-tier antimicrobials because they are third-generation cephalosporins, with a broader spectrum than other cephalosporins such as cephalexin and cefadroxil.7 Additionally, extended-spectrum β-lactamase (ESBL) Escherichia coli has been reported in dogs, and third-generation cephalosporins are considered risk factors for infections associated with MRSA and ESBL E coli in humans. They should be reserved for the treatment of severe MRSA infections in humans. Canine superficial pyoderma, also called bacterial folliculitis, is one of the most common problems veterinarians face, and the increasing prevalence of staphylococcal antimicrobial resistance poses a new challenge to treatment. Surface pyoderma; Superficial pyoderma; Deep pyoderma; Surface and superficial pyoderma can cause severe itching in your dog and can also be the cause of hair loss near the infected area or the redness in skin. Chloramphenicol, rifampin, and aminoglycosides are often last-resort options for MDR staphylococcal infections, mostly due to more severe potential adverse effects. The author, based on experience and other publications,5-7 modifies the ISCAID tiers for more strict antimicrobial stewardship (Box 3). Historically, rifampin was used in combination with other antimicrobials (e.g., doxycycline) due to concern with development of fast resistance; however, polyantimicrobial systemic therapy should be avoided due to potential for more resistance. Targeted antibiotics are administered to kill specific bacteria when the lab tests reveal the strain responsible for the infection. Veterinary School Applications Are Up 19% — What Does that Mean for the Profession? Figure 2. 5. Equally important is the need for an adequate duration of treatment. Six dogs experienced vomiting or diarrhoea but did not require discontinuation of the treatment. The clinical consensus guidelines of the WAVD state that empirical drug selection for systemic therapy is always contraindicated when a multidrug-resistant infection is suspected based on historical factors, due to the high prevalence of multidrug resistance within these strains.2 The ISCAID guidelines, last updated in 2014, outline 3 tiers of antimicrobials and their recommended use for canine superficial pyoderma.1 Clinical use by veterinary dermatologists may vary from these guidelines. doi: 10.1111/vde.12404. Loeffler A, Cobb MA, Bond R. Comparison of a chlorhexidine and a benzoyl peroxide shampoo as sole treatment in canine superficial pyoderma. The treatment must be tailored to each patient. INDICATIONS OF PYODERMA IN YOUR DOG. When a systemic antibiotic is needed, selection of one with the narrowest spectrum of activity possible will minimize the selection of resistant organisms. Potentiated sulfonamides are often efficacious against S pseudintermedius; however, they can have many side effects (e.g., hypothyroidism, keratoconjunctivitis sicca, hypersensitivity reaction in certain breeds), especially when given for a long period of time. The basic principles of successful systemic antimicrobial therapy include proper antimicrobial selection, establishment of an effective dosage, and long enough duration of treatment to ensure complete resolution of the infection. Mupirocin, a carboxylic acid ointment, is highly effective against MRS skin infections and can be used for localized treatment; however, the author uses mupirocin only in resistant cases, when other topicals are not effective or demonstrate resistance in vitro, as this is the most important topical antimicrobial used to treat methicillin-resistant S aureus (MRSA) in humans. 3. 2. The term methicillin-resistant staphylococcus (MRS) refers to any Staphylococcus species that is resistant to oxacillin; that is, it demonstrates in vitro resistance to all β-lactam antimicrobials, including all cephalosporins, penicillins (including potentiated amoxicillin), and carbapenem antimicrobials. To prevent frequent recurrence of superficial pyoderma, it is crucial to try to identify and control the underlying primary disease (e.g., allergy, endocrinopathy) that typically predisposes dogs to pyoderma. Bacterial culture and susceptibility testing is a very important diagnostic tool for identification of the bacteria involved and selection of appropriate antimicrobial therapy (. The typical duration of treatment for superficial pyoderma is 3 to 4 weeks, but more time may be needed. Dogs with superficial pyoderma should be bathed with a shampoo recommended by its veterinarian. Cytology is also very important for identification of co-infection with other microorganisms such as Malassezia pachydermatis and, less commonly, rod-shaped bacteria. doi: 10.1111/vde.12444. Skin cytology is the most important diagnostic test for canine pyoderma; however, it is still underused. 3. It is important to remember that none of the cephalosporins should be used for the treatment of MRS infections, which are resistant to these antimicrobials. Follow your vet's schedule for the antibiotics, even if your pet's symptoms disappear before the treatment's conclusion. Antibiotic therapies should be considered, including pulse therapy protocols, are currently strongly discouraged as they are likely promote. General health factors can also leave your pet 's pyoderma ISCAID guidelines include clindamycin and in! Vets often supplement systemic antibiotics with ointments and shampoos to expedite recovery equally important is the need for type! 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