Steroids and antibiotics in veterinary dermatology

When should we use them and when shouldn’t we- some more thoughts from Anthony Chadwick, The Webinar Vet, provider of fantastic, high value vet cpd

You know, we see an itchy dog and we immediately do what I used to do in my first days in practice, put it on steroids and it gets better. I really don’t think we should use steroids until we’ve made a diagnosis. I think sometimes we’ve gone too much the other way, where people say, I don’t want to use steroids at all. I think if steroids are used sensibly, especially in cats – cats are very resistant to steroid side effects – it is an okay drug to use. But I don’t recommend it when we really don’t know what’s going on first . So I’d like to make a diagnosis. I then start using the steroids if that’s appropriate. And I don’t use a lot of steroids, because I find that if I’m doing all the other things before steroids, I find I need to use them much less. The other thing that I say with steroids is, put them in the dangerous drugs cupboard! You have to think a little bit before you get to the dangerous drugs, but it might just make you not use them immediately. So do think about the other stuff before you immediately launch into corticosteroid use.

One of the few times I would use steroids before I’ve made a diagnosis is, sometimes dogs with otitis, very painful ears. You can’t get near them, and the dog is very uncomfortable. Quite often I’ll put him on a couple of weeks of steroids to calm those ears down. Then we can always work our way backwards and make a diagnosis. The other thing is, from a referral point of view that people often say is. Do you want the dog off of steroids before we refer it to you? And I say, Look, let’s just get the dog in. My first visit is really about going through the history and doing the simple things (I very rarely skin or blood test the dog at its first visit). Most of the time I’ll do those other things on the second visit if it’s appropriate, because at the second visit they’ve been on a food trial for a month. Some of these dogs are almost perfect on their return, and we find that it’s been a food allergy. So just avoid symptomatic treatments.

Again, if you’re not familiar with what a pyoderma looks like, and you’re not clipping up the dog to look at that, you can avoid treating the infections and the dog will continue to itch because it’s got that secondary infection. I think the other problem that happens is, we give a ten-day course of antibiotics, and the dog improves. You want it back in ten days, but the client decides that the dog looks a lot better and doesn’t turn up, or goes to see another vet, another one of your colleagues, who looks at the dog and says, It looks a lot better. We won’t bother with anything else.

This is probably my last point. Virtually every dog that I see has three to four weeks of antibiotics, because you need to give a longer course to really microscopically cure the pyoderma. So in ten days often the dog will look better, but it won’t on a microscopic level be cured. In the meantime we’re also looking at what was the trigger for the infection. But people tend to give too low a dose. They don’t weigh the dog. They don’t know what the antibiotic dosage should be, and then they don’t give a long enough course. And they do that because they’re trying to save the client money. It’s a false economy. I think we need to make sure that we’re giving a long enough course at the correct dose. So do make sure that you’re doing that.

All dogs need an absolute minimum of three weeks antibiotics but often will need longer than that. The most commonly used antibiotic in veterinary dermatology is cephalosporin at 15-30mg/kg bid

This article is taken from a veterinary webinar from The Webinar Vet entitled Practical Approaches to Managing Pruritus