pyoderma at vets south, exeter
TRANSCRIPT
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?