Veterinary Medicine - November 2008 - (Page PD6)

UPDATE ON TREATING CANINE STAPHYLOCOCCAL SKIN INFECTIONS Douglas J. DeBoer, DVM, DACVD School of Veterinary Medicine • University of Wisconsin-Madison • Madison, Wis. Patients with staphylococcal skin infections are seen every day in small-animal general practice. However, recent developments in treatment options, along with concerns about emerging antibiotic resistance, are changing the way we diagnose and treat these conditions. These six key points highlight the current principles and practices: Treating a staphylococcal infection is not enough. It is critical to search for the underlying cause of the infection and treat or prevent it. Coagulase-positive staphylococci are normal organisms on canine and feline skin. Infection occurs only in the presence of an underlying cause. It’s important to explain to clients that the staphylococcal infection is not something that their pet contracted from the environment or another animal. Some physiologic or microenvironmental change had to occur in the skin to allow colonization and infection. Thus, particularly in the case of recurrent infections, it is critical to search for this underlying cause and treat or prevent it. The choice of systemic antibiotic treatment is based on considerations of efficacy, safety, cost, and client compliance. Based on all these factors, veterinary dermatologists generally consider cephalosporins the antibiotics of choice for staphylococcal skin infections (Table 1, page 7). These drugs combine high efﬁcacy and safety with reasonable cost and relatively infrequent development of resistance. Other classes of antibiotics (e.g., macrolides, lincosamides, potentiated sulfa drugs) are generally associated with resistance rates of 10% to 30%, and resistance can develop rather rapidly with repeated use. Fluoroquinolone antibiotics, though effective against many staphylococcal infections, should be reserved for more unusual situations, such as Pseudomonas infections or organisms resistant to other drugs. Interestingly, chloramphenicol is making a comeback as an antibiotic useful for highly resistant strains of Staphylococcus. Because this antibiotic is, in my opinion, one of our last remaining hopes for some infections, it should never be used unless it is clear that no alternative exists, as documented by culture and susceptibility testing. Staphylococcal skin infections should be treated for at least one to two weeks past clinical resolution of the lesions. Some practitioners advocate prolonged, continuous, or pulse treatment schedules for patients with recurrent infections, but their advisability has been questioned recently. Generally, visible lesions of staphylococcal infection disappear before the infection is fully cured. Superﬁcial infections are usually treated for three to six weeks, depending on severity and patient response. Deeper infections (e.g., fur uncles, deeper abscesses, draining tracts) usually require much longer treatment—six to 12 weeks is common. Because of these rather long treatment durations, clients may become weary of administering oral medications, particularly those that must be administered several times daily (usually in addition to multiple other recommended treatments such as shampoos and topicals). 6 PRACTICAL DERMATOLOGY FOR THE BUSY PRACTITIONER

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Veterinary Medicine - November 2008 Contents Leading Off Editors' Guest Just Ask the Expert Letters Practice Makes Perfect Clinical Exposures Practice Matters Idea Exchange Author Guidelines A Challenging Case: Esophageal Leiomyoma in a Dog Osteoarthritis in Cats: What We Now Know About Recognition and Treatment Product Preview CE Form/Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - November 2008

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