Good morning to all. First of all, I would like to say thank you very much to webinar vet to be here today delivering my knowledge and my experience in treating effectively. Bacterial bioderma into dark.
Welcome. Now, until the first few years ago. Or several years ago, we used to treat bacteria pyoderma.
A lot with antibiotics with oral antibiotics. This was our mainstay for very, for many years. The problem started when More than a decade ago, we started to see resistance to staff still intermediate.
We started seeing resistance to the most common antibiotics, belactants. And from there, we had many, many, publications, studies showing us that the stuff to the intermediate, which is the most common, pathogen in dogs bioderma. He, he became multi-resistant to several antibiotics class.
So we had a problem. We had a problem. We need to think how could we over when we go over, over these infections.
How could we treat these infections? And since antibiotics were not the answer anymore or the easy answer. We started to invest in topical treatment.
And in our days, In the and we have very good topical treatments which allow us to treat the bacterial, bacterial bioderma just based on topicals. And this will be the first part of this presentation. We will see how to be successful using topicals.
And then in the second part we'll go through the antibiotics. Bearing in mind it's prudent use. Now, so, today.
And in the last few years, bearing, at least in the last decade. Topical treatment have priority. And when you talk about topical treatment.
We might say basic, if it is generalised by bacterial superficial bioderma, which is the most common feature, or we just do localised treatment. For example, like in the case of a fault. Folks that practise phallic dogs.
We know that they have faults in the face. These faults can be easily become inflamed, as I explained in the first presentation, they might become inflamed. And they might be a source of pruritus for the, for the patient and the source of B and because the fault allows a microenvironment.
That allows proliferation, allows the microenvirons of humidity for proliferation of bacteria. Now, we also have, speaking about bacterial proliferation, we have another condition which is called bacterial overgrowth. And bacterial overgrowth, it's thoroughly described in the first presentation, how to diagnose it.
But here, in summary, we can see an armpit of a patient which we can treat topically. This patient cells erythema. Shapia and alopecia.
He's critic. He has an underlying problem which is opic dermatitis, but he still needs treatment, topical treatment for his bacterial overgrowth on the skin due to the this biosis. Now look at this one.
This one has a generalised superficial bacterial bioderma. This one here. Might be the patient that we need to bathe.
He has several lesions. So it's easier to bathe, but topical treatment, it's still his is still a priority in his treatment. Now, how to choose the topical treatment?
First, we need to look at our patients, look at the owners, talk to the owner. And see if the owner has the ability to apply the topical treatment because it depends. It depends on the size of the patient.
Of course it's much easier to bathe a smaller dog compared to a big dog. Look at the animal behaviour, asked the owner. Does he likes to be bathed, or is that a big problem?
Look at his coat density. If the coat is very thick, very long. It's advised to clip the hair.
No it ecliptic the hair allows a better contact of the topical treatment with the skin. The other good thing, the other good part, advantage is that it is much easier. To apply the topical treatment and to maintain the skin clean.
It is also easier to bathe a dog that has a short hair coat. Now speaking about bath bathing and especially for big dogs, does the owner has the facilities to do it at home. You might want to need to ask this.
Sometimes it is necessary to have the patient based, for example, in the, in the clinic or in the special in the place for grooming facilities. Now, it's also important to know which are the advantages of using topical treatments. It has been shown that it allows a faster resolution of the infection.
With along with the faster resolution. It's a reduction in the amphibiotherapy if we are using ahiio therapy at the same time. Now, it is also much easier to remove all the microorganisms and organic debris from the skin surface.
It is necessary, in fact. It is also the other good thing about topical therapy is that he has, it has minimal side effects. Resistant to antiseptic products is very rare.
And in fact, antiseptic products in the topicals are the priority compared to topical antibiotics. Because of this reason and it's very rare because it's difficult for the bacteria to get resistant to topical products. Normally, the topical products, the antiseptics that we use, have a bactericidal effect against tay intermediate.
So Which are the sin skin disinfectants for bacterial bioderma. Number one, we have chloroxetine. Chl chloroetine, it's our molecule of choice.
And chloroxidine can be used from 0.4 0.5.
Percentage of dilution up to 4% in shampoos, for example. So chloroxidine has been shown in in in this dilution range that is effective, killing stuff so intermediates. And the good part about chloroxidine is that it is a wild world.
It is wild it is available in wild world. Another potential skin disinfectant that I'm going to talk in detail, it's hypochlorose acid. Hypochloric acid, used for skin, for skin treatment, is becoming popular in certain areas of the world.
Another skin disinfectant is benzoyl peroxide. Benzoyl peroxide, it's normally used in shampoos on 2.5% dilution.
And it is available worldwide. Finally, we have, I'm going also to talk about of it on iodine in a very specific application. But bearing in mind that depending where you live, there will be very likely other disinfectants in the market.
Now, the message that I always like to. Share here is that when you have a new skin disinfectant available, make sure that you know that you know the studies, make sure that he's been tested for staff still intermediate, number one, and if in the lab, and if possible, try always to, to check if it has been clinical trials with that disinfectant. OK, going to our first one, which is chloroxidine.
Chloroxidine has you know has anti a rapid antibacterial effect against stuff pseudintermediate, or either sensitive to the antibiotics, susceptible to the antibiotics, or either resistant. So it doesn't really matter, the resistant profile of the stat to intermediates because it will get killed with chloroxidine. And the other skin disinfectants, in fact.
Now, peroxidine has a residual action for at least 48 hours. Now, it might be ineffective in some strains of pseudomonas. Although, typically, we know that bacterial paradigm is caused by Staphylococcus pseudonremedius, in some rare rare cases, we might have involvement of pseudomonas.
So make sure that always do your cytology. And look for cocci, which will be your staff intermediate, or basilli, which potentially could be pseudomonas. Now, possible side effects of loidine.
Possible side effects, sometimes we have contact dermatitis. And contact dermatitis, it happens sometimes a few days later or weeks later after using the product. It holds me, it always pays pays my attention when the owner says that he is now becoming very red after bathing.
If that happens with the chloroxidine shampoo that the patient has been using, using sometimes for weeks, but now, and everything has been great, but now he's becoming great, mm, I will become, I in this case, I will become concerned if it is developing. I contact dermatitis to the shampoo. So I try to I try to switch to a shampoo that doesn't have chloroxetine, and I discussed with this with the owner.
Now, another potential problem with lorexD is that in higher concentrations, It might delayed healing. So we need to be careful sometimes, especially if there are deep lesions. We, the side effects always depend not only on the concentration that we are using, but also on the contact time.
Now another good thing about chloroxidine is that it's very effective against biofilms, and we know that stopsoreminius has the ability to produce biofilm, protecting himself in colonies with the mu mucopolysacchari protection against antibiotics. No, this is a very very good study and this study, I always like to show this study because this study or two groups of patients were assessed two groups of patients with superficial bioderma. It was a randomised blinded antibiotic control study.
And in this in this study, that lasted. 4 weeks. One group received a loroxidine, a 4% chlorroxidine shampoo twice a week.
A daily chloroidine spray. And the other group of patients received amoxiccycllin clavulanic acid. Every 12 hours.
And also during 4 weeks and the effectiveness was very similar. So this shows that topical treatment, topical treatment, chloroetine can be extremely effective. With a shampoo and then on the shampoo twice a week, and then with daily application of a spray.
No, sometimes spray it's a good option. Ma, so depending on the area of the body. But sometimes discs are very discs or wipes are very, very very useful, very friendly.
For example, discs and wipes are, very good to clean the fault. And this shows, shows this study shows the in vivo efficacy of discs with ovitrium and chloroxidine at 3%. And they are daily pads that were used daily during 2 weeks.
And we and the researchers could see that There was a very good improvement. It is in the number of cocai per oil field, decrease on the number of cocai per oil field per oil field on day 7, so a week later, it has decreased the number of coca, and this decreased we were still very significant, different from day one on when compared to 2 weeks on treatment. So, these discs, this shows these discs with afitrium and chloroxidine are an effective way also to deal with local cutaneous bacterial or malecisium overgrowth.
In vitro efficacy, we offer 3% chloroidine wipes. Has also been shown in a study, and this shows that wipes have a biocidal effect against several bacteria, including staph pseudointermediate, and also malacisia pachydermatis. Which many times, as we know, can come along with along with the bacterial dysbiosis.
Now, this is a study that shows cleansing cleaning wipes with 0.3% chloroxidine, 1% zinc zinc gluconate and 0.5 glimbazole.
And again, this is a pilot study in vitro and shows the antimicrobial activity of this type of wipes against stuff so the intermediate. Now, sprays are fantastic. another way, as we've seen are the wipes, the discs, but I also use, depending on the patient, the phones or also called the mousse.
The muses are easy to spread. It's very good, for example, in dogs that have that have only a few very low hair density on the phanttrum. It's very easy to apply.
And this study here shows that these the moses that show all of them were effective against, against stuff to intermediates. It was an invival trial with healthy dogs that showed that if the dogs had in fact a shorter hair coat, the contract, the contract of the moose was better with the, with the skin. So we have mooses that the mooses we have moose with chlroidine at 2% with et ettosingozine, salicylic acid, chloroxidine at 3%, or chlorozine at 2%.
And this first part shows the effectiveness of chloroxidine. So our first number one antiseptic on the skin. We've seen shampoo, we've seen the the the spray to wipes, the foams.
OK, let's look at another the infectant, which is hypochloro acid. Hypochorosasis, it's a natural microbial agent present in leukocytes. It has been shown, it has a very good bacter residual effect.
And an anti-inflammatory action. Now, the good part about hypochloric acid is that it doesn't prevent healing. So it has, he has been proved to be safe on open wounds, erosions or ulcers.
So we are taught here and out about using deeper lesions. It's available on liquid and spray to use on the skin. Has skin disinfectant for veterinary used in some countries.
Now, there is a also . A new publication about the use of this product has a cleaning solution, even thinking about canine otitis external. The topic here is not canine or external, but it's also shown here.
To be safe, so, OK, so we have a product that Dipochoic acid has a safe, another safe option in the market has a skin disinfectant with its advantage. Now, hypochloric acid. Also can be used around the eyes because 11 sometimes we have patients on with lesions on the face.
And the question is that, what should we used on the flee? What should we, how should we clean around the eyes? Be careful with chloroxidine because chloroxidine is, can be, can induce chemical keratitis, so don't use it around the eyes.
Hypochlorous acid, it's a it's a possibility in plephritis. And this study Suggests that that this product applied onto sterile wipes may represent a valid therapeutic o winged veal blephritis because of the clinical and antimicrobial microbial efficacy. Now another safe option if you don't have hypochlorous acid.
Because not all the countries might have this available, although there is hypocholic acid, a formulation straight for ocular use. You have here another another. Option.
The, the other option is topical cleaning with povion iodine, diluted pofione iodine with your NSAL or ringles like that, just dilute with saline or ringers, and you can dilute 120 and you can clean around the around the eyes. And it's safe. Although it might stain, stain, as we know, a bit with the yellow colour.
OK. We did, we need to do skin disinfection. But It's also very important to think about healing.
And We need to think about the healing process is a main feature. In closing the wounds, closing the lesions. Therefore, increasing the the skin barrier.
No, very most recently. The use of bio fluorescent light for biomodulation. Has been applied in case of superficial pyoderma with effectiveness.
Also deep yoderma, cases of deep yoderma, interdigital fronlosis, full dermatitis, and traumatic wounds. The fluorescent light biomodulation can be used once or twice a week. I tend to use once a week with two cycles.
And he has been shown also, he is shown to be an option in the treatment of canine superficial bacterial folliculitis. So depends on, as we know, the use of this of this of this light depends, for example, in the size. Of the lesions depends on the areas.
It is much, much easier if we have more localised areas. For example, one option is also to use, and it has been shown to be to that can be used in case of interdigital bioderma interdigital fronlosis. It has been shown to short the time to lesion resolution in the bioderma and interdigital fronlosis because of helping with anti-inflammatory and healing effect.
No, in general? Treatment with antiseptics I think it's perfect over topical antibiotics. When we use topical antibiotics, it's still potentially we can induce the resist antibiotic resistances.
If you are going to use antibiotic, topical antibiotics, consider antibiotics like cidic acid, neomycin, poly polymeine, or sulphur sulfadiazine. Which, as we know, is also effective against negative. Now, Moycine, Morezine is only available for human use, very important to use it for people with MRSA.
So, try to save this antibiotic, . Or try to save this ebiotic. Only use it.
If you use it as a last resource. OK. Put, put together topical treatments.
How how this day should be used, for example, in case of bio traumatic dermatitis. Makes sense that the very first thing to do. It's to clip the hair on the around the lesion.
This patient with bio traumatic dermatitis, the lesion can be cleaned once a day or, either with wipes, for example, with a disc. And can be also used in order to make the patient more comfortable because biotraumatic dermatitis can be very uncomfortable for the patient. It really cause causes pruritus, as we know.
And potentially we can use in these cases to decrease the pruritus and the inflammation. We can use hydrocortisone as zepona spray once a day because it has been shown in this clinical study that it's a quick and effective treatment. For resolving biodramatic dermatitis, and in this study, hydrocortisone acipoate was applied to 10 drugs at 2 pumps of spray per 100 squares per injured skin once a day for 7 days, and, and all the lesions cleared.
On day 7. So that's a possibility to use in bio in a bio traumatic dermatitis. After cleaning, Look here, to the, to the folds folds again, as I said as I explained before, they're very good.
They're easy to use with eye wipes, easy to clean with wipes, easy to clean with discs. It's also possible to apply a foam, for example. And again, look to this bacteria overgrowth syndrome.
Do your topical treatment. This patient had both armpits affected. He was clean every day with an antiseptic and then applied almost daily, easy.
And resolved. Bacterial superficial folliculitis again, it's possible to treat just using topical. If the hair is very long, you might, it might be advised to clean the hair.
But think about bathing this dog twice. A week leaving a contact time of 5 to 10 minutes and then applied topically every day the skin disinfectant. In many cases will resolve.
So this was the first part, the first part where we looked. On the topical treatments because this is our maintain. This is, this is our priority.
To be successful and we are going to be successful in many cases. Sometimes. We might need systemic antibiotics.
So the question is, when do we need systemic antibiotics? Cases of deep pyoderma. Cases of bacterial superficial folliculitis that are unresponsible.
To topical treatment. In general, When we think about systemic antibiotics. Using systemic terminology, we may need to think about culture.
And antibiogram. He one both culture and TV programme. Which could be done in every case.
Culture is therefore never contraindicated. Because by doing culture, we increase, we look at the potential resistance of the pathogen, and therefore we increase the likelihood. Of choosing the right antibiotic.
Let's go over. The these situations. And situations, for example, as I explained, many cases of deep yoderma.
They might need, they will need, due to, for example, if they are very severe, due to the risk of sepsis, we will need systemic antibiotics. Again, And all these patients, we do culture, but we also always do cytology. And clip to dry clip the hair to to treat this patient.
No, certainly. In many cases, We can start by doing imperial therapy. But if we suspect that antibiotic resistance is present, Then Yes, to do culture and sensitivity, it is, it is strongly advised to do culture and sensitivity.
And when do we suspect? About resistant. When less than 50% of reduction in the extent of the lesion.
Of superficial bacterial folliculitis. So we have less of 50% reduction within two weeks of antibiotic therapy. When also?
We have appearance of new lesions. Aules, pustules, colourants. After 2 weeks after initiating 2 or more weeks, let's say 2 or more weeks, after initiating treat initiating oral treatment, antibiotic treatment.
So new lesions are. After 22 weeks or more after the treatment. At an alarm for thinking about resistance.
To the current antibiotic. And when do also we really need to do a culture and energy and sensitivity when we have intracellular bacillin. And this happens, especially in cases of the bioderma.
Because basilli needs to be identified, the antibiotic resistance between the basilli. Are quite diverse. So we need to know which is the pathogen and we need to know which is his antibiotic sensitivity.
Now, it's also important if there is a previous history of multi resistant infection in that patient. Or in the other animals of the same household, mainly dogs. Make sure that you do your culture and sensitivity.
Now, when you, when did your culture and sensitivity comes back? You might be facing. The patient might be facing a multi-resistant infection.
Moti resistant profile. Means that there is resistance to 3 or more families of antibiotic. Now, the stuffindius has the same pathogenesis.
Regardless, the antibiotic profile. What changes here? He's his antibiotic profile.
So, look at the antibiotic profile, look of of your antibiograms. And look also take also in account the previous antibiotic the previous antibiotic history. Always ask yourself.
This It makes, does it make sense what I've seen in this result, bearing in mind. That my patient Was treated but then before with such and such antibiotic. So look at the results and interpret them.
It helps tremendously. To do when you do bacterial culture. Always do cytology from the same lesion.
And in if in this, if in the your bacterial culture. You have more than one microorganism identified normally. You will choose the antibiotic based on the sensitivity for stuff pseudointermediate because as we know, this is by far the number one pathogen when it in the bacterial bioderma.
Now by doing your sensitivity. For example, we will be able to see, as we can see in the picture, the presence of cockeye. Intracellular.
OK, if you're going, as I said, we are going to do our culture. And sensitivity will to do our culture by. First choosing an intact lesion.
Open it disinfect with alcohol? Leave it to dry. Open with a needle?
Squeeze the content. Users use your stereo swab. And then Apply a microscopic slide.
On the same lesion using the same material and go and look at it under the microscope. This will be very helpful. Now, sometimes we have a problem with the pooderma because in cases of the yoderma the culture from the biopsy bite me more liable in that defying the pathogen.
Why? Because on the skin surface there will be contaminants, and our pathogen might be deep on the tissues. So if we are going to do a biopsy.
Which is a more invasive procedure, as we know, might, we might need anaesthesia and so on. It's my advice if we are going to do biopsy. We're going to we're going to do culture from The deep tissue?
We also going to do histopathology. Because since we are there, we can, without any, we, we can we can and we should collect a 2nd or and a 3rd or a 4th. Sample for histopathology.
So One sample for a culture, another at least another sample for histopathology. And when you send your sample or samples to eopathology, Ask also to do special colorations for fungal. Just in case.
Because sometimes fungal infections, they can be very similar clinically to deep infections, to the bacterial infections. So ask special coloration on this pathology. Now, if you're doing a culture from a deep ioioderma.
The tissue that goes, the sample that goes for bacterial culture. You should perform bacterial culture culture for aerobic and anaerobic pathogens. I stood up both types.
So, but this is just in case of the yoderma, because if you are just doing a swab from a superficial bioderma, from a superficial bacterial folliculitis, from a bustule, for example, in this case, you only need aerobic culture. OK, you have your results back. No, what should I prescribe for the treatment of bioderma?
And it's not only here at this point, it's not only to look at the results. But also Taking account other factors. Like, is the drug available?
Taking in account this legislation in your country, local legislation. Taking account the size of the dog. Do we have a drug available for?
Sometimes it's more difficult to have some drugs for big dogs. Take also in account. Is the owner able to give oral medication?
And the side effects, potentially side effects of the medication, discuss them with the owner. Finally, take also in account the cost, especially in larger talks. And we start with Bettylactam's antibiotics.
There are this belactones, so we are talking about amoxcycline clavulanate. Among the cycling caulonate and first generation cephalosporins. Namely, cephalexin and cephedroxyl.
Which can can be used interchangeably. Our these are our first choice antibiotics. So the betolactone's antibiotics.
Which many times can be used empirically? If specialist if it's a first time presentation of a bioderma. They are safe.
They are well tolerated. They are broad spectrum antibiotic with a good penetration on the skin, very active against stuff pseudent remedials. So they are, in general, good choices.
For your patients. Another good choice that can be used. Another good for his first choice.
Is the Lycosamites group. They can also be used empirically or after culture and sensitivity because sometimes they are regional regional resistance, so Be careful if your antibiogram shows that there is a resistant to erythromycin, because erythromycin resistant isolates. Potentially, we can have here in these cases possibility of inducible resistance to lecosamide.
In order to know if we, if there is potentially inducible resistant to to lecosemide, you need to ask the lab to do another test, another specific test for this purpose. So If you want to, if you are going to use glicosamides, the number one, it's clindamycin. We have clindamycin, all world available, all oil available.
Really, clindamycin is very good for the skin, has a very good . Skin penetration. We are used to to use it.
It's been very safe, very well tolerated, a bit more narrow spectrum antibiotics when compared to the previous group. And in this group, we can, as I say, use clindamycin, but sometimes we have available in some countries lecomycin. Which is also has a good a good outcome.
Now, another potential, another antibiotic that we can use is that potentiated sulfonamides. Potentiated sulfa sulfonamides can be used empirical, but I rather advi I rather recommend to perform culture and sensitivity because sometimes there are regional differences. And the other thing is that if you're thinking about potentiated sulfonamides, we need your might to need to be careful with side effects.
Which we are going to talk in a second. Now, sulfonamides are broad spectrum antibiotics with excellent oral bioavailability in the talk. They do penetrate the skin.
The combination with temetropine or or methopprine decreased the rate of resistance. And also they will be reduced, potentially reduced effectiveness if it's very exudative or pruent lesions. Again, it's important here to have the lesions clean.
So which is the antibiotics that we have that we can do it? We can do it with temetopine, sulfadiazine, or remetoprine, sulfamethoxazole. If you are using or metoprine sulphur, the metoxin.
And make sure that you first you have your loading dose on the 1st day and then decrease the dose for the after for the second and for the following days of treatment. No. Sulfonamides are contraindicated in the Doberman pincher because this breed has been associated with idiosyncratic autoimmune side effects.
Be careful with this breed. In general, Sulfonamides can show side effects in the dog. And the side effects are allergic reactions.
Arthropathy anaemia and thrombocytopenia. Apathropathy. Kerato conjuntiti sicca.
And skin reactions. So make sure that you ask the owner if you see something unusual. For example, if we stop eating.
Or if he vomits. Oh Stop the antibiotic and call me. Call the clinic.
So, should explain to the owner the potential side effects. The other thing is do your monitoring. Due to the risk of of kerato conjunctivitis Zika.
I always do a tumour test at the beginning at the treatment before treatment. I only prescribe these antibiotics if the tears production is normal. And I keep checking the tear production in all the rechecks.
Now, another thing that is advised is to, before the treatment, starting the treatment, do blood, a complete CBC and clinical chemistry. And then, again, repeat this the blood test. During the treatment.
Now the other thing that is necessary to be aware is that sulfonamides may decrease ti for hormone. After the treatment, at least during 2 weeks. So, in fact, what we have here is the drug-induced hypothyroidism, and this is reversible.
So make sure that after a treatment, with sulfonamides, wait before checking C4. Now, our second choice antibiotics. Culture and sensitivity for the pathogenic.
Pathogenic agent. If we should demonstrate resistant to the previous antibiotics. And also potential use of second choice antibiotic is that if the previous antibiotics after doing the culture and the sensitivity.
Are not appropriate for that patient, for example, due to side effects. So, the antibiotics that I'm going to speak from here are antibiotics that It is good practise to do culture and sensitivity before prescribing them. And the first ones are 3rd generation encephalocephalosporins.
Now, make sure that you look at the resistance of first class cephalosporins, amoxiclo and oxycycline, which is your marker for Methicillin resistance stuff intermediate because if there is resistance already to first class cephalosporin, amoxiclov or ox or oxxycycline, it means that there is a resistance also to third generation cephalosporins. So, this is the first thing that you need to In to check when you receive your results. Now, 3rd 3rd generation cephalosporins are in general also considered very safe.
And here we have an injectable an injectable cephalexin, sorry, an injectable cephalosporin. Which is cephal vaccine. Cephal vaccine can be used, it's used subcutaneously.
Can be just a single injection or if there, there is still remaining infection, can be repeated. Now, make sure that we always check your patients and if necessary, and do cytology. Now, another 3rd generation cephalosporin is cephpodoxime.
Cepphtalloxin. It's only available it's oral, but it's only available in some countries. Another class of antibiotics.
That we should use that we could potentially use of culture and sensitivity. It's because they are active against Gram-posit and gram-negative bacteria, they are broad spectrum antibiotics. It's fluorine ones, flora wants.
Number one, make sure also that you don't use them in young growing dogs. And the other thing is that the most recent studies. Shows that the absorption of cyprothroxacin is variable in dogs.
So it is its use at this point is no longer recommended. So, OK, in 4los, we have 2 generations. We have a 2nd generation and the 3rd generation.
On the 2nd generation, we have neurofloxacin and marblefloxacin. Aero focusing and moral focusing, the the breaking points have been revised. And it's my advice to make, to make sure that your laboratory is also giving you A new category based on these new break points, which is the category of susceptible dose dependent dose dependent isolates.
Because some of the isolates . The, as I said, breakpoints change and this means that we are now interpreting the the isolates which are called resistance or susceptible. In with a different range of break points now.
Make sure this is this is available for you. Ask your lab if you have questions all the time that you have a question, ask your lab. Now, 3rd generation fluin loans.
We have Pradafloxacin, which is available . In most of the countries, Pradafloxacin has also been shown to be effective against canine bioderma. The other 3rd generation fluoroquinolone is orbfloxacin.
Or refluxesine has it's in the market for a bit longer, not available in all the countries, but it has been also shown to be effective in the treatment of superficial and deep bioderma. Now, let's go to another group of antibiotics which are the tetracyclines group. And in the cycling group.
The one that we have available in the vet in veterinary medicine. And can be used in after culture and sensitivity. It is doxycycline.
And It is advised to test for doxycycline susceptibility. Although normally if there is resistant to tetracycline, you might infer that there is also resistance to doxycycline. Now, doxycycline can cause vomit at higher dosage dosage.
We know that give it with food. We can also use doxycycline, any formulation, high glide or monohydrate. But it's again an antibiotic that we, we are used, we used to use, in fact, we use this antibiotic for for other infections apart from skin, as we know.
Like hemo parasites. So why you are, you are, we are used to this. Now, one that we are not used and has been tested for for methicillin resistant staph pseudointermediate infection is minocycline.
Minocycline belongs to the same group as tetras has toxi, but he has, he needs to be tested in the specific with a specific disc. So. Might happen that the isolate in fact is resistant to doxycycline, but susceptible to minocycline, but this needs to be tested.
Now, the dose that we have, the dosage that we have is that it's based on pharmacodynamics and pharmacokinetic study. It might cause vomit in dogs. Absorption is increased in an empty stomach.
It's available for in for human use only, and certainly we need clinical studies to assess its efficacy and safetiness. We all, until now, we only have one case reported with temporary improvement. We need to reserve 4 cases of multi-resistant pathogen.
These are the amiccosin, the rifeincine, and the chlorofinicol. So, these are antibiotics that if you when you need to prescribe, if you prescribe because really these are the last rest should be looked as the last resources. Then go through all the, go through all the side effects and make sure that you do the proper monitoring of the patients.
No, in general, OK. Think about duration of the treatment. I strongly advise to see your patient if recheck each 10 to 15 days, no longer than 2 weeks.
If you are using, and I'm knocking now in general for all the for or only topical treatment or topical and antibiotic treatment because if we prescribe antibiotic topical treatment is, is, will be there, it's still there. So, if you are giving systemic antibiotic, given until the infection clears. So that's why these periodic rechecks are important, so you're going to see if there are Lesions or if the lesions cleared.
Do not think, do not base your decision based just in what the owner says. No, recheck your patient. Do a thorough dermatological examination.
Now, if the infection cleared, you stop the antibiotic. They can again depends the time of the antibiotic will depend on the on the type of injection and the depth of infection. the, if there are deeper infections, we might need, for example, 4 weeks or, or, 6 weeks of treatment.
Something else if you after you stopping your antibiotic, continue topical treatment. In fact, topical treatment can be considered for the long term management to avoid recurrent bioderma. So your patient might after being clear of this, of, for example, of a bacterial folliculitis.
You might maintain your patience being bathed once a week. So we treat with topical treatment, bathing twice a week, then the infection clears, but the bacterial liquid is clear, but still maintain it with once a week bathing. So, take home messages.
Topical therapy is a priority in our days. It is there, it should be tailored to the patient needs and to the owner compliance. Now, for all cases of bioderma.
Consider the underlying cause of that bioderma. Correct the diagnose and correct the underlying causes if possible, to avoid recurrent recurrent bioderma. Now, in cases of, most cases, many cases, let's say of, for example, recurrent pyderma.
Is there are because the patient is atopic. Make sure that you do your diagnosis and control that atopic dermatitis. For most, finally, communication with the owner is essential.
It's, we need to explain the owner. What to do, why we are doing. And which will be the the effort, the cost involved in the treatment.
Because if the owner is aware of all the details, the compliances increase and therefore, the success of your treatment. Thank you very much for your attention. And Good luck.
It has been a pleasure.