Small Animal Dermatology, 3rd edition

CHAPTER 13 BACTERIAL PYODERMA 217

THERAPEUTICS

 Severe, generalized, deep: may require supportive care such as intravenous fluids,

parenteral antibiotics, and/or daily whirlpool baths.

 Shampoos mechanically remove surface debris and lower bacterial counts; best if also

antibacterial; use at least 1–2 times weekly for both treatment and prevention of recur-

rence.

 Whirlpool baths: deep pyoderma; remove crusted exudate; encourage drainage.

 Nutrition: avoid poor-quality diets and excessive supplementation; restricted antigen

food trial if suspect pyoderma is secondary to adverse food reaction.

 Fold pyoderma may require surgical correction to prevent recurrence; treatment

should primarily rely on topical therapy.

 Superficial pyoderma: use shampoo therapy as an initial protocol or adjunctive ther-

apy with appropriate antibiotics; antibiotic choice should be based on typical regional

response rates as well as level of systemic side effects; use appropriate dose and dura-

tion (minimum 21 days); emerging antibiotic resistance of great concern; topical ther-

apy vitally important to support decreased antibiotic dependency.

 Recurrent, resistant, or deep pyoderma: antibiotic selection based on culture (with

speciation) and sensitivity testing (Table 13.1).

 Multiple organisms with different antibiotic sensitivities: often best to choose antibi-

otic on basis of staphylococcal susceptibility; severe cases may require combination

therapy.

 Antimicrobial Guidelines Working Group of the International Society for Companion

Animal Infectious Diseases recommendations:

First tier (empiric): clindamycin, lincomycin, first-generation cephalosporins,

trimethoprim-potentiated sulfonamides

First or second tier: third-generation cephalosporins

Second tier (failure of empiric choice and cultures indicate sensitivity): doxycy-

cline, minocycline chloramphenicol, fluoroquinolones, rifampicin, aminoglyco-

sides

Third tier: linezolid, vancomycin; use strongly discouraged; reserved for serious

MRSA infections in humans.

 Corticosteroids: may encourage resistance and recurrence when used long term con-

currently with antibiotics; may be used short term at the onset of therapy to resolve

acute inflammation.

 Vaccines: immunomodulatory “staph vaccine” therapy – Staphage lysate (SPL;

Delmont Laboratories), staphoid AB, or autogenous staphylococcal bacterins; inac-

tivated suspensions of bacteria via heating, chemical inactivation, or bacteriophage

lysis; goal is to improve antibiotic efficacy, decrease recurrence, and avoid long-term

antibiotic therapy; beneficial effect may be due to upregulation of interferon-gamma

production or an antigen-specific immunologic response.

 Antibiotics:
Administer for a minimum of 2 weeks beyond clinical cure