Episode 30 - Understanding The New ISCAID Pyoderma Guidelines

This podcast is based upon the new 'Antimicrobial use guidelines for canine pyoderma by the International Society for Companion Animal Infectious Diseases (ISCAID)' available HERE

 

(00:00) John introduces the podcast with his co-hosts Sue Paterson & Producer Paul.

 

Chapter 1 – Understanding Pyoderma and the Need for New Guidelines

 

(02:56) Sue welcomes Dr. Anette Loeffler, who introduces herself and her background in veterinary dermatology. Originally from Germany, she studied in Munich and has worked in the UK for over 30 years. She is currently a dermatologist at the Royal Veterinary College (RVC) and has a special interest in Staphylococcus and bacterial skin infections and this has led her to work over the last 4 years on the new pyoderma treatment guidelines, aimed at improving antibiotic use and promoting topical therapy.

 

(04:30) Sue asks Anette to explain antimicrobial stewardship and why it is important. Anette describes antimicrobial resistance as a major global threat. Overuse of antibiotics leads to resistance, so it is crucial to avoid unnecessary prescriptions and focus on appropriate diagnostics.

 

(06:10) Sue asks how common pyoderma is in domestic species, particularly dogs and cats. Anette explains that staphylococcal pyoderma is very common in dogs due to their unique skin structure, making them more prone to bacterial overgrowth. While cats and other species can develop bacterial skin infections, it is far less frequent and usually not recurrent.

 

Chapter 2 – Diagnosing and Classifying Pyoderma

 

(08:00) John discusses evolving perspectives on pyoderma classification and asks if the traditional categories of superficial and deep pyoderma are still relevant. Anette confirms that the new guidelines still use these classifications as they help determine treatment:

 

1. Surface pyoderma (dysbiosis): Often in skin folds where bacteria and yeast overgrow due to friction and moisture.
2. Superficial pyoderma: Involves hair follicles and is the most common type.
3. Deep pyoderma: A more serious infection requiring systemic antibiotics.

 

(10:19) Sue notes that past treatment approaches lacked strong clinical evidence.

Anette explains that many historical treatment protocols were based on anecdotal evidence rather than research. While deep pyoderma has more robust studies, superficial cases often lacked proper research, leading to overuse of antibiotics.

 

(13:04) John asks how vets can determine whether a case is surface, superficial, or deep pyoderma. Anette explains that clinical examination alone can often differentiate them:

 

• Surface infections show redness and are in friction areas (e.g., nasal folds, hotspots).
• Superficial pyoderma presents with papules, pustules, and epidermal collarettes.
• Deep pyoderma causes swelling, draining tracts, haemorrhagic crusting, and pain.

 

(16:04) Sue asks how to confirm true bacterial pyoderma and rule out mimicking conditions. Anette stresses the importance of cytology, a simple and cost-effective test that can quickly confirm bacterial involvement. Cytology can also differentiate between bacterial infections, yeast overgrowth, and sterile pustular diseases.

 

 

Chapter 3 – Treatment Approaches and Key Takeaways from the New Guidelines

 

(19:36) John asks about traditional treatment approaches and why they need updating. Anette outlines how older guidelines recommended unnecessarily long courses of antibiotics (e.g., 3-4 weeks for superficial pyoderma, 4-6 weeks for deep pyoderma). While this was logical before antimicrobial resistance became a concern, modern research supports shorter, targeted treatments.

(26:13) Anette explains the new recommendations:

 

• Surface pyoderma should be treated topically only – systemic antibiotics are inappropriate.
• Superficial pyoderma should primarily be treated with topical therapy – which has been shown to be as successful as a course of antibiotics.
• Deep pyoderma requires systemic antibiotics but can benefit from adjunctive topical treatment.

 

(32:40) Sue asks about helping vets communicate these new approaches to pet owners.

Anette explains that the guidelines include tables, visual aids, and quick-reference guides to support busy practitioners.

 

(33:28) John asks about when systemic antibiotics are still necessary.

Anette explains that systemic therapy is still essential for deep pyoderma or when topical treatment alone is impractical (e.g., large dogs, owner limitations). In such cases, culture and susceptibility testing should guide antibiotic choice.

 

(38:15) Sue asks which antibiotics should be the first choice if empirical treatment is necessary. Anette recommends clindamycin, lincomycin, cephalexin, or co-amoxiclav as first-line choices, with fluoroquinolones reserved for resistant infections.

 

(42:32) Sue asks Anette for her top five takeaways from the guidelines:

 

1. Read the dog, not just the textbook. Diagnose based on clinical lesions and determine if the infection is surface, superficial, or deep.

 

2. Use cytology whenever possible. It’s quick, inexpensive, and helps confirm bacterial involvement.

 

3. Always look for the underlying cause. Pyoderma often recurs due to allergies or hormonal conditions.

 

4. Prioritise topical therapy. Topical antimicrobials alone are effective for many skin infections, reducing antibiotic use.

 

5. Use systemic antibiotics responsibly. Empirical choices should be limited to first-line drugs, and culture should guide second-line therapy.

 

(45:45) Sue mentions that the full guidelines will be available online via: WSAVA, ISCAID, and WAVD. Sue also mentioned a  WAVD webinar Anetta hosted, which is a must watch.

The guidelines are currently available HERE

 

(47:29) Outro – As always, Sue & John wrap up before John asks his co-hosts a light-hearted question to end on