Difficult pyoderma

RE: Difficult pyoderma

Stephen Shaw — Wed, 02 Sep 2015 17:56:04 GMT

RE: After 3-4 wks of antibiotics I spotted some new pustules which I cultured. This came back as coagulase-negative staphylococcus (MRS) with a more limited choice of antibiotics, one of which was enrofloxacin which I started at 5mg/kg.

You may need to consider your dose of antibiotic and use enrofloxacin at 10mg /kg, but you need more than one string to your bow when treating MRS and topical treatments, and principally daily chlorhexidine baths, if possible combined with chlorhexidine or alcoholic wipes are essential. Sometimes doing the baths at the clinic is the only way. If you are not careful you will run out of suitable veterinary antibiotics before too long.

With regard to the IDAT, do you test for cockroach in Hong Kong? - that might be relevant. There are few papers written about allergen-distribution in Asia, but there are data from Thailand and from Japan which may have limited relevance.

Chanthick, C., S. Anaman and K. Buathet (2008). "The prevalence of positive intradermal allergy tests in 114 dogs with atopic dermatitis in the Bangkok metropolis, Thailand." Vet Immunol Immunopathol 126(3-4): 256-262.

Masuda, K., M. Sakaguchi, S. Fujiwara, K. Kurata, K. Yamashita, T. Odagiri, Y. Nakao, N. Matsuki, K. Ono, T. Watari, A. Hasegawa and H. Tsujimoto (2000). "Positive reactions to common allergens in 42 atopic dogs in Japan." Vet Immunol Immunopathol 73(2): 193-204.

Moving forward, you might want to consider using Atopica (ciclosporin) as this will be less likely to encourage recurrent bacterial infection compared to prednisolone

HTH S.

RE: Difficult pyoderma

Anthony Todd — Wed, 02 Sep 2015 09:41:23 GMT

[quote user="Kara Gibson"] I already have to dog on 5mg EOD prednisolone .[/quote]

With respect that's not much of a dose for that dog and, IMHO, continuous steroids, unless at high doses, which we don't want to do, never works anywhere near as well as a single high enough dose repeated as necessary.

Also, with a continuous steroid regime, you don't know whether your elimination program is having any effect or it's just the dreaded 'roids.

I would suggest at least 1mg/lb as necessary and reduce the dose rate if that dose gives good relief.

I wouldn't be surprised if the skin infection went away once the insulted skin got better.

RE: Difficult pyoderma

Kara Gibson — Tue, 01 Sep 2015 02:31:08 GMT

Thank you for all your suggestions, they've given me a lot to think about. I already have to dog on 5mg EOD prednisolone and surprisingly currently he is not very itchy but I'm really struggling to get rid of this MRS infection. The latest (now third) culture and sensitivity has come back as sensitive to enrofloxacin but he has now been on this for 4 weeks and the response is insufficient.

I have been trying to get the dog to a point where I would be happy to start atopica (unfortunately we do not have apoquel available here) but I do not want to start it whilst we have a multi-resistant infection ongoing.

RE: Difficult pyoderma

Nicola Lawlor — Mon, 31 Aug 2015 12:09:20 GMT

Agree with all the above suggestions and especially about the compliance being a huge factor here. To throw another consideration into the mix, do you have access to atopica (cyclosporine) perhaps or apoquel (can't remember the generic name) both of which can help considerably for atopic dogs. It may just be that the owners would medicate daily with better compliance when they will not bath the dog or adhere to diets well because they take more effort.

RE: Difficult pyoderma

Lindsey Edwards — Sat, 29 Aug 2015 20:44:39 GMT

Would you have better compliance with a different method of topical meds? Vetericyn spray or medicated wipes such as malacetic in between shampoos to reduce burden of infection?

RE: Difficult pyoderma

Virginia Campbell — Thu, 27 Aug 2015 22:28:40 GMT

Agree compliance probably main issue. Perhaps there are cultural differences and you have to be even blunter and bossier than you would be with similar UK clients? I worked in Auckland for a while in a teaching practice that had quite a few chinese trainee nurses and also some chinese clients. We had one set of clients in whose English wasn't great, can't remember what for, some chronic medical thing where compliance was important. The vet called a nurse in to translate. The vet was gently explaining things and it got translated into a loud and vigorous torrent of chinese with what seemed like brutal stabbing emphasis at various points. I don't know what she said but the clients left like meek little lambs and tgereafter fed exactly the correct number of kibbles etc, probably would've painted the dog blue if instructed. On pain of death of the dog or themselves, who knows? Perhaps this was unusual but it may be worth enlisting a native vet or nurse to discuss bathing and food. If owner finds bathing too icky/ couldn't be bothered/ darling Fido doesn't like it, but owner is minted, you could get her to pay your nurses or dog groomer to bathe it 3 times a week. If it is hypersensitive to Staph (did your allergy panel include this?) then bathing is going to do the most to reduce allergen load. Staph lysate injections worth investigating too. Freezing the food apparently helps to kill some of the storage mites and also Indorex (or similar) the house to reduce dust mites. I've seen clients replace carpets with wooden floors for the sake of atopic dogs too! Her tough luck that she chose a fashionable but mega atopy prone breed. I've seen a couple of horrendously atopic Frenchies.

RE: Difficult pyoderma

Anthony Todd — Thu, 27 Aug 2015 16:52:44 GMT

I'd rather think of the dog and put it on adequate intermittent pred. whilst you explore the possibilities of elimination of cause.

Chances of relief with the history etc. you've quoted is, frankly, near nil.

Key thing, where most modvets go wrong, is to use it intermittently to effect, single adequate dose repeat as necessary. You'll find you get relief for up to a week, sometimes much longer, as exposure may be seasonal and/or intermittent.

You can continue to use elimination diets etc and check for fleas etc. concurrently.

Owners are more responsive when their animal is happy!

Before I get another red star I'm not suggesting pred on day one and repeats for ever, I'm saying preds for relief whilst the prolonged elimination/testing process goes on, maybe you'll get lucky and find it.

RE: Difficult pyoderma

Martin Atkinson — Thu, 27 Aug 2015 12:33:09 GMT

[quote user="Anthony Dennison"]You're not missing anything - compliance is missing.[/quote]

[quote user="Kara Gibson"]A food trial was unsuccessful, although I suspect it was not strict despite repeated requests.[/quote]

[quote user="Kara Gibson"]This initially responded well to ceporex and oral itraconazole as well as Malseb baths (although I struggle to get the owner to bath him as much as she should).[/quote]

And there is the evidence. I think you need to have words with the client and say that without them fully on board the chances of success are slim. The chances are that it is atopy or a food allergy that is driving this and unless you can control that you will never win. I'm not overly happy using cyclosporine in dogs full stop let alone in cases with uncontrolled pyoderma so what are the chances of getting Apoquel in HK?

However even with the best will I have had one dog that kept getting recurrent pyoderma. In the end, with the advice of a dermatologist, we just kept it on pulse doses of appropriate antibiotic i.e. a week on and a week off. I recall we used oxytetracycline because this also has some immuno-modulatory effect.

Maybe it is Hong Kong Chinese but I have a couple presently with a Shih Tzu that I suspect may be a food allergy but they insist on feeding it human food, not RMB or BARF, Chinese food with MSG and all! I gave then a talk about this last week and they were due back in this morning but they no-showed. I suspect they don't want to listen.

RE: Difficult pyoderma

Anthony Dennison — Thu, 27 Aug 2015 11:21:35 GMT

You're not missing anything - compliance is missing.