Page 1463 - Clinical Small Animal Internal Medicine

158 Principles of Therapy of Dermatologic Diseases 1401

neomycin, mupirocin, nitrofurazone, silver sulfadiazine, agents include ketoconazole, itraconazole, fluconazole,
VetBooks.ir nisin, and enzyme systems. Often, topical antibacterial terbinafine, and amphotericin B.
Ketoconazole is most commonly used in cases of
agents contain glucocorticoids and antifungals which
enhance their effect against other organisms and help
reduce inflammation and pruritus. Benzoyl peroxide Malassezia dermatitis and dermatophytosis in dogs. It
should not be used solely as a first choice for systemic
and clindamycin are often efficacious products for mycosis and should be avoided in cats due to its hepato-
acne cases. Mupirocin is particularly effective against toxic effects.
Staphylococcus infections, including methicillin‐resistant Itraconazole is better tolerated in cats compared to
bacteria. These products are usually available as creams, ketoconazole. Itraconazole is also commonly used in
ointments, gels, sprays, or wipes and some may also be systemic infections and Malassezia dermatitis, but may
available in the form of shampoos, such as benzoyl per- be cost‐prohibitive in large‐breed dogs.
oxide, and ear solutions, such as acetic and boric acid. Fluconazole can be used for Malassezia dermatitis,
Systemic antibiotics are usually indicated to treat but it is mostly useful in systemic infections when brain
severe and generalized bacterial skin infections includ- or ocular penetration is needed.
ing superficial and deep pyodermas and wounds. The Terbinafine has been reported to be effective in
use of systemic antibiotics in cases of otitis media Malassezia dermatitis and can also be used for dermato-
remains controversial; however, high doses of antibiotics phytosis and systemic or deep mycoses.
may be used in combination with topical therapy in Amphotericin B is mostly indicated for cases of sys-
selective cases. The most common systemic antibiotics temic mycosis but potential nephrotoxicity is a limiting
used include amoxicillin‐clavulanic acid, cefovecin factor to its use. Lipid‐based formulations are available
sodium, cefpodoxime proxetil, cephalexin, clindamycin and are much less nephrotoxic than the traditional
HCl, potentiated sulfonamides, doxycycline HCl, chlo- (deoxycholate) form.
ramphenicol, enrofloxacin, and marbofloxacin. Ideally,
for recurrent or chronic infections, systemic antibiotic Antiparasitics
selection should be based on bacterial culture and sensi-
tivity. Broad‐spectrum antibiotics such as fluoroqui- Antiparasitic products are used for prevention of fleas,
nolones should be avoided empirically and as first‐choice ticks and lice, and treatment of parasitic diseases such as
agents as they may select for bacterial resistance. ear mites, demodicosis, sarcoptic mange, and cheyletiel-
Ciprofloxacin has poor and variable oral bioavailability losis. Most commonly used antiparasitic formulations
in dogs and cats and should be avoided in these species. include collars, sprays, shampoos, dips, spot‐on solu-
tions, otic solutions, and ointments.
Amitraz solution diluted and applied as a dip is labeled
Antifungal Agents
for the treatment of canine demodicosis. Amitraz should
Topical antifungals are usually prescribed for localized be avoided or used carefully in cats. Rotenone ointment
fungal infections, otitis externa associated with may also be used in localized forms of canine demodicosis.
Malassezia infections, or as concurrent therapy with Flea and tick preventatives are available in a variety of
systemic medications for more generalized or severe combinations and include deltamethrin, imidacloprid, flu-
cases. The most commonly used topical antifungal methrin, fipronil, (S)‐methoprene, dinotefuran, pyriprox-
agents include clotrimazole, miconazole nitrate, nysta- yfen, permethrin, spinetoram, moxidectin, and indoxacarb.
tin, ketoconazole, posaconazole, terbinafine, and lime An imidacloprid and moxidectin combination has also
sulfur. Some of these products may contain a combina- been used successfully for the treatment of sarcoptic
tion of glucocorticoids and antibiotics which might be mange, cheyletiellosis, and mild cases of demodicosis.
beneficial when concurrent bacterial infection and Products containing permethrin should not be used in
inflammation and/or pruritus are present. These agents cats due to their sensitivity to this compound. Other pyre-
are usually available as creams, ointments, gels, solu- throids should be used carefully and according to label
tions, shampoos, rinses, and wipes. instructions, particularly in small kittens. Lime sulfur dip
Systemic antifungals are usually indicated for extensive is effective against canine and feline scabies (Notoedres),
or severe superficial, subcutaneous and systemic or deep feline surface demodicosis (Demodex gatoi), cheyletiello-
fungal infections including dermatophytosis, Malassezia sis and lice, but it is ineffective against fleas. There are sev-
dermatitis, onychomycosis, candidiasis, sporotrichosis, eral effective products available for the treatment of ear
blastomycosis, cryptococcosis, histoplasmosis, and mites including products containing pyrethrin, ivermec-
aspergillosis. Systemic antifungals may also be used in tin, milbemycin, selamectin, and thiabendazole.
severe otitis externa cases in conjunction with topical Systemic antiparasitic agents include ivermectin,
therapy. The most commonly used systemic antifungal doramectin, moxidectin, milbemycin oxime, selamectin,