Antimicrobials for skin disease

Oral ketoconazole

When the underlying cause persists

Polypharmacy products

Do appropriate diagnostics

Topical products

Use narrowest spectrum and lowest tier drug

If systemic infection is noted

Correct any underlying cause

Combination of topical and systemic antibiotics

4-6 weeks

Doxycycline

7-10 days

Topical antibacterial

Poulticing and hot compresses

Leave it untreated

Topical antifungals

Enilconazole

Ketoconazole

Pruritus

Debride and lavage with 2-4% chlorhexidine

Trimethoprim/sulphonamide

Topical treatment with 2-4% chlorhexidine

Culture and sensitivity testing

Minimum 3 weeks

Debride and lavage

Trimethoprim/sulphonamide

Systemic antibacterials based on cytology

Topical treatment only, using drugs such as Framycetin, Gentamycin, Polymyxin B, Florfenicol, Fusidic acid/framycetin, or Polymyxin B/miconazole.

For small areas of superficial infection, use topical anti-bacterials/antiseptics such as chlorhexidine-based products or tetracycline/thiamphenicol spray. For larger areas, use a non-critically-important systemic antibiotic such as penicillin, cephalosporins, or oxytetracycline.

Avoid lancing and draining the abscess due to the caseous nature of rabbit pus. Antibiotics are unlikely to be curative and are normally used in conjunction with surgical management. Culture and susceptibility testing should ideally be performed on a section of the abscess wall, not the pus.

Antifungal therapy may be required for maintenance therapy if the underlying cause persists. However, it is important not to use a polypharmacy product with an antibiotic. It is better to establish and correct/control the underlying cause where possible.

It is important to be sure of what you are treating by doing appropriate diagnostics. Use topical products where possible. If systemic antibiotics are required, use the narrowest spectrum and lowest tier drug that is likely to be effective.

Bacterial and C&S testing should be done if rods are seen on cytology, if there are deep infections, if there is poor response to prior antibiotics, or if a resistant organism is suspected.

It is important to treat an infection long enough to fully resolve it, but no longer than necessary. Additionally, it is important to correct any underlying cause, as prevention is better than cure.

Ensure bacteria are involved – do cytology whenever possible. Antibacterial treatment not suitable for, e.g. Malassezia dermatitis, Treatment of non-specific skin problems (e.g. pruritus). Use topical antibacterials/antibiotics where possible - minimise use of systemic antibiotics. Use the narrowest spectrum and lowest tier antibiotic that is likely to be effective. Correct the underlying cause.

Debride and lavage if systemically well and no pyrexic: Topical treatment with 2-4% chlorhexidine. If systemically unwell and pyrexic: Systemic antibacterials based on cytology: For cocci: Clindamycin, Cefalexin, Amoxicillin/clavulanate, Trimethoprim/sulphonamide. For rods: Flouroquinolones.

Topical only treatment: 2-4% chlorhexidine, Fusidic acid +/- glucocorticoid, Silver sulphadiazine (if rods). If required: Clindamycin, Cefalexin, Amoxicilline/clavulanate, Trimethoprim/sulphonamide. Culture if rods are seen on cytology or there is a history of MRSP/MRSA or multiple prior antibacterial courses. Treat for minimum 3 weeks or 1 week beyond clinical cure. Repeat cytology to assess response. Use doses at top end of range for better skin penetration.