Are there any particular risk factors for abscess development?
There are certain tissues and organs that are fairly commonly sites of abscesses. For example, anal sacs that become impacted or infected may develop an abscess. A generalized blood-borne infection may result in a liver abscess. Damage to a tooth may result in a tooth root abscess. A sexually intact male dog may develop an infection and subsequent abscess in the prostate gland. A bite wound can result in an abscess under the skin. An inhaled foreign object or severe pneumonia may case a lung abscess. Finally, an inner ear infection, severe sinus infection, or infection deep in the mouth can result in a brain abscess.
Treatment depends on the location of the abscess and the severity of the infection. Most abscesses are treated on an outpatient basis, rather than in the hospital. The key is to remove the pocket of pus, either surgically, or by draining and flushing. If a foreign object caused the abscess, it is critical to ensure that it be removed or the abscess will return.
Antibiotic therapy is a critical component of successful treatment of abscesses. The antibiotic will be chosen based on the bacteria involved, and the length of treatment will depend upon both the bacteria and the location. It is important to give the antibiotics for the entire time they are prescribed.
It is also important to ensure adequate pain relief during treatment of an abscess. Your veterinarian will prescribe an appropriate pain medication to be given alongside the antibiotic.
Your veterinarian may talk with you about maintaining adequate nutrition to ensure good healing. This may involve a temporary dietary change. Finally, it will be important to restrict activity during recovery to allow the tissue to heal properly. If the abscess was surgically removed, then keeping the dog quiet and contained is absolutely mandatory.
Therapy: selecting an appropriate antibiotic
Once a pyoderma has been diagnosed, it is important to consider if the infection is deep, severe and/or generalised enough to warrant treatment with systemic antibiotics. Preferred alternatives for mild, surface and/or focal infections include topical antimicrobial shampoos and sprays, or even topical antibiotics if topical antiseptics do not clear the infection. Topical antiseptic treatments can hasten clearing the infection, or will greatly reduce the need for systemic therapy (Scott and others 2001, de Jaham 2003, Murayama and others 2010).
The vast majority of skin infections in companion animals are associated with coagulase-positive staphylococci, with Staphylococcus pseudintermedius (part of the Staphylococcus intermedius group (SIG) the commonest causative agent in canine pyoderma (Devriese and others 2005, Bannoehr and others 2007).
There have been many studies describing the antibiotic susceptibility of SIG isolates (eg, Medleau and others 1986, Ihrke 1987, Ihrke 1996, Piriz and others 1996, Pellerin and others 1998, Ganiere and others 2005, Jones and others 2007, Norström and others 2009, Yoon and others 2010, Ghidini and others 2011). These show that the antibiotic sensitivity of SIG isolates vary. In particular, the number of drug-resistant, multidrug-resistant (ie, resistant to three or more classes of antimicrobial), and meticillin-resistant isolates has increased over time. Regular updates on susceptibility patterns to antimicrobials used in veterinary medicine are, therefore, required (Authier and others 2006). In addition, antimicrobial susceptibility patterns vary between countries, and clinicians should use data relevant to their location. A recent systemic review of systemic antibiotic therapy for canine pyoderma evaluated 17 clinical trials (Summers and others 2012). The authors concluded that there was good evidence supporting the high efficacy of subcutaneously injected cefovecin in superficial pyoderma and for oral clavulanate-amoxicillin in deep pyoderma. There was fair evidence for moderate to high efficacy of oral clavulanate-amoxicillin, clindamycin, cefadroxil, trimethoprim-sulphamethoxazole and sulfadimethoxine-ormetoprim in superficial pyoderma, and oral pradofloxacin, oral cefadroxil and subcutaneously injected cefovecin in deep pyoderma. It is possible to use this efficacy data and SIG susceptibility data to estimate the probability of successful management of staphylococcal skin infections with different antibiotics, and classify them into first-, second- and third-line antibiotics.
First-line antibiotics include established and well-tolerated narrow and broad-spectrum drugs with antistaphylococcal activity. They are no less potent than higher-tier drugs in the correct circumstances, and are appropriate for empirical treatment of uncomplicated canine pyoderma. First-line drugs include cefadroxil, cefalexin, clavulanate-amoxicillin, clindamycin and lincomycin. Cefpodoxime and cefovecin can be included as first-line antibiotics where medication may be difficult, and/or compliance is, or likely to be, poor (Van Vlaenderen and others 2011). Long-term injectable or once-daily palatable oral antibiotics are useful if there is, or likely to be, poor adherence to the treatment regimen, problems with communicating the treatment regimen to the owner, and/or multiple therapies within a treatment regimen.
Inherent resistance of staphylococci limits the usefulness of tetracyclines (Kim and others 2005, Yoon and others 2010), some sulfonamides (Papich 1988) and simple penicillins (Abraham and Chain 1988, Yoon and others 2010). Tetracyclines and sulfonamides, however, may be useful for meticillin-resistant Staphylococcus aureus or S pseudintermedius infections when their use is indicated by in vitro sensitivity tests (Morris and others 2006).
Second-line antibiotics should only be used when there is culture evidence that first-line drugs will not be effective. These antibiotics are not appropriate for empirical antibiotic treatment (Authier and others 2006). Second-line antibiotics include newer broad-spectrum drugs important to animal and human health where the development of resistance is of greater concern. Second-line antibiotics include: cefovecin, cefpodoxime, difloxacin, enrofloxacin, marbofloxacin, orbifloxacin and pradofloxacin. The recent decline in staphylococcal susceptibility to fluoroquinolones is probably due to the common use of these drugs (Prescott and others 2002). To limit the emergence of resistance, fluoroquinolones should only be used where second-line antimicrobials are necessary (Authier and others 2006).
Third-line antibiotics are very important to animal and human health, especially for treatment of multidrug-resistant organisms. Resistance towards these drugs is of great concern and/or they have greater potential for adverse effects. Most of these drugs are not licensed for animals, and there are few safety and efficacy data. Third-line antibiotics must only be used when there is culture evidence of sensitivity, no first- or second-line antibiotics are effective, and topical antimicrobial therapy is not feasible or effective (Authier and others 2006). Third-line antibiotics include: aminoglycosides, azithromycin, ceftazidime, chloramphenicol, clarithromycin, florphenicol, imipenem, phosphomycin, piperacillin, rifampin, tiamphenicol and ticarcillin.
The development of resistant bacteria in human health is a big concern. In our ethical role of healthcare professionals, veterinarians should never use drugs deemed critically important to human health (eg, vancomycin, teicoplanin, linezolid etc) in animals. Some countries, moreover, expressly prohibit the use of human antibiotics not licensed for animals (eg, azithromycin, ceftazidime, clarithromycin, imipenem, phosphomycin, piperacillin, rifampicin, ticarcillin and others), so those antibiotics should preferably be avoided, even if there is evidence of sensitivity. Clinicians are responsible for ensuring that it is legal to use non-licensed drugs in their countries.
Ideally, treatment should not be started until the results of bacterial cultures and antimicrobial sensitivity tests are available. If immediate treatment is necessary, the selection of an appropriate drug should be based on clinical signs and cytology, bearing in mind the most likely organisms and their likely antimicrobial sensitivity patterns in each case. When culture results become available clinicians should be prepared to escalate treatment by selecting a higher-tier drug, or de-escalate treatment to a lower-tier drug, as indicated.
How to Prevent Skin Abscesses in Dogs
Since most skin abscesses are due to a break on the skin from an injury, the best way to prevent skin abscess formation is to make sure injuries of this nature are avoided. Make sure that your dog does not have access to any object that can puncture or lacerate their skin. Regular tick and flea preventive medications will also help reduce insect bites and decrease the risks of skin abscesses in dogs.
Natural Antibiotics to PREVENT and TREAT Infection
Skin abscesses often appear as painful swelling on the skin which can be firm or fluid-filled to the touch, depending on how thick the pus is inside. Typically, skin abscesses appear suddenly, often with a substantial amount of tissue inflammation surrounding it. They are commonly found on the skin, mucous membranes, or even inside the animal’s body. Continue reading to learn more about abscesses and how to help your dog!