In: Dermatology for the Small Animal Practitioner, Mueller R.S. (Ed.).

Publisher: Teton NewMedia, Jackson, WY, USA (www.tetonnm.com/). Internet Publisher: International Veterinary Information Service, Ithaca NY (www.ivis.org), Last updated: 27-Mar-2007; A3718.0307 Treatment of Bacterial Infection R. S. Mueller Department of Clinical Sciences Coll. of Veterinary Medicine & Biomedical Sciences, Colorado State University, Fort Collins, CO, USA. Treatment of Bacterial Infection Antibiotics are frequently used in veterinary dermatology, because many conditions are associated with secondary bacterial infection. Dogs with chronic allergies, immune-mediated dermatoses, or endocrinopathies frequently develop secondary pyodermas that exacerbate these conditions and necessitate antibacterial treatment (Table 3-2). Not all available antibiotics are useful for skin infections so that spectrum of activity as well as pharmacology of the different antibacterial drugs has to be considered. The overwhelming majority of skin infections in the dog and cat is caused by Staphylococcus intermedius. Mixed infections can involve organisms such as Escherichia coli or Pseudomonas aeruginosa, which usually develop concurrently with most patients' primary agent, S. intermedius. Proper dosage and proper duration are important for the success of antibacterial therapy. Antibiotics should be given for at least 3 weeks or longer or until at least 1 week after resolution of clinical signs. Relapses are common in patients on short courses of pharmacotherapy or those receiving medications at low dosages! Deep infections may take 6 to 12 weeks to resolve. Pyodermas can, at least initially, be treated empirically. If appropriate therapy does not resolve the condition, taking a culture is indicated (view). Each sample for culture and sensitivity should be accompanied by cytologic examination and culture results interpreted in light of the cytology, as growth of different microorganisms does not indicate necessarily that they are present in significant numbers in vivo. Table 3-2. Selected Antibiotics in Small Animal Dermatology Dog Dose (D) Cat Dose (C)

Drug

Formulation Comments

Adverse Effects

Indications

Trimethoprim/ 5/25 mg and sulfamethoxaz 20/100 mg ole coated tablets, 40 mg/ 200 mg, 80 mg/400 mg, and 160 mg/800 mg

Not for Doberman Pinschers. Resistance pattern varies, low in England and the United States, high in Australia

Keratoconjunctivitis Infections with 15-30 mg/kg sicca, drug reactions gram-positive q 12 h (D,C) (cutaneous bacteria. Many eruptions, gram-negative polyarthritis, bone organisms of the marrow suppression), family hepatotoxic, Enterobacteriaceae gastrointestinal are Pseudomonas

Table 3-2. Selected Antibiotics in Small Animal Dermatology Dog Dose (D) Cat Dose (C)

Drug

Formulation Comments

Adverse Effects

Indications

tablets, 8 mg/40 mg/ml syrup

symptoms, fever, aeruginosa also hypothyroidism with susceptible (but extended use not) Keratoconjunctivitis Infections with sicca, drug reactions gram-positive (cutaneous bacteria. Many eruptions, gram-negative polyarthritis, bone organisms of the 15-30 mg/kg marrow suppression), family q 12 h (D, C) hepatotoxic, Enterobacteriaceae gastrointestinal are also susceptible symptoms, fever, (but not hypothyroidism with Pseudomonas extended use aeruginosa)

Not for Doberman Pinschers. 180 mg/820 Resistance pattern Trimethoprim/ mg tablets, 9 varies, low in sulfadiazine mg/41 mg/ml England and the syrup United States, high in Australia

Erythromycin

250 mg and 500 mg tablets, 500 mg coated tablets, 20 mg/ml, 40 mg/ml, 80 mg/ml, 120 mg/ml syrup

Give without food. Inexpensive! Resistance develops relatively quickly. Do Vomiting, diarrhea, not administer nausea concurrently with terfenadine, cyclosporine, or ketaconazole

15 mg/kg Bacterial superficial q 8 h without pyoderma food (D,C)

Lincomycin

200 and 500 mg tablets, 500 mg capsules

Give without food. Contraindicated in rabbits, hamsters, and guinea pigs!

Vomiting, diarrhea (less common than with erythromycin)

Infections with most gram-positive cocci 20-30 mg/kg including q 12 h Staphylococci without food Nocardia and (D, C) Actinomyces may also be susceptible Infections with Actinomyces, most spirochetes and gram-positive and 10 mg/kg gram-negative q 6-8 h (D, C) cocci, which do not produce penicillinase Most organisms that 10-20 mg/kg cause skin disease q 8 h (D, C) are resistant to ampicillin and amoxycillin, thus it

Penicillin V

125, 250, 500 mg tablets, 25 mg/ml and 50 mg/ml oral suspension 500 mg, 750 mg, 1000 mg tablets, 50 mg/ml syrup

Not commonly used in dermatology because most strains of Staphylococcus intermedius strains are resistant to penicillin

Gastrointestinal signs with oral administration, hypersensitivity reactions

Amoxycillin

Not commonly used Vomiting, diarrhea, in dermatology allergic reactions because most Staphylococcus intermedius strains

Table 3-2. Selected Antibiotics in Small Animal Dermatology Dog Dose (D) Cat Dose (C)

Drug

Formulation Comments

Adverse Effects

Indications

are resistant to amoxycillin In vitro resistance of Staphylococci 12.5/50 mg, extremely low, but 62.5/250 mg, sensitivity in vitro Clavulanic 125/500 mg not always Vomiting, diarrhea, acid/amoxycilli tablets, correlating with allergic reactions n 12.5/50 mg results in vivo. May syrup be more efficacious with q 8 h administration 250 mg and 500 mg Effective against Vomiting, diarrhea, capsules, 25 most gram-positive allergic reactions mg/ml cocci solution 500 mg, 1000 mg tablets, 250 mg, 500 mg Used commonly in capsules, 75 veterinary mg, 300 mg, dermatology 600 mg tablets, 50 mg/ml syrup 1000 mg tablets, 50 mg/ml syrup

is rarely indicated

12.5-25 mg/kg Bacterial pyoderma q 8-12h (D, C)

Cloxacillin

Pyoderma caused by sensitive cocci

20-40 mg/kg q 8h (D, C)

Cephalexin

Vomiting and diarrhea; very rarely Superficial and excitability, deep bacterial tachypnea or blood pyodermas dyscrasias

20-30 mg/kg q 8-12h (D, C)

Cefadroxil

Vomiting and Superficial and diarrhea, very rarely deep bacterial tachypnea or blood pyodermas dyscrasias

20-30 mg/kg q 8-12 h (D, C) 250-500 mg/animal q 8 h (in combination with niacinamide at 250-500 mg/animal q 8 h) (D, C)

Tetracycline

Should not be given with amphotericin B or erythromycin. In 250 mg, 500 veterinary mg capsules dermatology used for immunomodulatory effects

In combination with Nausea, vomiting, niacinamid used for discoloration of teeth the treatment of in puppies and discoid lupus kittens, phototoxic erythematosus, reactions, idiopathic hepatotoxicity onychomadesis

Doxycyline

50 mg, 100 Also used for effects Nausea, vomiting, Bacterial superficial 2.5-5 mg/kg mg, 200 mg on cells of the discoloration of teeth pyoderma, q 24 h (if capsules, 100 immune system and in puppies and mycobacterial used for

Table 3-2. Selected Antibiotics in Small Animal Dermatology Dog Dose (D) Cat Dose (C) immunemediated diseases, it is combined with niacinamide at 250-500 mg/animal q 8h) (D, C)

Drug

Formulation Comments

Adverse Effects

Indications

mg/ml paste, 1 mg/ml, 5 kittens; phototoxic cytokine production mg/ml reactions suspension

infections, discoid lupus erythematosus

Clindamycin

75 mg, 150 mg, 300 mg capsules

Bacterial superficial pyoderma, Skin rashes, mycobacterial vomiting, diarrhea infections, discoid lupus erythematosus Cartilage erosions in puppies, vomiting and diarrhea. Hypersensitivities and CNS signs could potentially occur. Crystalluria may occur in dehydrated animals

Infections with gram-positive cocci, 5-10 mg most anaerobic mg/kg q 12h organisms, (D, C) Nocardia, Actinomyces

Enrofloxacin

Not in immature 5.7 mg, 22.7 animals! Ineffective mg, 50 mg, against anaerobic 68 mg, 136 organisms. mg, 150 mg Resistance may tablets occur, particularly to Pseudomonas

Infections with staphylococci, mycobacteria, most gram-negative organisms

5-20 mg/kg q 24 h (D) 5 mg/kg q 24 h (C)

Ciprofloxacin

Cartilage erosions in puppies; vomiting 100 mg, 250 Ineffective against and diarrhea. mg , 500 mg, anaerobe organisms. Hypersensitivities 750 mg Resistance may and CNS signs could coated occur, particularly to potentially occur. tablets Pseudomonas Crystalluria may occur in dehydrated animals Not in immature animals! Ineffective against anaerobe organisms. Resistance may occur, particularly to Pseudomonas Cartilage erosions in puppies, vomiting and diarrhea. Hypersensitivities and CNS signs could potentially occur -

Infections with staphylococci, 5-15 mg/kg q mycobacteria, most 12 h (D, C) gram-negative organisms

25-mg, 50mg, 100-mg, 200-mg Marbofloxacin scored coated tablets Mupirocin

Infections with staphylococci, mycobacteria, most gram-negative organisms

2.5-5 mg/kg q 24 h without food (D, C)

2% ointment Effective against gram-positive organisms,

Localized superficial Apply to bacterial infections, affected areas q 12 h,

Table 3-2. Selected Antibiotics in Small Animal Dermatology Dog Dose (D) Cat Dose (C) prevent animal from licking area for 10 minutes (D, C)

Drug

Formulation Comments

Adverse Effects

Indications

particularly Staphylococci

feline acne