Dose assessment of 2% chlorhexidine acetate for canine superficial pyoderma

The dose of 2% chlorhexidine acetate (2CA; Nolvasan^® Surgical Scrub; Fort Dodge Animal Health, Fort Dodge, IA, USA) for canine superficial pyoderma was evaluated. The first trial compared three doses (group 1, 57 mL/m² body surface area; group 2, 29 mL/m² body surface area; and group 3, 19 mL/m² body surface area) in a randomized, double‐blind, controlled fashion. Twenty‐seven dogs with superficial pyoderma were treated with 2CA at the allocated doses every 2 days for 1 week. The owners and investigators subjectively evaluated the dogs, and investigators scored skin lesions, including erythema, papules/pustules, alopecia and scales, on a 0–4 scale. There were no significant differences in response between the treatment groups. The second trial established a practical dose‐measuring method for 2CA. Sixty‐eight owners were asked to apply 2CA on their palm in an amount corresponding to a Japanese ¥500 coin, 26.5 mm in diameter. This yielded an average dose of 0.90 ± 0.40 mL. Mathematically, the doses used in groups 1, 2 and 3 can be represented as one coin per approximately one‐, two‐ and three‐hand‐sized lesions, respectively. The results therefore suggest that owners instructed to apply one coin of the product per two‐hand‐sized areas of superficial pyoderma would use the range of doses evaluated in this trial.     

Efficacy of a surgical scrub including 2% chlorhexidine acetate for canine superficial pyoderma

The clinical efficacy of a surgical scrub containing 2% chlorhexidine acetate (2CA; Nolvasan^® Surgical Scrub; Fort Dodge Animal Health, USA) was evaluated for the topical management of canine superficial pyoderma. The first study was a randomized, double‐blind, controlled trial. The control was a shampoo containing 4% chlorhexidine gluconate (4CG; Skin Clinic Shampoo; CHD MEDICS, Goyang, Korea). Ten dogs with symmetrical lesions of canine superficial pyoderma were allocated to receive either 2CA or the control shampoo applied to either side of the body twice weekly for 1 week. Both the owners and the investigators subjectively scored skin lesions including pruritus, erythema, crusted papules and scales on a scale of 0–3. The 2CA and 4CG resulted in almost the same degree of improvement of skin lesions, and there were no significant differences between the two groups. The second study was an open trial of 2CA monotherapy in eight dogs with cefalexin‐resistant Staphylococcus intermedius group‐associated superficial pyoderma. The 2CA monotherapy was applied every 2 days for 2 weeks. Five dogs improved with 2CA monotherapy, one partially improved and two did not. No adverse reactions were seen in either trial. This suggests that a 2CA surgical scrub could be a useful and safe topical adjunct therapy for dogs with superficial pyoderma involving cefalexin‐resistant Staphylococcus intermedius group.     

Clindamycin hydrochloride and clavulanate-amoxycillin in the treatment of canine superficial pyoderma.

A masked, randomised, controlled clinical trial for the treatment of canine superficial pyoderma was undertaken. Dogs with a clinical diagnosis of superficial pyoderma, supported by bacterial culture were admitted to the trial and randomly assigned to treatment with either clindamycin hydrochloride at 5.5 mg/kg twice daily or clavulanate-amoxycillin at 12.5 mg/kg twice daily. After 21 days the animals were re-assessed, and therapy was continued for a further 21 days in the dogs with persistent lesions if bacterial culture demonstrated continued sensitivity. Twenty-nine dogs were treated with clindamycin hydrochloride and 27 with clavulanate-amoxycillin. Complete cure was obtained after three weeks in 17 (59 per cent) of the clindamycin-treated cases, but in only eight (30 per cent) of the clavulanate-amoxycillin treated group. Clindamycin was significantly more effective than clavulanate-amoxycillin for the treatment of superficial pyoderma in dogs.     

Effects of an ethyl lactate shampoo in conjunction with a systemic antibiotic in the treatment of canine superficial bacterial pyoderma in an open-label,nonplacebo-controlled study

An open-label, nonplacebo-controlled study was designed to compare systemic cephalexin therapy versus systemic cephalexin and ethyl lactate shampoo therapy in the treatment of canine superficial bacterial pyoderma. Twenty client-owned dogs diagnosed with generalized superficial bacterial pyoderma (SP) were alternately assigned to oral treatment with cephalexin (25 to 30 mg/kg every 12 hours) or treatment with cephalexin (as for Group 1) and twice-weekly shampooing with a 10% ethyl lactate shampoo, which was left in contact with the dog's skin for 10 minutes. On Days 14 and 28, skin lesion severity scores, assessed by the investigators, were significantly (P <.01) lower for the group treated with cephalexin and shampoo than for the group treated with cephalexin only. On Day 14, dog owners gave better scores to dogs treated with cephalexin and shampoo for haircoat appearance and body odor than for dogs treated only with cephalexin. Clinical and cytologic resolution of SP occurred significantly (P <.02) sooner in the cephalexin/shampoo group (29.4 days) than in the cephalexin only group (37.8 days).     

The effectiveness of systemic antimicrobial treatment in canine superficial and deep pyoderma: a systematic review

Aim – To identify and evaluate existing evidence for the effectiveness of systemic antimicrobial treatments for naturally occurring superficial and deep canine pyoderma. Method – Electronic searches of PubMed, MEDLINE and CAB Direct were carried out (25 May 2011) without date or language restrictions. Proceedings of ESVD/ECVD, AAVD/ACVD, NAVDF and WCVD annual congresses were searched. Unpublished studies were sought via the Veterinary Dermatology discussion list and Veterinary Information Network. Results – Seventeen full‐length, peer‐reviewed controlled trials reporting clinical outcomes of systemic antimicrobial treatment for canine pyoderma were identified. Outcomes specific to superficial or deep pyoderma were reported in nine and five studies, respectively. Five studies reported outcomes only for nondifferentiated pyoderma depth. Heterogeneity of study designs and outcome measures made meta‐analysis inappropriate. A good level of evidence was identified supporting the high efficacy of subcutaneously injected cefovecin in superficial pyoderma and for oral amoxicillin–clavulanic acid in deep pyoderma. A fair level of evidence was identified for moderate to high efficacy of oral amoxicillin–clavulanic acid, clindamycin, cefadroxil, trimethoprim–sulphamethoxazole and sulfadimethoxine–ormetoprim in superficial pyoderma and oral pradofloxacin, oral cefadroxil and subcutaneously injected cefovecin in deep pyoderma. Eleven trials reported observations of adverse effects in treated pyoderma cases by intervention group; four dogs were withdrawn owing to the severity of adverse effects. Conclusions – There is a need for greater numbers of adequately sized, blinded, randomized controlled trials evaluating systemic antimicrobial interventions for canine pyoderma. Improved differentiation between superficial and deep pyoderma in outcome reporting, outcome measure standardization and association of outcomes with causative bacterial species and their resistance patterns are required.     

Comparison of two shampoos as sole treatment for canine bacterial overgrowth syndrome

Two antibacterial shampoos for the treatment of canine bacterial overgrowth syndrome (BOGS) were compared in a prospective controlled clinical trial. Forty dogs with clinical signs (pruritus, erythema and excoriations without pustules and/or collarettes) and cytological findings compatible with bacterial overgrowth were treated twice weekly with 3 per cent chlorhexidine shampoo (3 per cent CHX) or 2.5 per cent benzoyl peroxide shampoo (2.5 per cent BPO) and evaluated every two weeks for up to six weeks until cytological cure. Pruritus, erythema, greasy seborrhoea, malodour, excoriations, secondary hair loss, lichenification, hyperpigmentation and lesion extent were each scored on a 0 to 3 severity scale and combined to calculate an aggregate score. Among the 34 dogs with good compliance to treatment, reduction of cocci counts of at least 90 per cent was recorded in 11 of 18 dogs after 3 per cent CHX and nine of 16 dogs after 2.5 per cent BPO, with no significant difference between the two products (P=0.98). Lesion score was significantly reduced in both groups (63.48 (34.45)) per cent with 3 per cent CHX v 54.45 (33.61) per cent with 2.5 per cent BPO, P=0.36) and time to cytological cure was not significantly different between groups (P=0.13), at the end of the treatment. In the present study, 3 per cent CHX and 2.5 per cent BPO were similarly effective in the treatment of canine BOGS.     

Topical treatment of canine and feline pyoderma

Abstract This paper is a review of commonly used topical antibacterial medications: benzoyl peroxide, chlorhexidine, povidone iodine, ethyl lactate, triclosan, mupirocin, neomycin, polymyxin B, bacitracin and fusidic acid. Included is a review of the pharmacokinetics, modes of action, adverse effects and clinical uses in veterinary dermatology. General recommendations for topical antibacterial therapy are presented. Résumé— Cet article est une revue des topiques antibactériens les plus couramment utilisés: peroxyde de benzoyle, chlorhexidine, povidone iodée, lactate d'éthyle, triclosan, mupirocine, néomycine, polymyxine B, bacitracine et acide fucidique. Il inclut notamment une revue des pharmacocinétiques, des modes d'action, des effets secondaires et des indications thérapeutiques de ces produits en dermatologie vétérinaire. Les indications générales du traitement topique antibactérien sont présentées. [Guaguere, E. Topical treatment of canine and feline pyoderma. (Traitement topique des pyodermites canines et félines). Veterinary Dermatology 1996; 7 : 145–151.] Resumen Este articulo es una revisión de los productos tópicos antibacterianos más frecuentemente utilizados: peróxido de benzoilo, clorhexidina, povidona yodada, etillactato, triclosan, mupirocina, neomicina, polimixina B, bacitracina y ácido fusidico. Se incluye una revisión de la farmacocinética, mecanismos de acción, efectos colaterales y sus usos clínicos en dermatologia veterinaria. Se presentan recomendaciones generales para la terapia antibacteriana tópica. [Guaguere, E. Topical treatment of canine and feline pyoderma. (Tratamiento topico de la pioderma canina y felina). Veterinary Dermatology 1996; 7 : 145–151.] Zusammenfassung— Diese Veröffentlichung besteht in einer Übersicht von häufig verwendeten topischen antibakteriellen Arzneimitteln: Benzoylperoxid, Chlorhexidin, Povidon-Jod, Ethyllaktat, Triklosan, Mupirocin, Neomycin, Polymyxin B, Bacitracin und Fusidinsäure. Mit eingeschlossen ist eine Übersicht über Pharmakokinetik, Wirkungsweise, Nebenwirkungen und klinische Anwendung in der Veterinärdermatologie. Allgemeine Empfehlungen für die lokale antibakterielle Therapie werden dargestellt. [Guaguere, E. Topical treatment of canine and feline pyoderma (Lokale Behandlung von kaninen und felinen Pyodermien). Veterinary Dermatology 1996; 7 : 145–151.]     

Efficacy and tolerability of once-daily cephalexin in canine superficial pyoderma: an open controlled study

OBJECTIVES: The aims of this study were to evaluate the efficacy and tolerability of oral cephalexin given at 30 mg/kg once daily in dogs with superficial pyoderma and to compare them with those of oral cephalexin given at 15 mg/kg twice daily. METHODS: Twenty dogs with superficial pyoderma were treated with cephalexin at 30 to 60 mg/kg orally once daily (group A) and compared with 20 dogs treated at a dose of 15 to 30 mg/kg orally twice daily (group B). Dogs were treated until 14 days after clinical remission. Type and distribution of lesions, pruritus and general health status were assessed every 14 days using a numerical scale until 14 days after treatment discontinuation. Total scores for each evaluation day were compared between the two groups as well as time to obtain resolution and percentage of relapses. RESULTS: Resolution of superficial pyoderma was obtained in all dogs in 14 to 42 days (median 28 days for both groups), with no difference between groups. Six dogs experienced vomiting or diarrhoea but did not require discontinuation of the treatment. Only one dog (in group A) relapsed nine days after treatment discontinuation. CLINICAL SIGNIFICANCE: Once-daily cephalexin is as effective as twice-daily cephalexin in the treatment of canine superficial pyoderma.     

In vitro antiseptic susceptibilities for Staphylococcus pseudintermedius isolated from canine superficial pyoderma in Japan

Background –  Topical therapy, particularly with chlorhexidine, is becoming increasingly common as a treatment option for canine pyoderma; however, there are limited studies on the susceptibility of Staphylococcus pseudintermedius to chlorhexidine compounds. Objectives –  To determine the in vitro susceptibility of both meticillin‐resistant and meticillin‐susceptible S. pseudintermedius isolates to chlorhexidine and other antiseptic agents and the presence of multidrug efflux pump genes. Samples –  One hundred S. pseudintermedius isolates from 23 initial and 77 recurrent cases of canine pyoderma. Methods –  After bacterial identification and mecA testing, minimal inhibitory concentrations (MICs) of antiseptic agents were determined. Multidrug efflux pump genes, including qacA, qacB and smr, were identified. Results –  Of the 100 isolates, 57 were identified as meticillin‐resistant S. pseudintermedius. The MIC₉₀ of chlorhexidine acetate, chlorhexidine gluconate, acriflavine, ethidium bromide and benzalkonium chloride were 1, 1, 2, 0.5 and 2 μg/mL, respectively. Multidrug efflux pump genes qacA, qacB and smr were not detected in any of the isolates. Conclusions and clinical importance –  The MICs for chlorhexidine and other antiseptics remain low, and multidrug efflux pump genes were not found in the tested isolates.     

Miconazole/chlorhexidine shampoo as an adjunct to systemic therapy in controlling dermatophytosis in cats

A 2 per cent miconazole/2 per cent chlorhexidine shampoo was used in two groups of Persian cats infected with Microsporum canis. In the first group, the cats were treated with griseofulvin alone while, in the second, griseofulvin was used with the shampoo. The clinical signs of the cats were scored on a scale of 1 to 4 for seborrhoea, ease of epilation of hair and the extent of primary lesions, to try to give an overall impression of hair coat condition. The speed of resolution of the infection was assessed in terms of time to mycological cure. Samples were taken from the environment of both groups to assess the degree of environmental contamination at the end of treatment. No statistically significant difference was found between the two groups for time to mycological cure, although the lesion scores in the second group decreased significantly more quickly than those of the first group. Additionally, no dermatophytes were cultured from the environment in the second group at the end of the study.     

Multidrug- and methicillin resistant Staphylococcus pseudintermedius as a cause of canine pyoderma: a case report

A case of a dog with a long-term inflammatory skin disorder due to infection with methicillin-resistant Staphylococcus pseudintermedius (MRSP) is described. After initial diagnostics of MRSP, follow-up swabs of the dog (nose, skin) were taken twice after four and seven weeks. MRSP was constantly isolated from the skin and once from the nose. Since infected humans might be a source of reinfection, the owners of the dog were screened (nasal) three times during their pet's therapy. Thereby, the male owner was found to be colonized with MRSP once in the first sampling round. Comparative typing of all MRSP-isolates by pulsed-field gel electrophoresis (PFGE), SCCmec typing, multilocus sequence typing (MLST), spa typing, PCR-detection of the leukotoxin encoding operon (LukI) and the Staphylococcus intermedius-exfoliative toxin (SIET) as well as antimicrobial resistance profiling by broth microdilution revealed that all five MRSP isolates from the dog and the single isolate from the owner were indistinguishable by any of the applied methods. All isolates were assigned to a certain strain, a multidrug-resistant MRSP belonging to sequence type (ST) 71, spa type (t)05, harbouring SCCmecIII as well as the genes encoding LukI and SIET. In this case, a number of reasons might have contributed to therapy failure and re-infection, respectively (e. g. contact to other MRSP-colonized dogs, contact to MRSP-colonized humans, refusal to clip the dog's fur). In addition, MRSP-contaminated objects or surfaces in the household, which were difficult to disinfect or simply not considered as a potential source of MRSP, might have served as a source of re-infection. These results envision the possibility of a dog-to-human transmission of MRSP and the relevance of this aspect as a potential source of re-infection in cases of bacterial-supported long-term skin disorders in canine patients. First cases of MRSP infections in humans have been described only recently. However, the general pathogenic potential of multidrug resistant MRSP in humans is unknown so far and needs further investigation.     

Nodular granulomatous glossitis as the sole clinical sign in canine leishmaniosis

A 5.5‐year‐old, intact male Rottweiler dog was admitted with a history of multifocal nodular tongue lesions which progressively deteriorated during the previous year. Physical examination revealed several reddish nodules with central depression on the surface of the tongue in an otherwise healthy dog. Clinicopathologic abnormalities included eosinophilia and hyperproteinemia. Lingual nodule cytopathology, histopathology, and immunohistochemistry revealed Leishmania spp. amastigotes and a severe granulomatous glossitis. The dog was also seroreactive to L infantum antigens by an indirect immunofluorescence assay. Clinical reevaluation 3 months after the institution of treatment with allopurinol and miltefosine indicated that the nodular lesions had completely regressed. In endemic areas, lingual nodular lesions may rarely be the sole clinical sign of canine leishmaniosis. Standard medical treatment may provide an excellent prognosis.     

Serum thyroxine and triiodothyronine concentrations in canine pyoderma

In an effort to evaluate the effect of pyoderma on circulating iodothyronines, plasma triiodothyronine (T3) and thyroxine (T4) values were determined before and after thyroid stimulating hormone administration in 25 dogs with pyoderma and in 15 controls. Basal T4 values were increased in dogs with pyoderma, but neither stimulated T4 nor T3 values were altered by this condition. On the basis of low values for circulating iodothyronines, hypothyroidism was suspected in 3 dogs in the pyoderma group. The dog with the most involved lesions had extremely low T3 and T4 values as well as an autoimmune disease. It was concluded that most dogs with pyoderma do not have thyroid dysfunction.     

Efficacy of once-daily clindamycin hydrochloride in the treatment of superficial bacterial pyoderma in dogs.

Twenty-one dogs with canine superficial bacterial pyoderma were treated with clindamycin at a dosage of approximately 11 mg/kg body weight, q 24 hours, given orally for 14 to 42 days. All dogs were reexamined on days 14, 28, and, if necessary, 42 and given a clinical score of excellent (i.e., complete remission), good (i.e., primary lesions resolved but secondary lesions evident), fair (i.e., partial improvement but primary lesions still evident), or poor (i.e., no improvement or worsening of the lesions). A clinical score of excellent was obtained in 71.4% (15/21) of the dogs in this study within 14 to 28 days.     

Clinical efficacy and safety of cefovecin in the treatment of canine pyoderma and wound infections

OBJECTIVES: To determine the efficacy and safety of cefovecin in the treatment of bacterial skin infections in dogs. METHOD: Dogs with superficial or deep pyoderma or wounds/abscesses were enrolled in three separate studies. Dogs (354) were randomised to treatment and received either cefovecin administered by subcutaneous injection at 14 day intervals, as clinically necessary, or amoxicillin/clavulanic acid as oral tablets twice daily for 14 days. Courses of treatment were repeated at 14 day intervals up to a total of four courses. Clinicians responsible for assessing lesions were masked to treatment allocation. Only animals where the presence of a pretreatment bacterial pathogen was confirmed were included in the analysis of efficacy. Cases were evaluated for clinical efficacy at 28 days after initiation of the final course of treatment. Clinical efficacy was assessed by scoring the clinical signs typical of skin infections. RESULTS: Cefovecin demonstrated statistical non-inferiority compared with amoxicillin/clavulanic acid for all three clinical diagnoses; for cefovecin, up to 96.9 per cent efficacy was observed versus 92.5 per cent for amoxicillin/clavulanic acid. CLINICAL SIGNIFICANCE: Cefovecin was shown to be as effective as amoxicillin/clavulanic acid administered orally in the treatment of bacterial skin infections in dogs. Cefovecin offers the additional benefit of eliminating owner non-compliance.