An overview of the latest treatment options
Speaking at the Atlantic Coast Veterinary Conference (ACVC), Paul Bloom DVM, DACVD, DABVP, outlined a few new drugs to consider implementing into your treatment plan for patients with pyoderma, pruritus, and pruritus. ‘otitis.
Treatment options for veterinary dermatology patients have advanced considerably in recent years. Paul Bloom, DVM, DACVD, DABVP, summarized the latest treatments available to treat pyoderma, pruritus, and ear infections. If you didn’t already know, these are great additions to your therapy arsenal.
Bloom has separated these new drugs into broad categories of antibiotics and antipruritics. The mainstay of antibiotics for pyoderma used to be cephalexin, a first generation cephalosporin. Although this is arguably the first-line treatment for bacterial folliculitis, newer antibiotics used to treat pyoderma include cefpodoxime (an oral antibiotic) and cefovecin (trade name Convenia, a long-lasting injectable antibiotic), which are both third generation broad spectrum. cephalosporins. Bloom discussed the potential issues with using third-generation cephalosporins as a first-line treatment.
The oral drug cefpodoxime is promoted by the company as a first-line antibiotic for pyoderma; however, the broad spectrum nature enhances the development of Gram negative bacteria producing extended spectrum beta-lactamases. These very resistant bacteria are major causes of serious infections in humans. Whether targeted for treatment or not, and whether pathogenic or not, resistant bacterial organisms can transfer their resistance genes to other organisms in the environment or other species (from animals to animals). the man). The advantage of administering cefpodoxime over cephalexin appears to be primarily logistical, as cefpodoxime is administered once daily, compared to cephalexin which is administered twice daily. However, Bloom said, the risks to developing resistant organisms outweigh the logistical benefits.
Similar concerns exist for cefovecin. This parenteral antibiotic has been approved in other countries for the treatment of many organisms (including Staphylococcus intermediate, beta-hemolytic Streptococci, Escherichia coli, Pasteurella multocida, Proteus spp, Staphylococcus intermediate, and Streptococcus canis. Due to the similar risks of breeding for resistant bacteria, Bloom cautions that cefovecin should be reserved for patients who cannot be medicated orally. Therapeutic concentrations are maintained for approximately 7-14 days after injection, with a specific treatment schedule depending on the specific bacteria and MIC. Although sub-therapeutic, tissue concentrations persist for up to 65 days. It is questioned whether this persistent sub-therapeutic tissue concentration will select for the resistant bacteria or not. Specific concerns exist regarding the selection of extended spectrum beta-lactamases (Enterobacteriaceae such as E. coli and Klebsiella pneumoniae) multidrug-resistant. Bloom also reminded us that with any new therapy, the long-term side effects are not yet fully understood.
Available antipruritic drugs include oclacitinib (Apoquel), modified cyclosporine (Atopica and Cyclavance), and lokivetmab (Cytopoint). These 3 drugs have different mechanisms of action.
Oclacitinib is an inhibitor of the janus kinase pathway (JAK 1). Janus kinase 1 is an intracellular pathway that is activated when cytokines bind to specific receptors on the cell membrane. Activation results in the production of various cytokines that initiate and perpetuate pruritus. Oclacitinib inhibits the activation of the JAK 1 pathway, limiting the amount of pro-inflammatory and itchy cytokines produced. It may also be useful off-label for other immune-mediated diseases including vasculitis, ischemic dermatopathy, leafy pemphigus, and discoid lupus erythematosus. Adverse effects seem to be rare, but may include neutropenia or leukopenia and may reduce the seizure threshold.
Bloom reminds us of an important factor to consider when using oclacitinib; it will mask the pruritus whatever the etiology. For example, a patient with sarcoptic mange, flea allergic dermatitis, or bacterial or yeast pyoderma, possibly masking the underlying untreated disease. For this reason, identifying the underlying cause of pruritus is an important part of diagnosis and treatment planning.
Although they are not new, modified cyclosporins are still widely used in dermatology. Bloom cautions that using modified cyclosporins, such as Atopica or Cyclavance, is essential to achieve consistent absorption. Bloom recommended the use of modified cyclosporin in uncomplicated atopic dermatitis, where oclacitinib and lokivetmab have failed. Full therapeutic effect is usually achieved within 4-6 weeks of administration. Adverse effects appear to be minimal and consist of gastrointestinal signs, skin papillomatosis and gingival hyperplasia. Maropitant or ondansetron may help to compensate for vomiting.
Another new drug used in veterinary dermatology is lokivetmab, a canine monoclonal antibody that binds to and neutralizes IL-31. Blooms noted that while small amounts of IL-31 are beneficial, higher amounts are harmful and contribute to the pathogenesis of atopic dermatitis. Lokivetmab is given by subcutaneous injection once every 30 to 60 days. As this is a specific canine monoclonal antibody, it can only be used in dogs. Bloom recommended that it be used in cases of pruritus due to allergic skin disease, with or without concomitant demodex or bacterial pyoderma or cystitis, or in patients with a history (or current) of cancer. Bloom notes that cases that have not responded to oclacitinib or lokivetmab may respond to the other treatment, due to the different mechanisms of action. So, if a treatment trial with one of these drugs doesn’t work, it’s worth trying the other.
Bloom’s latest update in “New Drugs in Veterinary Dermatology” concerns the treatment of ear infections. Administering topical ear medications can be difficult for owners, and treatment is often prescribed for 7-14 days. Easotic is a new product containing hydrocortisone aceponate, miconazole and gentamicin. What is particularly unique about this treatment is the delivery system. Easotic comes in a pump bottle, with a flexible tip that allows easy application of the medication deep (but safely) into the ear canal. The pump is dosed to allow the delivery of 1 cc with each pump and the duration of treatment is only 5 days. Bloom’s experience in this regard has been positive, due to both compliance and efficiency.
Dermatological conditions are one of the most common diagnoses requiring veterinary care, and several new treatments have become available in recent years. Bloom’s overview of new treatments should help all practitioners better understand the options available to care for their patients.
Dr. Rebecca A Packer is board certified in Neurology by the American College of Veterinary Internal Medicine and is an Associate Veterinarian at BluePearl Specialty and Emergency Pet Hospital in Lafayette, Colorado. She is also the founder and owner of the Pre-Veterinary Mentoring Group, LLC, through which she provides mentorship to pre-veterinary students on their way to veterinary school, and is the founder and owner of The Pocket Neurologist, LLC, a veterinarian. teleconsultation service to the veterinarian.