Antiseptic cream/ointment/gel choice for pyoderma

Re: Antiseptic cream/ointment/gel choice for pyoderma

Martin Atkinson — Tue, 29 Jul 2014 19:17:47 GMT

[quote user="John Flynn"]

What active ingredients / brand do folks use as topical antiseptic of choice for canine superficial pyoderma?

[/quote]You have to question whether it should be treated at all but if the animal is symptomatic, if there are persistent focal active spots after bathing in chlorhexidine, I use Mupirocin ointment (Bactroban). This was recommended by a veterinary dermatologist (forget who) works well. Also make sure there's not some malassezia in there as well in which case Malaseb shampoo.

Re: Antiseptic cream/ointment/gel choice for pyoderma

Neil Wheadon — Mon, 28 Jul 2014 22:26:34 GMT

Apologies for double posting. Ipads mean 2 seperate points mash into eachother. I have NEVER used a buster collar for a hot spot. Again personal experience in that if you can't itch it, it's murder and I know this is strong language but I think it's almost cruel, how would you like it? Hot spots clear very quickly with a few days fuciderm after clipping and cleaning. If he dog is uncomfortable a barrier simply isn't the right thing to do is it? Neil

Re: Antiseptic cream/ointment/gel choice for pyoderma

Neil Wheadon — Mon, 28 Jul 2014 22:21:56 GMT

John makes a good point Superficial pyoderma - Fuciderm Pustules to me means deeper pyoderma and so antibiotics (cephalexin) and a short course of steroids, maybe to take the itch away. However his observation of antibiotic resistance is a good one. Why has potentiated sulphonamides gone out of vogue. 20 years ago these were the first line, yes the occasional dog went lame but if you warn the owner and better than using broad spectrums routinely? Neil

Re: Antiseptic cream/ointment/gel choice for pyoderma

John Flynn — Mon, 28 Jul 2014 21:02:27 GMT

I think a lot of these descriptions would fall under what I would call a "surface" pyoderma.

I was wondering more about focal areas of what I would call "superficial" folliculitis - with papules and pustules and epidermal collarettes?

As an aside, here's an (old) abstract outlining some of the concerns with widespread topical use of fusidic acid and highlighting concerns re the developemnt of resistance to this important systemic anti-staphylococcal antimicrobial:

Clin Infect Dis. 2006 Feb 1;42(3):394-400. Epub 2005 Dec 15.

Dumb and dumber--the potential waste of a useful antistaphylococcal agent: emerging fusidic acid resistance in Staphylococcus aureus.

Howden BP1, Grayson ML.

Author information

Abstract

Fusidic acid has activity against a range of pathogens but has mainly been used to treat staphylococcal infections. Fusidic acid monotherapy, especially topical preparations, has been strongly associated with the emergence of fusidic acid resistance among both methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible S. aureus. Key resistance determinants include mutations in the fusA gene, which encodes elongation factor G, and plasmid-mediated resistance (i.e., acquisition of resistance gene fusB). Clonal outbreaks of fusidic acid-resistant S. aureus have been noted throughout the United Kingdom and Europe, such that the efficacy of fusidic acid is threatened. Fusidic acid in combination with other agents, such as rifampicin, has proven effective for difficult-to-treat MRSA infections and provides a convenient oral alternative to oxazolidinones. Ensuring that systemic fusidic acid is always used in combination and that the use of topical fusidic acid is either abolished or restricted will be vital if we are to prevent the loss of this potentially useful agent.

Re: Antiseptic cream/ointment/gel choice for pyoderma

Glenn Hodgson — Mon, 28 Jul 2014 20:33:17 GMT

Fuciderm in the main. Not shy of some preds/voren to make the sad/pruritic dogs happy again.

I also advocate removing the scabby bits to let "the air" in to do its stuff. I often dispense surgical swabs and chlorhex for this.

Re: Antiseptic cream/ointment/gel choice for pyoderma

Sammy82 — Mon, 28 Jul 2014 19:53:20 GMT

Usually I use a combination of antiseptic and AB ointment. I clip the matted fur with scissors and show the owner how to wash the area twice daily with diluted Hibiscrub, dry with paper towels and apply ointment (usually Fuciderm or Surolan). A head collar is a must, and if the dog is very itchy I give a shot of voren or short course (1 week, then phase out 2nd week) oral preds.

If the pyoderma is widespread, deep or not clearing up with the above treatment in about 1 week I give at least 2 weeks of oral Amox+Clav too.

(Fuciderm is amazing for cat scratches)

Re: Antiseptic cream/ointment/gel choice for pyoderma

Anthony Todd — Mon, 28 Jul 2014 19:30:10 GMT

[quote user="Neil Wheadon"]but it's the itch that drives dogs nuts. Neil[/quote]

Re: Antiseptic cream/ointment/gel choice for pyoderma

Neil Wheadon — Sun, 27 Jul 2014 22:50:40 GMT

I was referred about 10 years ago for an area on my arm that consistently came up red and itchy annually and it was diagnosed as an allergic reaction by a certified dermatologist. It was maddening, it itched like crazy and looked like superficial pyoderma. I scrubbed it with chlorhexadine - nothing, however apply a spot of fuciderm and wow the itch went within about 30 seconds, and I stopped tearing that area apart. I always use Fuciderm in superficial pyoderma / hot spots as yes chlorhexadine may kill the bugs but it's the itch that drives dogs nuts. Neil

Re: Antiseptic cream/ointment/gel choice for pyoderma

Yantha Smyth — Sun, 27 Jul 2014 21:48:53 GMT

The Vetruus chlorexyderm spot gel is a good topical antiseptic gel, and is steroid free which I think is an advantage in some cases. Re the cascade I doubt fuciderm is the only option, as there are plenty of chlorhexidine based shampoos and solutions/sprays that are indicated for use in pyoderma also.

Re: Antiseptic cream/ointment/gel choice for pyoderma

Anthony Todd — Sun, 27 Jul 2014 21:36:53 GMT

[quote user="robloxley"]

Chlorhexidine

[/quote]

I always found anything done or applied topically usually just added to the irritation and was licked off which often was the start of the pyoderma anyway [unless you used the restraining Elizabethan collar]......

Systemic treatment was totally tolerated and usually gave quicker and obvious relief in 24 hours. Clean it up then if you want or need.

Re: Antiseptic cream/ointment/gel choice for pyoderma

John Flynn — Sun, 27 Jul 2014 14:27:22 GMT

[quote user="Michael Woodhouse"]As Fuciderm is licensed how are you justifying an off licence choice - or is there something I am missing?[/quote]

Just looking for any recommendations from folks on alternatives to what I currently use - I'm not a good source of info on UK regulations on medicines choices or looking for the thread to descend into an exhausting debate on these. As this seems to come up on a lot of threads on clinical matters, I do wonder if it would be worth having a single point of reference for discussions of UK medicines legislation?

That said, I personally don't routinely reach for important antibiotics in resistant human infections such as fusidic acid without very good reason. I wouldn't consider first-line treatment of canine superficial bacterial folliculitis (a very common presentation) to be a good reason. I don't know if that answers your question.

Re: Antiseptic cream/ointment/gel choice for pyoderma

John Flynn — Sun, 27 Jul 2014 14:27:22 GMT

[quote user="Michael Woodhouse"]As Fuciderm is licensed how are you justifying an off licence choice - or is there something I am missing?[/quote]

Re: Antiseptic cream/ointment/gel choice for pyoderma

Kishor Mahind — Sun, 27 Jul 2014 14:23:01 GMT

I tend to use Fuciderm after cleaning with chlorhexidine.

Also in very severely matted and moist lesions I sedate the dog to clip and clean the wound thoroughly first.

Re: Antiseptic cream/ointment/gel choice for pyoderma

Michael Woodhouse — Sun, 27 Jul 2014 14:08:14 GMT

As Fuciderm is licensed how are you justifying an off licence choice - or is there something I am missing?

Re: Antiseptic cream/ointment/gel choice for pyoderma

John Flynn — Sun, 27 Jul 2014 08:06:43 GMT

[quote user="robloxley"]Chlorhexidine[/quote]

Thanks.

What concentration?

Do you have a preferred chlorhexidine-"product" for this application?

Re: Antiseptic cream/ointment/gel choice for pyoderma

Rob Loxley — Sun, 27 Jul 2014 00:57:57 GMT

Chlorhexidine