Skin Therapy - Pyoderma Flashcards

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0
Q

Which antibiotics are pseudintermedius resistant to UK?

A
  • penicillin, oxytet highest
  • lincomycin, erythromycin, trimethoprim low
  • 1% to enrofloxacin and marbofloxacoin
  • none to cefalexin, co-amoxiclav, oxacillin, meticillin
    > study 1980s, likely increased now
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1
Q

2 methods of antiobiotic choice?

A
  1. empirical
    - classical superficiial pyoderma/folliculitis = probably s. pseudintermedius
    - wet lesions = gram neg?
    - local knowledge sensitivity patterns
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2
Q

What are some alternative method of antibacterial tx for superficial pyoderma?

A

Topical therapy
- antibacterial shampoo (combo or alone)
Clindamycin (Antirobe)
- some resistancre

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3
Q

Most common deep pyoderma organisms?

A
  • rods (pseudomonas) so not b lactams - fluoroquinolones better
  • cocci (staph)- cefalexine
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4
Q

Possible reasons for resistance?

A
> clinical 
- wrong dose
- compliance
- absorption
- underlying cause 
- resustance developed during tx
> bacteria 
- intrinsic resistance (natural trait) 
- acquired resistnace (mutations)
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5
Q

What abx still gets multiresistnat bugs? MRSP

A

oxytet (but reserve for more serious infections than skin disease!!)

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6
Q

Is MRSP more virulent than normal buugs?

A

NO

  • just more difficult to treat
  • may actually be weaker
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7
Q

Which animals are at risk of MRSP infection?

A
  • lots of vet visits and lots of abx use in the past
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8
Q

Is rifampin lic ?

A

NO

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9
Q

What ROA iss best for gentamycin?

A

Not systemic (nephrotox)

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10
Q

Can MRSA spread to pets?

A

YEs

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11
Q

Can MRSP spreadto people?

A

YES - refer owner to GP if treating animal case

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12
Q

3 tx options for MRSP?

A
  1. systemic tx if in vitro susceptability proven (rarely with MRSP, for MRSA most cat/dog strains susceptible to potentialted sulphonamidees and tetracyclines, 50% to clindamycin )
  2. topical tx alone
  3. off lic (exotic abx)
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13
Q

Which topical antimicrobial agents have proven efficacy against staph?

A
  • fusidic acid (low MICs shown for MRSA/MRSP)
  • chlorhexidine
  • benzoyl
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14
Q

Should vancomycin be used?

A

No!! save for human tx of MRSA

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15
Q

WHat should be done before using exotics abx?

A

Get advice from uni etc.

- trerat environment etc.

16
Q

4 main things to do with skin disease to minimise resistance?

A
  1. cytology
  2. early culture
  3. read the data sheet!!!
  4. control spread! last case seen in the day, dont wait in waiting room etc.
18
Q

What empiral assumptions can be made when treating skin bacterial infections?

A
  • classical superficial pyoderma/folliculitis probably S. intermedius
  • wet lesions: G-ves?
  • local knowledge sensitvity patterns
19
Q

Which ABx are s. pseudintermedius most and least resistant to?

A

1988 study (so will have ^ now)

  • no resisntace to cefalexin, co-amoxiclav, oxacillin, metacillin
  • 1% resistnace to enrofloxacin and marbofloxacin
  • low resistnace to trimethoprim, erythromycin, lincomycin
  • medium resistnace to oxytetracycline
  • high resistance to penicillin
20
Q

Alternatives to Abx tx in superifical pyoderma?

A

> Clindamycin (Antirobe)

  • narrow-spec
  • topical antibacterial shampoos
  • in combination or alone
  • products with proven efficacy (chlorhexidine, benzoyl peroxide)
  • owner compliance (2x weekly bathing, min 10mins contact time)
21
Q

How can tx for deep pyoderma be chosen semi-empirically?

A
  • 60-80% pseudintermedius
  • alwways culture
  • while waiting for lab results (~1 week) tx based on cytology
    > cocci: cefalexine
    > rods: fluoroquinolones
  • duration of tx many weeks, at least 2 weeks beyong clinical cure!!!
22
Q

What is MRSP?

A

> methicillin-resistnace staphylococcus pseudintermedius

  • gene encoding broad-spec B-lactam ABx resistance
  • more resistant than MRSA
  • 20% pseudintermedius submissions
23
Q

What type of infections may be caused by MRSP? Which species?

A
  • dogs and cats
  • sometimes horses and donkeys
    > superficial and deep pyoderma
    > septicaemia, UTI, pneumonia, wound infections
24
Q

Tx options for MRSP and other multi-drug resistnant skin pathogens?

A
  1. systemic tx if in vitro susceptibility identified
    - MRSA: most cat and dog isolates susceptible to potentiated sulphonamides and tetracyclines (50% also to clindamycin)
  2. topical tx only
  3. offlicence tx with exotic ABx
25
Q

Egs of topical tx for multi-drug resistant pathogens?

A
  • fusidic acid (low MICs shown for animals MRSA and MRSP recently)
  • chlorhexidine
  • benzoyl peroxide
26
Q

Egs of exotic Abx?

A
  • apramycin
  • amikacin
  • vancomycin
  • chloramphenicol
  • rifampicin
    > do not use without advice
27
Q

What is convenia?

A
  • long acting cephalosporin (==fluoroquinolones, G- coverage too)
  • cefovecin 80mg/cl reconstituted powder
28
Q

Indications of convenia in dogs?

A

> skin and soft tissue infections - pyoderma, wounds, abscess (s. intermedius, B-haemalytic strep, E. coli, P. multocida)
UTIs (E.Coli, proteus spp)

29
Q

Indications for convenia in cats?

A

> skin and soft tissue abscesses, wounds (P. multocida, fusobacterium spp. bacteroides spp., prevotella oralis, B-haemolytic strep, s. intermedius)
UTIs (E. coli)

30
Q

contraindications for convenia?

A
  • hypersesntivity to cephalopsporins or penicillin
  • small mammals (guinaepigs, rabbits)
  • dogs and cats < 8 weeks
    > reserve 3rd gen cephalosporins for cases with c+s and failure or expected failure to respons to other drugs