Pyoderma: principles of rational antibiotic therapy

Elza, an intact female Welsh Corgi Pembroke, 1.8 years old, weighing 9.8 kg, developed symptoms suddenly. After an evening walk, the dog ate the food offered for dinner, but instead of settling down as usual, she began frantically licking and biting the skin in the thigh and pelvic area. It was impossible to distract her; she continued to torment the skin throughout the night. She refused the morning portion of food. The owners, completely exhausted after a sleepless night, had to go to work, hoping to find their pet healthy in the evening. However, when they returned home, the dog did not come to greet them. Hidden in a secluded place, she continued to lick the itchy areas, which had become bright red and had already lost their hair.

Frightened and confused, the owners took Elza to the veterinary clinic.

During the veterinary examination, extensive alopecia was found on the lateral surfaces of the thighs and pelvis, measuring about 7×2 cm, with well-defined margins. The skin in this area was erythematous, moist, and painful on palpation, which also drew the dog's attention. Overall, the dog appeared depressed. No other abnormalities were found on examination. Careful inspection of the skin and coat revealed signs of flea activity.

It turned out that the owners were convinced that animals should be treated for fleas only during the summer months. The last spot-on treatment against ectoparasites had been applied two months earlier.

Cytological examination of the impression smear revealed a significant number of neutrophils, single epithelial cells, and a small amount of coccal flora. Cytological conclusion: "neutrophilic inflammation with a septic component".

During the appointment, Elza was immediately treated for fleas with a spot-on solution. The owners were advised to treat the premises with insecticidal agents, for example, Cyflunit-ON. Prednipharm Solutab containing prednisolone was selected as an anti-inflammatory product to relieve itching and the neutrophilic response, at an oral dose of 0.5 mg/kg per day. Based on the nature of symptom onset, signs of flea infestation, and the cytological findings, the cause of the disease was diagnosed as flea allergic dermatitis. Despite the parasitic origin of the condition, given the extensive skin lesions that created significant portals of entry for infection, it was decided to prescribe an antibiotic.

The animal had never previously received antibacterial products. Therefore, a first-line broad-spectrum antibiotic based on amoxicillin and clavulanic acid – Synuxol-Nita – was selected. It was prescribed at a dose of 12.5 mg per kg of body weight, calculated as the total amount of active substances, twice daily for 14 days.

At the follow-up visit after 6 days of treatment, a pronounced clinical effect was noted. The areas of alopecia had not enlarged, and no new lesions had appeared. The skin in the affected area was dry, and its color did not differ from that of healthy skin. The owners reported that the itching began to subside after the first two doses of the medications and was now no longer observed at all. Appetite had returned to normal. Elza appeared active and content. No side effects from the medications were observed. In view of the marked positive response, prednisolone was discontinued. Therapy with Synuxol-Nita was continued according to the original prescription.

At the next appointment, on day 14 of treatment, complete clinical recovery was observed. The dog was treated again with a spot-on ectoparasiticide. The owners were advised to treat the dog against ectoparasites regularly, regardless of the season.

Toby is a neutered male Yorkshire Terrier, 6 years old, weighing 3.8 kg. The owner presented with complaints of a skin lesion that was not accompanied by itching. The symptoms developed gradually over 3-5 weeks and had by now become quite pronounced. Toby is often taken out of town to a country house, where he is sometimes left to his own devices. Treatment against ecto- and endoparasites is performed regularly, and he was vaccinated on schedule. He is fed commercial pet food and table scraps.

On examination, extensive skin involvement was found on the back and lateral body surface in the form of patchy alopecia resembling "moth-eaten fur" – generalized areas of papules, crusts, scales, epidermal collarettes, and multifocal alopecia. In addition, various dental deposits, periodontitis, and gingivitis accompanied by oral halitosis were detected.

For diagnostic purposes, material from the affected skin was collected for examination. Stained smear impressions using rapid stains, deep skin scrapings, and trichoscopy were performed. No evidence of fungal hair infection or parasitic skin disease was found.

Cytological examination revealed neutrophilic septic inflammation associated with coccal bacterial flora. Based on the analysis of all collected data, a diagnosis of superficial pyoderma was made. A comprehensive treatment plan was prescribed. Bathing with an antibacterial medicated shampoo containing 4% chlorhexidine, with a contact time on the skin of at least 5 minutes, was recommended every other day until discontinued by the veterinarian. Ultrasonic dental cleaning was also advised. In such cases, systemic antibacterial therapy is likewise recommended for at least 3 weeks and at sufficiently high "skin" doses; among the available products, the choice should be made in favor of those with the lowest risk of adverse effects. Accordingly, a safe broad-spectrum antibiotic from the first-line group was selected for systemic antibacterial therapy. The choice fell on Synuxol-Nita, which contains amoxicillin with clavulanic acid. This combination of two sufficiently safe and synergistically acting substances provides a broad spectrum of antimicrobial activity. Good tolerability and low toxicity make it suitable for long courses at doses sufficient to accumulate in the skin.

Synuxol-Nita was prescribed at a dose of 20 mg/kg body weight orally, twice daily, for a course of at least 3 weeks. At the 7-day follow-up visit, the owner reported no problems administering the tablets. Toby ate them together with his food. Despite the high dosage, the product was well tolerated. Appetite, activity, and the quality of defecation remained normal. By this stage, the clinical picture already showed positive results. The owner noted a reduction in skin scaling, no new lesions had appeared, the old lesions had become less swollen, and pathological hair loss had stopped. Treatment with Synuxol-Nita was continued in the same dosage and for the same duration.

On day 21 of treatment, the clinical signs had been completely resolved. A repeat skin impression smear showed 2+ nucleated and anucleate keratinocytes, while neutrophils and bacterial flora were negative. In addition, the antibiotic had a positive effect on the condition of the oral cavity. The owner was very pleased with the treatment results. Based on the cytological findings, it was decided to discontinue Synuxol-Nita. Bathing with the shampoo was continued for another 14 days.

Dermatological problems often lead pet owners to veterinary specialists. In many cases, a comprehensive approach to diagnosis and treatment makes it possible to achieve reliable positive results.

Side effects from long-term use of antibacterial products can be avoided by choosing quality antibiotics from the list of first-choice drugs.

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