Pyoderma Treatment Flashcards by Dasha Vezeleva

What are the 3 types of pyoderma?

Surface
Superficial
Deep pyoderma

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What is the likely pathogen for surface pyoderma?

Unknown - many different causes
Yeasts, Bacteria, etc.

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What is the likely pathogen for superficial pyoderma?

Over 90% of cases S. pseudintermedius

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What is the likely pathogen for deep pyoderma?

S. pseudintermedius ~60% cases
Other 40% of cases need lab to diagnose

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What is this type of pyoderma and the types of lesions?

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What is this type of pyoderma and the types of lesions?

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What is this type of pyoderma and the types of lesions?

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What is the difference between surface and deep pyoderma? What are the organisms responsible? How does the treatment differ?

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How does treatment for these 2 causes of pyoderma differ?

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What currently poses the biggest threat to modern medicine?

Drug-resistant bacterial infections

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What are the 2 routes of administration for antibacterial therapy for canine pyoderma?

Topical application
Systemic route

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What are the topical options available for treatment of canine pyoderma? What about systemic?

Topical - Shampoos, creams, gels, drops, foam
Systemic - Tablets, Injections

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What kinds of infections is topical antibacterial therapy recommended for in canine pyoderma?

Recommended for surface and superficial pyoderma as sole therapy
High concentrations achieved at site of infection

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What kinds of infections is systemic therapy recommended for in canine pyoderma?

For deep pyoderma
In some cases of superficial pyoderma
NEVER for surface infections

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Do you need laboratory testing in order to begin topical therapy for treatment of skin infections?

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What are the 2 options for systemic therapy and what are these choices based on?

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What are some additional considerations you should think about while choosing antibacterial therapy for skin infections?

Whether or not the product is licensed
Narrow vs. broad spectrum

Why is cytology so ideal for diagnosing surface infections?

Identifies relevant pathogen (and therapy)
Monitor progress

What are the topical antibacterial products available for use for pyoderma?

Fusidic Acid
Chlorhexidine (+/- miconazole)
Polymyxin B (Surolan)
Silver Sulfadiazine
+/- Glucocorticoids - situation dependent

What kind of therapy can be used as sole antibacterial in the majority of cases of dogs with surface and superficial pyoderma?

Topical antibacterial

Is there any clinically relevant resistance described in topical antibacterial use? Is resistance testing needed?

No
No resistance testing needed

What is the concentration of drug at site of infection with topical antibacterial therapy?

High

What is CRITICAL in the effectiveness of topical antibacterial therapy?

COMPLIANCE

What is the typical frequency of shampoo use for topical antibacterial therapy? What about gels or drops?

Shampoo - 2-3x per week with 10 min contact
Gel/Drops - 2x daily for 2 weeks

Is topical antibacterial therapy for short term or long term use?

Suitable for long term use

What does topical antibacterial therapy reduce the risk of (think spreading)?

Contagion

How does the owner benefit from using topical antimicrobial therapies on their pet?

Owner can be more in control Able to use more or less when needed

What is the old vs. new system of antimicrobial use for superficial pyoderma?

How is chlorhexidine used in the majority of dogs with superficial pyoderma?

Can work as sole antibacterial therapy

What important strain of bacteria is chlorhexidine effective against in canine superficial pyoderma?

MRSP

What are the first tier drugs if systemic therapy is needed for superficial pyoderma? What must you consider when choosing these drugs?

Can be chosen empirically Need to know knowledge of MRSP prevalence in area Clindamycin - for dogs with little exposure to abx Cefalexin Amoxicillin-Clavulanic acid TMPS (Potentiated Sulphonamides)

What are the second tier drugs if systemic therapy is needed for superficial pyoderma? What must you do before prescribing these drugs?

ONLY prescribe after culture and sensitivity testing Doxycycline/minocycline Fluoroquinolones Cefovecin

what are the important factors to consider when prescribing systemic therapy for superficial pyoderma? Think - Correct dosing, Duration and follow-up

What is the brand name of Cefovecin?

Convenia

What kind of drug is Cefovecin (convenia)? Spectrum Duration of action Method of administration Activity

Broad spectrum Third generation cephalosporin Long-acting Injectable Activity against gram + and gram - (culture/sensitivity)

What is this condition? What should drug choice for this condition always be based on?

What should you avoid when obtaining a sample for deep pyoderma? What sites should you sample from?

Avoid surface bacteria Swabs from draining tracts/sinuses Tissue culture from biopsies (into plain pots) FNA from nodules

How long should you treat with systemic antibacterials for superficial pyoderma? What about deep pyoderma?

What is important to rule out if there is no response to treatment, before considering resistance to an antibiotic?

Check compliance

What is the difference between resistance and recurrence?

Resistance - patient does not respond to antimicrobial therapy (might even worsen) Recurrence - infection waxes and wanes, keeps coming back due to underlying issue not being resolved

What is MRSA/MRSP resistant to? Why are these pathogens important? Are these bacteria more virulent than non-MR variants? Why are they more dangerous?

Which medications is pet MRSA susceptible to?

Tetracyclines TMPS