PEER
REVIEWED
46
CE: CANINE ATOPIC DERMATITIS
S pseudintermedius-associated pyoderma in dogs has
increased interest in targeted topical antimicrobial
therapy with chlorhexidine shampoos and sprays.
11
More severe or generalized cases of pyoderma
may require first-line systemic antimicrobials
( BOX 3 ); bacterial culture and susceptibility testing
may be needed in cases of recurrent pyoderma.
12
For
Malassezia dermatitis, there is evidence for use of
topical miconazole/chlorhexidine shampoo treatment
(Malaseb, bayerdvm.com ; twice a week for 3 weeks)
and, in severe cases, systemic treatments with azole
derivatives ( BOX 3 ). Many drug interactions exist
with use of azole drugs, especially with ketoconazole.
13
Frequent use of systematic antimicrobials (antibiotics
and antifungals) is not recommended because it is likely
associated with increased prevalence of drug resistance.
BOX 3 Systemic Antimicrobial
Options for Severe Skin Infection
Pyoderma
Cephalexin, cefadroxil 15-30 mg/kg PO q12h
Cefpodoxime 5-10 mg/kg PO q24h
Clindamycin 5.5-11 mg/kg PO q12h
Lincomycin 15-25 mg/kg PO q12h
Malassezia dermatitis
Ketoconazole 5-10 mg/kg q24h
Itraconazole 5 mg/kg q24h for 3 weeks
Terbinafine 30 mg/kg q24h for 3 weeks
FIGURE 4. A 6-year-old mixed-breed dog with CAD and flea allergy dermatitis with severe pruritus and secondary bacterial infection
at initial presentation (A, C). After failed allergen-specific immunotherapy, treating fleas and resolving secondary infection, the dog's
allergies became well controlled with frequent medicated baths and lokivetmab, anti–canine IL-31 monoclonal antibody (B, D).
A
C
B
D