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An Urban Experience
J. Sykes1
1University of California- Davis, Department of Medicine & Epidemiology, Davis, USA
The International Society for Companion Animal Infectious Diseases (ISCAID) Antimicrobial Guidelines Working Group was formed to develop guidelines
for antimicrobial drug use in dogs and cats, because
of concerns that antimicrobial drug resistance has dramatically increased in prevalence among isolates from dogs and cats in the last decade. The founding members of the ISCAID Working Group are Scott Weese, Joseph Blondeau, Dawn Boothe, Edward Breitschwerdt, Luca Guardabassi, Andrew Hillier, Michael Lappin, David Lloyd, Mark Papich, Shelley Rankin, Jane Sykes, and John Turnidge. Input has also been obtained from panels of Diplomates of relevant specialty groups. It should
be noted that members of the working group receive support from a variety of industry groups that provide funding for honoraria and research.
Guidelines for treatment of urinary tract disease in dogs and cats, respiratory disease and superficial pyoderma have been published and are available as open access documents for any individual to download (www.iscaid. org). During the course of guideline development, it became clear that there is a significant lack of objective, published information. Accordingly, recommendations are based on available data, whenever present, along with expert opinion, considering principles of infectious diseases, antimicrobial treatment, antimicrobial resistance, pharmacology, and internal medicine. Clinical trials that evaluate antimicrobial drug regimes for bacterial infections in dogs and cats are encouraged.
Because of the increased prevalence of antimicrobial drug resistance, the need to properly document the presence of an infection before initiating antimicrobial drug treatment is more important than ever. In veterinary medicine, this may be at odds with client financial resources. However, inappropriate use of antimicrobial drugs is wasteful of client resources when an infection is not present or a multidrug resistant pathogen is present, and risks selection for antimicrobial resistant bacteria that may be harmful to the pet, other animals, and also humans that are in contact with the animal. Clinicians should choose laboratories for culture and susceptibility (C&S) testing that follow protocols and use breakpoints published by the Clinical and Laboratory Standards
Institute (CLSI), EUCAST or other internationally recognized institutions. The Working Group hopes that veterinarians will re-think the empiric use of antimicrobial drugs, especially when the underlying condition is not immediately life-threatening. An emphasis on rational antimicrobial treatment needs to be made to pet owners.
A selection of the basic recommendations within the respiratory and superficial pyoderma guidelines are summarized below and will be discussed. Doses of specific antimicrobial drugs are listed in the guidelines.1-3 Updated urinary tract guidelines include information on bacterial prostatitis and urological procedures, and are covered elsewhere in these conference proceedings. In general, as the guidelines have evolved, there has been an emphasis on shortening the duration of antimicrobial therapy.
The cause of most superficial bacterial folliculitis (SBF) in dogs is Staphylococcus pseudintermedius. Methicillin- resistant S. pseudintermedius (MRSP), which is often highly multi-resistant, has now spread rapidly throughout the world. This has focused attention on the need to ensure that diagnosis and treatment of SBF is managed in an optimal way so as to resist the spread of this organism.
SBF only occurs when there is an underlying problem such as allergic dermatoses, hyperadrenocorticism, hypothyroidism, or demodicosis. These need to be differentiated from SBF.
Diagnosis of SBF should be supported by cytological examination and the demonstration of coccoid
bacteria associated with inflammatory cells and within phagocytes. Cytology is also important for identification of co-infection with Malassezia pachydermatis.
SBF must be distinguished from other causes of folliculitis and pustular disease. It should be differentiated from demodicosis by deep skin scrapings and from dermatophytosis by fungal culture.
Culture is essential if there is a poor response to 2 weeks of appropriate systemic antimicrobial therapy, emergence of new lesions 2 weeks or more after the initiation of such therapy, presence of residual lesions after 6 weeks of therapy combined with cytology demonstrating infection with cocci, when cytology reveals intracellular bacterial rods, and when there has been a history of a multidrug resistant infection in the dog or a dog that shares the household. C&S testing is encouraged in cases of recurrent SBF infection or when there has been a history of treatment with antimicrobial drugs.

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