Chapter 102 • Demonstration and written instructions should be provided to clients on the proper use of prescribed topical products: the reason to use them, the way to use them, the desired response, the duration of treatment, and the need for a recheck to follow progress. • A gentle, general cleansing shampoo should be used before an antimicrobial shampoo to clean the skin and hair coat and minimize the amount of the more expensive medicated product. • The hair coat should be kept short for easier and more successful management of recurrent infections. • The client should be instructed to ensure at least 10 minutes of contact time with gentle lathering for antimicrobial shampoos. • Tepid or cool water should be used and the animal should be rinsed very well, especially when skin is inflamed and pruritic. • The animal should be bathed at least twice weekly to treat a cutaneous infection and then as needed for maintenance. • Antimicrobial sprays, rinses, or wipes should be used between shampoos for continual and residual activity. • Cytologic examination is extremely important before, during, and after treatment to gauge response. Dermatologists typically use 3% or 4% chlorhexidine shampoos (see Table 102-1). A recent clinical study documented better efficacy of a 3% chlorhexidine gluconate shampoo than of a 2.5% benzoyl peroxide shampoo used as sole therapy for canine superficial pyoderma (Loeffler et al, 2011). A Japanese study (Murayama et al, 2010) revealed comparable clinical activity for a 2% chlorhexidine acetate surgical scrub and a 4% chlorhexidine gluconate shampoo in 10 dogs with superficial pyoderma when treated twice per week. Additionally, in a population of seven dogs with methicillin-resistant staphylococcal (MRS) pyoderma treated with the 2% scrub every 2 days for 2 weeks, five dogs responded completely and one partially. Clinical efficacy may be more contingent on frequency of treatment than concentration of the active ingredient. For more residual activity, a chlorhexidine leave-on conditioner/rinse, spray, or wipe should be used between shampoos (see Table 102-1).
Topical Therapy for Infectious Diseases
Basic Guidelines for Topical Antimicrobials
Bacterial Pyoderma
Chlorhexidine
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