Module 3: Healthcare practices for common medical conditions in shelters
Best Practice Treatments for Skin Bacterial Infections
What about treatment of bacterial infections of the skin, wounds, and abscesses? What are the recommended antibiotics? Which are best for use in shelters based on efficacy, cost and frequency of administration?
According to the ASV Guidelines, “Antibiotic selection and dosing should be specific to the infection and animal being treated, and when possible, based on appropriate diagnostics. Shelters should follow published guidelines for antimicrobial use in companion animals.”
Veterinarians, whether in private practice or shelters, have a responsibility for antimicrobial stewardship. Veterinarians should practice judicious selection of antibiotics using evidence-based guidelines for those that are most effective for common bacterial infections. Such stewardship protects the availability of effective antibiotics for animals and people by decreasing risk for antibiotic resistance and protects the patient from unnecessary adverse reactions. The major driver of antibiotic resistance is widespread antibiotic use, including appropriate and inappropriate use.
The AVMA has published a position statement on judicious use of antimicrobials and a policy to guide antimicrobial stewardship. The AVMA has also provided “do’s and don’ts” for antibiotic therapy of dogs and cats.
The core elements of antibiotic stewardship are
- Select the most narrow-spectrum antibiotic that is effective
- Administer the antibiotic at recommended optimal doses and duration
- Refer to published guidelines for antibiotic use
- Do not prescribe antibiotics if unnecessary for resolving the medical condition. Antibiotics should not be prescribed on a “just in case” basis.
- Perform culture/sensitivity testing before switching or combining antibiotics for perceived treatment failures
- Conduct other diagnostic tests to rule out nonbacterial causes before switching or combining antibiotics for perceived treatment failures
The International Society for Companion Animal Infectious Diseases (ISCAID) published guidelines for diagnosis and treatment of bacterial skin infections in dogs caused by Staphylococcus pseudointermedius, the most common pyoderma in dogs and a common condition in shelter dogs.
Key Takeaways for ISCAID Guidelines for Treatment of Skin Bacterial Infections in Dogs
- Diagnosis based on clinical signs and rapid low-tech cytology to confirm cocci and neutrophils
- Papules, pustules, crusts, epidermal collarettes, patchy alopecia, erythema
- Scotch tape prep for dry lesions – press sticky side of tape on lesions, then press this side onto a drop of methylen blue on a glass slide
- Impression smear for greasy/moist lesions – rub surface of slide on lesions and stain with Diff Quik or methylene blue or Gram stain
- Select a recommended “first tier” antibiotic for empirical treatment
- Cephalexin 30 mg/kg PO BID
- Cefpodoxime (Simplicef) 5-10 mg/kg PO SID
- Amoxicillin–clavulanate (Clavamox, Clavacillin) 12.5 mg/kg PO BID
- Clindamycin 5.5-10 mg/kg PO BID
- Cefovecin (Convenia) 8 mg/kg SQ every 2 weeks
- Treat for 2-3 weeks or 7 days beyond resolution of clinical signs. Most cases should resolve in this time frame.
- Treatment failure
- Clinical signs persist beyond 3 weeks of first tier antibiotic treatment or disease progresses
- Must perform a bacterial culture and sensitivity test on samples from pustules, crust, epidermal collarettes
- Do not switch antibiotics or combine antibiotics without the culture/sensitivity testing!
- Select a recommended “second tier” antibiotic pending culture/sensitivity test results
- Doxycycline or minocycline 10 mg/kg PO SID
- Enrofloxacin 5–20 mg/kg PO SID
- Marbofloxacin 2.75–5.5 mg/kg PO SID
- Orbifloxacin 7.5 mg/kg PO SID
- Ciprofloxacin 25 mg/kg PO SID
- Pradofloxacin 3 mg/kg PO SID
- Treat for 3 weeks or 7 days beyond resolution of clinical signs.
Recommended antibiotics for empirical treatment of pyoderma, wounds and abscesses in dogs:
- Cephalexin 30 mg/kg PO BID
- Cefpodoxime (Simplicef) 5-10 mg/kg PO SID
- Amoxicillin–clavulanate (Clavamox, Clavacillin) 12.5 mg/kg PO BID
- Clindamycin 5.5-10 mg/kg PO BID
- Cefovecin (Convenia) 8 mg/kg SQ every 2 weeks
Recommended antibiotics for empirical treatment of pyoderma, wounds and abscesses in cats:
- Cephalexin 30 mg/kg PO BID
- Amoxicillin–clavulanate (Clavamox, Clavacillin) 12.5 mg/kg PO BID
- Clindamycin 5.5-10 mg/kg PO BID
- Cefovecin (Convenia) 8 mg/kg SQ every 2 weeks
Note that most of the recommended antibiotics for empirical treatment of pyoderma, wounds, and abscesses in dogs and cats require twice daily administration. For many shelters, this is a real challenge for staff tasked with many other responsibilities, resulting in low compliance and inappropriate time intervals between doses. In addition, some cats are not amenable to oral medications, especially twice daily, and become very stressed with the frequent handling. For these reasons, it is more practical and feasible to select an antibiotic that can be given once daily or an injectable antibiotic that provides 2 weeks of coverage.
For shelter dogs, cefpodoxime (Simplicef) is the only first tier antibiotic that can be given orally once daily for at least 14 days. For shelter cats, there is no oral antibiotic that can be given once daily – an injection of cefovecin (Convenia) may be the best option for cats.
Every shelter must weigh costs, ease and reliability of administration, and staff time when choosing their first line antibiotic choice for empirical treatment of dogs and cats with pyoderma, wounds, and abscesses. The principles of antibiotic stewardship must also be considered when choosing and using antibiotics in the shelter.
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