Darren Berger, DVM, DACVD, covers drug and treatment options
Sponsored by Virbac
While attending the 2023 Fetch dvm360® Conference in Kansas City, Darren Berger, DVM, DACVD, presented on the 3 common scenarios of canine pyoderma and what guidelines and treatments are available. When asked about what he wanted attendees to learn from the talk, Berger focused on antimicrobials. “The key for using antimicrobials in general practice is to make sure we’re choosing the appropriate drug, asking if this is a patient that would benefit from topicals, and checking why the patient is getting recurrent pyoderma in the first place.”
When looking at owner knowledge of antimicrobial resistance, Berger states their main concern is cost. The best thing about first tier drugs—like Clindamycin, Amoxicillin, and Trimethoprim—is they also happen to be the cheapest. Prescribing one of these drugs to a pet means not only are vets doing the right thing, but they are also aligning with client expectations. For cat owners, the focus is more on routes of administration.
Being a rather controversial topic in veterinary dermatology, Berger says, “Bugs change and grow under pressure. I’m putting extended pressure, extended courses of antibiotics in my patient and forcing those biomes to potentially change to survive.” He calls into question the idea of a 21-day treatment window, and a treat, clear, stop mentality. There is not enough literature to support where this recommendation originated from. Rather, choosing the appropriate drug and combining it with the right topical therapy will lead to a better resolution for the patient.
The recurrence rate is crucial for determining if a vet is keeping an infection at bay. Berger insists that, “This concept of dealing with atopy, of treating the disease, leads to less antimicrobial usage and in and of itself is antimicrobial stewardship.” Bathing with medicated shampoos is a great way of providing antimicrobial efficacy, even after a single bath.
When it comes to suspected resistance to treatment, a cotton swab soaked in sterile saline led to more bacteria recovery than a dry one, which Berger and his colleagues explored. Under a microscope, a vet can examine if the sample is a bug, mixed bacteria, or something else. Once verified, the sample then goes to a lab.
Overall, there is no one-size-fits-all approach to treating pyoderma. It is a multilayered condition that forces veterinarians to consider all options and what is happening on and beneath the skin.