Pyoderma at Vets South, Exeter

The Changing Face of Canine Pyoderma- New Strategies for Control

Anthony Chadwick BVSc CertVD MRCVSThe Webinar Vet

David Lloyd

• Antibiotic stewardship CPD should be obligatory• FECAVA conference Dublin 2012• Pre-congress 2015- free for BVA members• www.theinternationalwebinarvet.com/precongress

Ian Mason

“The dog is a pyoderma waiting to happen”

What we are covering this afternoon

• Why is the dog a pyoderma waiting to happen?• Classification of pyoderma• Clinical signs• Diagnosis of pyoderma- ddx• Treatment• Problems with resistance

Why?

Normal defence mechanisms defective

• Physical• Chemical• Microbial

A Pathogenic Staphylococcus

• S pseudintermedius• Bacteria produces a variety of substances including enterotoxins,

toxic shock protein, protein A and haemolysins• Increase adhesion to keratinocytes• Act as superantigens and upregulate the immunological responses• Some strains produce slime which encapsulate the bacteria and

inhibit phagocytosis whilst increasing its ability to adhere

Classification of pyoderma

• Surface• Superficial• Deep

Surface pyodermas

• Pyotraumatic dermatitis• Intertrigo(skin fold pyoderma)• Impetigo

Superficial pyodermas

• Superficial bacterial folliculitis• Mucocutaneous pyoderma

Deep pyodermas

• Deep folliculitis/furunculosis• Deep pyotraumatic furunculosis• Nasal folliculitis/furunculosis• Pedal furunculosis• GSD pyoderma• Acral lick dermatitis• Abscesses and granulomas

Clinical signs

Clinical signs

Diagnosis

• Cytology• Culture and sensitivity• Biopsy

What is your most likely diagnosis?

• Acute Pyoderma• Demodicosis• Chronic pyoderma• Mycosis fungoides• Pemphigus foliaceous

Differential Diagnosis

Pyoderma is always a secondary disease

Differentials

• Allergy• Ectoparasite• Endocrine

How long would you treat a pyoderma case?

• 7 days• 7-14 days• 15-21 days• 22-30 days• Longer than 1 month

Treatment

• Systemic• Topical

Systemic Treatments

• Antibiotics• Staphage lysate• Autogenous vaccines

Topical Treatments

• Shampoos• Creams• Ointments

Antibiotics

• Potentiated sulphonamides 15-30mg/kg bid• Clindamycin 11mg/kg sid• Potentiated amoxicillin 12.5mg/kg bid• Cephalexin 15-30mg/kg bid• Cefovecin 8mg/kg ev 14 days• Enrofloxacin 5mg/kg sid• Marbofloxacin 2mg/kg sid

Cefovecin

• Can increase compliance• But sub-optimal levels of antibiotic after the 2 weeks• Is a 3rd generation cephalosporin

Staphage lysate

• Stimulates both humoral and cellular immunity• 1 study showed 77% of dogs had significant

benefits

Autogenous vaccines

• Prepared individually for each dog from a culture• Given with antibiotics and then weaned off

antibiotics• Speak to RVC• Particularly useful in cases of recurrent idiopathic

pyoderma

Shampoos

• Ethyl Lactate• Chlorhexidine• Benzoyl peroxide

Creams

• Fusidic acid• Mupirocin

Problems with Resistance Ollie 3yo

Ollie 3yo Bulldog

• Pyoderma caused by MRSP• Sensitive to doxycycline• Treated with chlorhexidine shampoo

MRSA and MRSP

How often have you seen a resistant case this year• 0• 1-2• 3-5• 6-10• More than 10

Methicillin resistance

• First reported in 1960s• Due to a mecA gene encoding an altered PBP• S aureus human pathogen• S pseudintermedius companion animal pathogen• More of a problem in USA and Europe but coming

How can we prevent

• Better hygiene in the practice.• Use less antibiotics where possible.• Higher doses and for longer times.• Use appropriate antibiotic for pyoderma.• Teach compliance.• Don’t use corticosteroids at the same time

Do you use something milky for your cat speys?

• Yes• No

The Webinar Vet Vets South offer

• 3 talks as recordings• Slides on slideshare• £1 trial• Pre-congress day free for BVA members

Thanks

• David Lloyd• You for listening

Any Questions?