PRESENTATION
BROCHURE
CANINE PYODERMA Ana Goicoa Valdevira Juan Rejas Lรณpez
CANINE PYODERMA
CANINE PYODERMA
Canine Pyoderma
Ana Goicoa Valdevira Juan Rejas López
CANINE PYODERMA
eBook
available
PY094420_Canine_Pyodermas_COVER_SERVET.indd 3
This book, written for veterinary practitioners, describes the different presentations of pyoderma, the diseases it is most commonly associated with, the action protocol in each case, its diagnosis (both clinical and laboratory), and its treatment. All of this information is accompanied by a wealth of visual material to ensure it is easily understood.
TARGET AUDIENCE:
30/5/19 13:15
ESTIMATED
RETAIL PRICE ✱ Small animal vets. Dermatology ✱ Veterinary students FORMAT: 17 × 24 cm. NUMBER OF PAGES: 100. NUMBER OF IMAGES: 54. BINDING: hardcover.
€50
Authors ANA GOICOA VALDEVIRA Lecturer at the Department of Anatomy, Animal Production and Clinical Veterinary Sciences at the University of Santiago de Compostela. Head of the Internal Medicine Service at Rof Codina Veterinary Teaching Hospital, Faculty of Veterinary Medicine of Lugo. JUAN REJAS LÓPEZ Lecturer in the Department of Veterinary Medicine, Surgery and Anatomy at the University of León (Spain). He teaches general pathology, clinical examination techniques, and medical pathology in the areas of dermatology and neurology.
KEY FEATURES:
➜ A scientifically rigorous review of canine pyoderma, one of the dermatological diseases most commonly diagnosed in daily small animal practice. ➜ Shows the methods to identify each type of pyoderma, and describes the most common ones, their aetiology and diagnosis. ➜ Includes information about the latest treatments available, bearing mind the appearance in the last few years of multiresistant bacteria.
Presentation of the book This book is primarily designed to serve as a clinical and educational aid for veterinary surgeons, to provide a scientific reference covering current knowledge of canine pyodermas, but without detracting from its usefulness as a supporting textbook for students working towards a degree in veterinary medicine. Canine pyoderma is any cutaneous infection caused by staphylococci or yeasts. It is one of the most commonly diagnosed dermatological disease encountered in everyday clinical practice. However, due to the various clinical presentations of pyoderma, vets often find it hard to recognise this condition, so it is under- or misdiagnosed. Therefore, it frequently becomes chronic and turn into a dire situation for all involved: for the vet, the animal, and their owner. It is worth highlighting that this dermatological disease, in most cases, is a secondary complication. The main aim of the diagnosis should be to identify the underlying cause. Even though this may be a costly and painstaking task, it is absolutely necessary to ensure the process recedes and the treatment is a success. Hence, this manual initially describes the microorganisms that are usually the causal agent, presents different bacteriological diagnostic techniques that are easy to carry out in a veterinary practice, and explains how to perform them correctly and how to identify which bacteria are present. It also goes through the methods for recognising each type of pyoderma and provides a description of the most common ones, their aetiology, and their diagnosis. Finally, the chapter on treatments includes an in-depth explanation of the latest treatments currently available while also focusing on the appearance of multidrug-resistant bacteria over the last few years. The text is accompanied by complementary pictures and illustrations to facilitate the recognition of each condition and a series of flow charts to help make differential diagnoses.
Canine Pyoderma
The authors Ana Goicoa Valdevira Dr Goicoa is a lecturer at the Department of Anatomy, Animal Production and Clinical Veterinary Sciences at the University of Santiago de Compostela (Spain). She delivers the courses Clinical Medicine I and II in the areas of dermatology and haematology. She is head of the Internal Medicine Service at Rof Codina Veterinary Teaching Hospital (Lugo Faculty of Veterinary Medicine). Dr Goicoa is also certified in internal medicine by the Spanish Small Animal Veterinary Association (AVEPA). She has written and coauthored several books and articles published in Spanish and international journals.
Juan Rejas Lรณpez
He was the Managing Director of the University of Leรณn Veterinary Hospital from March 2013 to May 2016. Dr Rejas has also written and coauthored several books and articles published in specialist journals.
hkeita/shutterstock.com
Dr Rejas lectures within the Department of Veterinary Medicine, Surgery and Anatomy at the University of Leรณn (Spain). He teaches general pathology, clinical examination techniques, and medical pathology in the areas of dermatology and neurology.
Table of contents 1. Introduction
6. Treatment
2. Aetiology The functions of the skin Skin bacterial flora
3. Aetiopathogenesis 4. Bacteriological diagnosis Cytological examination of the skin Bacteriological skin culture
5. Classification of pyoderma: description and diagnosis Surface pyoderma Intertrigo Acute moist dermatitis (hot spots) Superficial pyoderma Impetigo Superficial bacterial folliculitis Bacterial or Malassezia overgrowth Mucocutaneous pyoderma Deep pyoderma Intertrigo Acne Nasal bridge furunculosis Pyotraumatic furunculosis Acral lick furunculosis Post-grooming furunculosis Callus pyoderma German Shepherd cellulitis
Premises Commonly used topical agents Antiseptics In vitro efficacy In vivo efficacy
Honey and oils Antibiotics Antifungals Systemic antibiotic therapy Resistant infections due to Staphylococcus pseudintermedius Recommendations for uncomplicated pyoderma Treatment of multidrug-resistant staphylococcal pyoderma Antiseptics Topical antibiotics Systemic antibiotics Final recommendations based on the type of pyoderma Intertrigo Acute moist dermatitis Overgrowth Mucocutaneous pyoderma Impetigo Superficial folliculitis Deep pyoderma Acne Nasal bridge furunculosis Pyotraumatic furunculosis Acral lick furunculosis Post-grooming furunculosis Callus pyoderma German Shepherd cellulitis
Bacterins and immunomodulatory agents
Editorial Servet
■
Plaza Antonio Beltrán Martínez, 1 Centro Empresarial El Trovador planta 8, oficina 50002 Zaragoza, Spain
■
+34 976 461 480
CANINE PYODERMA Ana Goicoa Valdevira Juan Rejas Lรณpez
CANINE PYODERMA PY094420_Canine_Pyodermas_COVER_SERVET.indd 3
30/5/19 13:15
CANINE PYODERMA
■ Other formulations are used for more focal or less extensive lesions, and most,
except for mousses, are applied once or twice per day. Patients should be entertained (by giving them food or playing with them) after application to distract them from licking the area: ■ Mousses, lotions, solutions, or aerosols, which are not rinsed after application, and contain antiseptics, antibiotics or antifungals. These can be combined with shampoo treatment (applied on days on which the patient is not bathed) and are also useful for nongeneralised lesions of varying extension. Mousses can be applied almost anywhere and used for focal or diffuse diseases, while lotions, solutions, and sprays are more effective for the treatment of areas with little hair, such as the axillae, groin, and ventral abdomen. ■ Creams, ointments, and gels containing antiseptics, antibiotics, or antifungals are useful for the treatment of focal lesions such as furunculosis and intertrigo, lesions in interdigital spaces, and areas with little hair. ■ Wipes impregnated with antiseptics, useful for conditions affecting interdigital spaces or folds.
OBSERVATIONS SUPPORTING THE TOPICAL TREATMENT OF PYODERMA Anette Loeffler made the following three interesting observations in a round table discussion (Lloyd and Varjonen, 2017): (1) In many bacterial skin infections, particularly pseudopyoderma and superficial pyoderma, topical treatment can replace systemic antibiotic therapy; (2) there is no evidence of therapeutic failure with topical antibacterial products; and (3) it is plausible that the high concentrations reached in areas in which topical treatments are applied exceed the minimum inhibitory concentrations (MIC) for the microorganisms in question, and therefore sensitivity tests may not be relevant when topical treatment are used.
50
05_treatment.indd 50
30/5/19 13:04
TREATMENT
5
Antiseptics Among the antiseptics most commonly available are combinations of acetic acid and boric acid (both at 2 %), hypochlorous acid, chlorhexidine salts at varying concentrations (usually 2–4 %), combined with miconazole (2 %) or at lower concentrations (0.30–0.45 %) in gel or impregnated wipes, chloroxylenol (2 %), ethyl lactate (10 %), benzoyl peroxide (2.5 % in shampoo and 2.5 and 5.0 % in gel form), povidone iodine (10 %) and, until recently, triclosan (0.3 %).
In vitro The minimum inhibitory concentration (MIC) in S. pseudintermedius isolates has been determined for some of these antiseptics. Values range from less than 0.5 μg/ml for triclosan and hypochlorous acid to 0.5–16.0 μg/ml for different chlorhexidine salts (acetate, gluconate, and digluconate) (Valentine et al., 2012; Murayama et al., 2013; Couto et al., 2014; Clark et al., 2015; Uri et al., 2016). These concentrations are much lower than those of commercial products, even when diluted with water; thus, 0.3 % triclosan is equivalent to 3,000 μg/ml, and 3 % chlorhexidine salt is equivalent to 30,000 μg/ml. Importantly, no differences in the MIC have been reported between methicillin-resistant and methicillin-sensitive S. pseudintermedius strains, indicating that multidrug-resistant strains are equally sensitive to antiseptics (Valentine et al., 2012; Couto et al., 2014; Clark et al., 2015; Uri et al., 2016). For M. pachydermatis, MICs of less than 2 μg/ml and 15 μg/ml have been reported for hypochlorous acid and chlorhexidine, respectively (Uri et al., 2016). Young et al. (2012) compared the in vitro efficacy of different shampoos against methicillin-resistant and methicillin-sensitive S. pseudintermedius and M. pachydermatis. Efficacy against all strains was observed for the three chlorhexidine gluconate-containing shampoos analysed (2–4 %) at dilutions of over 1:1,000. By contrast, those containing benzoyl peroxide, ethyl lactate, acetic acid + boric acid, and chloroxylenol were only effective against S. pseudintermedius either undiluted or at a dilution of 1:2, and against M. pachydermatis at dilutions of 1:500 (benzoyl peroxide and ethyl lactate) and 1:8–1:16 (acetic acid + boric acid and chloroxylenol). Kloos and coworkers (2013) measured the growth inhibition zone produced in S. pseudintermedius cultures by hairs taken from dogs that had been bathed 4 times in 9 days with different shampoos. Hairs were collected up to 7 days after the last bath to evaluate the residual effect. Hairs treated with three chlorhexidine shampoos (2–3 %), one of which also contained miconazole and another of which was accompanied by treatment with 3 % chlorhexidine lotion (applied after drying), significantly inhibited bacterial growth for at least 7 days. However, significantly smaller growth inhibition zones were observed for 0.8 % chlorhexidine 51
05_treatment.indd 51
30/5/19 13:04
CANINE PYODERMA
shampoo and for ethyl lactate shampoo. For example, of 11 samples of hairs washed with ethyl lactate shampoo and collected immediately after the last bath, only one showed inhibition zones after 2 days, 2 after 4 days, and only one after 7 days. No growth inhibition zones were observed for the remaining samples. For benzoyl peroxide-containing shampoo, no growth inhibition zone were observed for any samples, even for hairs collected on the same day of the last bath. It should be noted that shampoo containing 4 % chlorhexidine gluconate produced medium-sized growth inhibition zone, similar to those observed for the 0.8 % formulation. Based on this observation, the authors concluded that a shampoo’s efficacy depends not only on the concentration of the active ingredients, but also on the formulation. This view is supported by the findings of other studies. A shampoo containing 3 % chlorhexidine digluconate combined with phytosphingosine showed poorer in vitro efficacy than one containing 4 % chlorhexidine gluconate combined with isopropyl alcohol (Uri et al., 2016) and two other formulations containing 2 % and 4 % chlorhexidine gluconate (Mesman et al., 2016), although in all cases efficacy was demonstrated. Mesman and colleagues (2016) evaluated the residual effect of chlorhexidine salt aerosols at different concentrations (1–4 %), and found that treated hairs inhibited in vitro growth of S. pseudintermedius in all cases up to 10 days after application, with larger growth inhibition zones observed for products containing concentrations of 2–4 %. Similarly, a study by Ramos et al. (2019) of several mousses containing chlorhexidine (2–3 %) combined with imidazole reported residual effects persisting for up to 10 days. Interestingly, the MIC of miconazole in S. pseudintermedius is also low, ranging from 1–4 μg/ml in most cases in both methicillin-resistant and methicillinsensitive colonies, and the MIC of the combination of equal parts chlorhexidine + miconazole (0.25–0.50 μg/ml in 190 of 198 colonies) is lower than that of either product alone, indicating a synergistic effect in vitro (Boyen et al., 2012; Weese et al., 2012; Clark et al., 2015). In the aforementioned study by Mesman et al. (2016), the largest growth inhibition zones in S. pseudintermedius samples were produced by hairs treated with an aerosol containing a combination of chlorhexidine gluconate and miconazole (both at 2 %). This effect was even greater than that observed for two formulations containing chlorhexidine at 3–4 %. These MICs are much lower than those obtained for the concentrations of miconazole used in topical preparations (2 %). Therefore, topical application of miconazole may be a therapeutic option even in cases of multidrug-resistant staphylococcal infections. However, in vivo evidence from clinical trials is lacking, and will be required to confirm the efficacy of this approach, which may also depend on other factors such as pH, salt concentrations, and temperature (Nenoff et al., 2017). 52
05_treatment.indd 52
30/5/19 13:04
TREATMENT
5
In vivo It should be borne in mind that the aforementioned results were obtained in vitro, and therefore may not correspond to in vivo activity, which can be influenced by a variety of parameters. For example, the antiseptic may not reach the deeper layers of the skin or the hair follicles, may fail to adequately penetrate the lesions (papules or pustules), or may show diminished effectiveness in organic matter or in response to the presence of biofilms (Murayama et al., 2013), which are produced by most S. pseudintermedius strains isolated from pyoderma lesions (Singh et al., 2013; Casagrande Proietti et al., 2015), and by most M. pachydermatis strains isolated from dogs (Figueredo et al., 2012). In their 2012 review of studies of topical treatments for cutaneous bacterial or yeast infections, Mueller and coworkers highlighted the notable lack of highquality randomised controlled trials and concluded that the existing evidence, obtained from randomised, double-blind, placebo-controlled trials of chlorhexidine, should only be rated only as level I. In their study of superficial staphylococcal pyoderma, Loeffler et al. (2011) compared the in vivo efficacy of two shampoos, one containing 3 % chlorhexidine gluconate and another containing 2.5 % benzoyl peroxide. They reported greater efficacy for the chlorhexidine-containing shampoo, which resulted in a marked improvement or clinical cure after 3 weeks in 7 out of 10 dogs when applied twice per week, compared with only 2 out of 10 dogs treated with the benzoyl peroxidecontaining shampoo. In their study of dogs with bacterial overgrowth, Viaud et al. (2012) reported similar efficacy (defined as an improvement in the clinical picture and a reduction in the bacterial count on cytology) for 3 % chlorhexidine digluconate and 2.5 % benzoyl peroxide shampoos, although a marked improvement in the clinical picture (>85 %) was observed in a larger proportion of dogs bathed with chlorhexidine than with benzoyl peroxide (38.9 % versus 18.8 %). Nagata et al. (2006) compared the effects of treatment with a 2 % chlorhexidine formulation versus a 10 % ethyl lactate formulation in dogs with superficial pyoderma, and reported better lesion evolution in dogs treated with the former. Borio et al. (2015) demonstrated that two weekly baths with 4 % chlorhexidine shampoo together with daily application of 4 % chlorhexidine lotion was effective in 25 of 26 dogs with superficial pyoderma caused by S. pseudintermedius (methicillin-resistant and methicillin-sensitive), with an efficacy similar to that observed in dogs treated with oral amoxicillin-clavulanic acid twice per day. Murayama et al. (2010a, 2010b, and 2011) evaluated the efficacy of several chlorhexidine formulations that were rinsed following application: 8 out of 10 dogs with methicillin-resistant S. intermedius pyoderma showed a good response after application every 2 days for 2 weeks of two distinct 2 % formulations (each applied 53
05_treatment.indd 53
30/5/19 13:04
CANINE PYODERMA
to one half of the body); 6 out of 8 dogs with cephalexin-resistant S. intermedius pyoderma showed an excellent or good response after application of a 2 % formulation every 2 days for 2 weeks; 6 and 7 out of 10 dogs showed a good response after only 2 applications in 1 week of 2 % and 4 % chlorhexidine formulations, respectively (each applied to one half of the body); and out of 27 dogs with pyoderma caused by cocci that were treated every 2 days for 1 week with different amounts of 2 % chlorhexidine, 22 showed a good treatment response, with the worst responses observed in the group that received the smallest amount of the product per body surface area. Maynard and colleagues (2011) compared the effects of bathing 1–3 times per week with two shampoos, one containing 3 % chlorhexidine and the other containing a combination of 2 % chlorhexidine and 2 % miconazole, in patients with dermatitis due to M. pachydermatis. Cytological cure (a decrease in the number of yeasts) was achieved in most patients within 4 weeks, with no significant differences between the two shampoos used. In both groups a marked clinical response was achieved in approximately 40 % of the dogs and good response in 50 %. Udenberg et al. (2015) reported no differences with respect to controls (treated with physiological saline) in 8 dogs with superficial pyoderma that were treated twice per day for 4 weeks with 0.011 % hypochlorous acid. Moreover, half of the dogs were withdrawn from the study owing to a lack of effect. These solutions are well tolerated, although occasional contact hypersensitivity reactions have been described (Calogiuri et al., 2013). Out of 176 dogs treated with chlorhexidine in several studies, only 2 exhibited reactions that required withdrawal from the study, and another 5 had transient reactions, mainly pruritus or scaling (Nagata et al., 2006; Murayama et al., 2010a, 2010b and 2011; Loeffler et al., 2011; Maynard et al., 2011; Viaud et al. 2012; Borio et al., 2015).
In summary, current in vitro and in vivo data demonstrate the efficacy of 2–4 % chlorhexidine formulations, either alone or combined with miconazole, in infections caused by S. pseudintermedius or M. pachydermatis.
For several other compounds, much poorer in vitro efficacy against staphylococci (benzoyl peroxide, ethyl lactate, acetic acid + boric acid, chloroxylenol) and yeast (acetic acid + boric acid, chloroxylenol) has been reported. Moreover, poor in vivo efficacy in dogs with superficial pyoderma has been reported for benzoyl peroxide, ethyl lactate, and hypochlorous acid. 54
05_treatment.indd 54
30/5/19 13:04
TREATMENT
5
Honey and oils The efficacy of a honey-based ointment (48 %) has been demonstrated both in vitro against S. pseudintermedius and M. pachydermatis, and in vivo in dogs with focal pseudopyoderma lesions (intertrigo, acute moist dermatitis), in which treatment once per day was of comparable efficacy to 3 % chlorhexidine shampoo, resulting in lesion resolution in 85 % of dogs within 2 weeks and a decrease in cocci and yeast counts (Jakobsson, 2011; Oliveira et al., 2018). However, it should be borne in mind that the antimicrobial activity of honey varies widely depending on the type of honey and its concentration (Mandal and Mandal, 2011; Almasaudi et al., 2017). Analysis of another honey-based ointment (100 % manuka honey) revealed no in vitro efficacy against S. pseudintermedius or M. pachydermatis (Uri et al., 2016). In vitro data show that certain oils, such as manuka-based oils, exert antimicrobial activity against methicillin-resistant and methicillin-sensitive S. pseudintermedius (Song et al., 2013). Moreover, application of these products in sprays or baths reduces the severity and extension of superficial pyoderma and Malassezia dermatitis (Bensignor and Vidémont, 2017; Duangkaew et al., 2017) and accelerates the healing of superficial pyoderma treated with systemic antibiotics (Bensignor et al., 2016).
Antibiotics A wide range of antibiotic formulations are commercially available, including topical creams, gels, solutions, and lotions that can be used to treat focal lesions caused by staphylococci, especially if topical antiseptics fail to resolve the infection (Beco et al., 2013b; Hillier et al., 2014). These are discussed in the section titled “Treatment of pyoderma due to multidrug-resistant staphylococci.”
Antifungals Several authors (Cafarchia et al., 2012; Peano et al., 2012; Chiavassa et al., 2014) have determined the MICs for a variety of antifungal compounds against M. pachydermatis, and have reported the lowest values for itraconazole (≤0.016 μg/ml in yeast isolates), ketoconazole (≤0.06 μg/ml), and terbinafine (≤0.25 μg/ml), and poorer results for miconazole and clotrimazole (≤16 μg/ ml). In general, the concentrations achieved with the topical formulations commercially available are higher than the MICs of these antifungals, whether in the form of a solution, shampoo, or cream containing 2 % ketoconazole, 0.87– 2.00 % miconazole, 1 % clotrimazole, or 1 % terbinafine. 55
05_treatment.indd 55
30/5/19 13:04
CANINE PYODERMA
SYSTEMIC ANTIBIOTIC THERAPY Antibiotic resistance of S. pseudintermedius Before the beginning of this century data demonstrating the presence of staphylococcal isolates in canine pyoderma were scarce, with the exception of data generated between 1988 and 1992 at the Veterinary Teaching Hospital of the Complutense University, Madrid (Piriz et al., 1996). Of the most commonly used oral antibiotics tested, staphylococci showed sensitivity to amoxicillin–clavulanic acid, first-generation cephalosporins, and fluoroquinolones, mild resistance to clindamycin, moderate resistance to doxycycline, and variable resistance to sulfonamidetrimethoprim. Table 1 lists reports of antibiotic resistance in S. intermedius isolates from 1995 to 1997 in healthy dogs and dogs with pyoderma in Europe. Loeffler et al. (2007) claimed to have isolated the first multidrug-resistant strain of S. intermedius described in Europe in 2005, although such strains were likely among those described earlier by Piriz et al. (1996). Since then there have been many reports describing the detection of methicillin-resistant S. pseudintermedius (MRSP), which mainly spreads due to clonal dissemination. In addition to exhibiting resistance to beta-lactam antibiotics (amoxicillin–clavulanic and cephalosporins, both first and third generation), these bacteria are also frequently resistant to several other classes of commonly used antimicrobial drugs (Duijkeren et al., 2011; Morris et al., 2017). Perreten et al. (2010) characterised the antibiotic resistance of 103 MRSP strains isolated in Europe and North America between 2004 and 2009: 100 % were resistant to beta-lactams, 89.3 % to clindamycin, 84.5 % to enrofloxacin, 69.9 % to tetracycline, and 90.3 % to trimethoprim. The authors described two MRSP clones, one in Europe and the other in North America. Henceforth we will focus on the frequencies of resistance described in Europe for MRSP or multidrug-resistant but methicillin-sensitive S. pseudintermedius. As we will discuss later, the data reported by Perreten et al. (2010) already indicate that something unusual is happening: tetracyclines, which had been considered a poor choice for the treatment of pyoderma, are now the treatment of choice in many cases owing to the prevalence of multidrug-resistant staphylococci. Ruscher et al. (2009) characterised the antibiotic sensitivity profile of 46 MRSP isolates collected in Germany in 2007: 45 out of the 46 isolates were
56
05_treatment.indd 56
30/5/19 13:04
5
TREATMENT Table 1. Percentage of resistant S. intermedius strains isolated from healthy dogs and dogs with pyoderma in Europe (1995–2007).
Country (years) and number of strains isolated France United France Greece (1995– Kingdom (2002) 6 (1999– 1999)3 (1996– 2001)5 n = 50 4 1998) n = 393 n = 53 n = 429
United Kingdom (1995)1 n = 103
France (1995– 1996)2 n = 100
Amoxicillin–clavulanic acid
0
1
—
—
0
Cephalexin (or cefalotin)
0
2
—
—
Enrofloxacin
0
5
6
Clindamycin
11.7
23
—
Antibiotic ( % resistance)
Sulfonamide– trimethoprim (TMP) Doxycycline (or other tetracycline)
Denmark (2000– 2005)7 n = 84
Italy (2006– 2007)8 n = 114
0
0
0
7.5
0
0
0
0.9
5.7
2
1.2
1.8
—
18.9
22
34.5
9.6
3.6
3.5
29.8
—
—
36
—
—
92.5
0 resistant to TMP
37.9
35
—
—
32.1
28
Lloyd et al., 1996. Pellerin et al., 1998 (includes all non-sensitives: resistant and intermediate). 3 Ganière et al., 2001 (includes all non-sensitives: resistant and intermediate). 4 Lloyd et al., 1999. 5 Saridomichelakis et al., 2002. 6 Ganiere et al., 2005 (includes all non-sensitives: resistant and intermediate). 7 Pedersen et al., 2007. 8 Vanni et al., 2009. 1 2
resistant to clindamycin and to 3 different fluoroquinolones, and all were resistant to sulfonamide-trimethoprim. None were sensitive to gentamicin or tobramycin, but 15 were sensitive to tetracyclines. By definition, MRSP strains are resistant to all beta-lactam antibiotics (regardless of antibiotic sensitivity test results), including cephalosporins, penicillins, and the combination of amoxicillin + clavulanic acid, and for the most part are resistant to several other antibiotics. Therefore, fluoroquinolones, macrolides, lincosamides (clindamycin), and sulfonamide-trimethoprim are not usually an option for treatment. The remaining options include drugs such as tetracyclines, chloramphenicol, aminoglycosides, and rifampicin. The most appropriate drug should be selected based on the results of an in-vitro antibiotic sensitivity test
57
05_treatment.indd 57
30/5/19 13:04
CANINE PYODERMA
(Papich, 2012). We will discuss this topic further in the section on “Treatment of pyoderma due to multidrug-resistant staphylococci”. Several studies have assessed levels of resistance in Europe in recent years. Of over 1,000 strains isolated from dogs and cats in the United Kingdom in 2012 (Beever et al., 2015), few (1–2 %) were resistant to methicillin, amoxicillin–clavulanic acid, cephalexin, or cefovecin, 3–4 % were resistant to enrofloxacin and marbofloxacin, 6.0 % to sulfonamide–trimethoprim, 10.6 % to clindamycin, and 24.3 % to oxytetracycline. In Denmark, of over 300 S. pseudintermedius isolates collected between 2012 and 2013 (Larsen et al., 2015), 4.3 % were resistant to methicillin and amoxicillin–clavulanic acid, 3.2 % to enrofloxacin, 5.5 % to sulfonamide– trimethoprim, and 24.5 % to clindamycin, although clindamycin resistance was much lower (14.0 %) in staphylococci isolated from first-time superficial pyoderma lesions that had not been previously treated. A study (Grönthal et al., 2017) of almost 2,000 S. pseudintermedius isolates collected in Finland between 2011 and 2015 found that 13.7 % were resistant to methicillin, 11.8 % to sulfonamide–trimethoprim, and 30.8 % to clindamycin. Of almost 250 S. pseudintermedius isolates collected in France in 2010, 16.9 % were resistant to methicillin, 23.5 % to enrofloxacin, 37.0 % to lincomycin, and 55.1 % to tetracycline (Haenni et al., 2014). However, other studies from this decade have reported much higher rates of MRSP, including 33.3 % of samples (21 out of 63) sent to a veterinary faculty in Italy between 2011 and 2014 (Ventrella et al., 2017). As mentioned above, Perreten et al. (2010) described two distinct MRSP clones, one in Europe and the other in North America. In their review of MRSP clones isolated in Europe, Pires dos Santos et al. (2016) found that 64.3 % belonged to the clonal complex (CC) 71 and 25.5 % to CC258, although these proportions appear to have changed over the last few years (Duim et al., 2016; Grönthal et al., 2017; Kizerwetter-Świda et al., 2017; Ventrella et al., 2017). This finding is of particular interest, as it demonstrates that different clones show distinct patterns of resistance. Thus, CC258 exhibits lower rates of resistance to chloramphenicol, gentamicin, and enrofloxacin and higher rates of resistance to tetracycline and sulfonamide– trimethoprim than CC71 (Pires dos Santos et al., 2016).
58
05_treatment.indd 58
30/5/19 13:04
The publishing strength of Grupo AsĂs Editorial Servet, a division of Grupo AsĂs, has become one of the reference publishing companies in the veterinary sector worldwide. More than 15 years of experience in the publishing of contents about veterinary medicine guarantees the quality of its work. With a wide national and international distribution, the books in its catalogue are present in many different countries and have been translated into nine languages to date: English, French, Portuguese, German, Italian, Turkish, Japanese, Russian and Chinese. Its identifying characteristic is a large multidisciplinary team formed by doctors and graduates in Veterinary Medicine and Fine Arts, and specialised designers with a great knowledge of the sector in which they work. Every book is subject to thorough technical and linguistic reviews and analyses, which allow the creation of works with a unique design and excellent contents. Servet works with the most renowned national and international authors to include the topics most demanded by veterinary surgeons in its catalogue. In addition to its own works, Servet also prepares books for companies and the main multinational companies in the sector are among its clients.
Communication services Online visualisation of the sample chapter. Presentation brochure in PDF format, compatible with mobile devices.
Servet (División de Grupo Asís Biomedia S.L.) Centro Empresarial El Trovador, planta 8, oficina I Plaza Antonio Beltrán Martínez, 1 • 50002 Zaragoza (España) Tel.: +34 976 461 480 • Fax: +34 976 423 000 • www.grupoasis.com