Topicals as an Antibiotic-Sparing Strategy in Veterinary Dermatology

Antimicrobial resistance (AMR) is a growing global threat affecting both human and veterinary medicine. In small animal practice, skin infections, particularly canine pyoderma, are common reasons for systemic antibiotic prescriptions. This makes dermatology a critical area for improving antimicrobial stewardship.Current international guidelines emphasize a key principle: topical antimicrobial therapy should be the first-line treatment for surface and superficial pyoderma, reserving systemic antibiotics primarily for deep infections or cases that fail appropriate topical management (Loeffler et al., ISCAID Guidelines 2025).

Why Topical Shampoos Help Reduce Resistance

1. Reduced Systemic Selection Pressure

Systemic antibiotics affect not only the infection site but also the gut, skin, and environmental microbiota, increasing selective pressure for resistant strains.In contrast, topical antiseptics act locally, minimising broader microbial disruption.

2. Lower Risk of Resistance Development

Antiseptics such as chlorhexidine act through multiple cellular targets (membrane disruption, protein denaturation), making resistance development less likely compared with antibiotics that act on a single molecular pathway. Long-term veterinary dermatology use has shown sustained efficacy with minimal documented resistance concerns.

3. Evidence of Comparable Clinical Effectiveness

A randomized controlled trial demonstrated that a 4% chlorhexidine shampoo protocol (combined with topical solution) was clinically comparable to systemic amoxicillin-clavulanate for treating superficial canine pyoderma (Borio et al., 2015). This supports the concept that many mild-to-moderate infections can be managed effectively without systemic antibiotics.

Clinical Application: When Topicals Should Be First-Line

Topicaltherapy alone is often appropriate for:

• Surface pyoderma (e.g., hot spots, intertrigo)
• Localized or mild-to-moderate superficial bacterial folliculitis
• Maintenance therapy in recurrent cases linked to underlying disease

Systemic antibiotics remain indicated for:

• Deep pyoderma
• Generalized severe infections with systemic illness
• Cases unresponsive to properly administered topical therapy

(ISCAID Guidelines 2014, updated 2025)

Practical Protocol Principles

Effective shampoo therapy depends on correct use, here are some take outs from the ISCAID Guidelines:

• Use 2-4% chlorhexidine shampoos (or chlorhexidine-miconazole combinations when yeast is involved).
• Apply 2-3 times weekly initially, adjusting based on response.
• Maintain 5-10 minutes of contact time before rinsing.
• Combine with leave-on topical products for localized lesions to enhance compliance.

When properly implemented, topical therapy can significantly reduce systemic antibiotic prescriptions in dermatology cases.

The Stewardship Impact

Integrating topical shampoos into routine dermatologic protocols contributes to antimicrobial stewardship by:

• Decreasing unnecessary systemic antibiotic exposure
• Reducing recurrence driven by repeated antibiotic courses
• Supporting guideline-based, evidence-driven care
• Maintaining therapeutic efficacy while lowering AMR risk

In modern veterinary medicine, topical shampoos are not merely supportive treatments, they are a strategic component of responsible antibiotic use.

Product recommendations:

The following products are some of our best heroes in the fight against over use of antibiotics:

Clorexyderm 4% Shampoo

Shampoo with disinfectant action containing chlorhexidine digluconate, formulated to support skin hygiene in cases of microbial overgrowth.

CLX-Wipes

Practical cleaning wet wipes for dogs, cats, horses and other animals, containing chlorhexidine and Tris-EDTA. Great for daily cleansing of paws, interdigital spaces and skin folds. Great for easy use in-between baths.

Clorexyderm Spot Gel

A moisturising gel that includes chlorhexidine and Tris-EDTA for moisturization and protection.Creates a protective, yet breathable, film on the skin that can help prevent additional unwanted bacteria to access the skin or wound.

Clorexyderm Solution

A disinfectant rich in moisturising and emollient substances that does not require rinsing after application. Contains both chlorhexidine and Tris-EDTA. Can be used between baths or in some cases instead of.

Otodine & Otodine Wipes

Our patented formula for ears. Includes a unique combination of chlorhexidine andTris-EDTA. Available both as a solution to drop directly in the ear and wipesthat can be an easy alternative or addition for the pet owner to use at home.

Key References

• Loeffler A. et al. ISCAID Guidelines for the treatment of canine pyoderma (2025).
• Hillier A. et al. ISCAID Guidelines for superficial bacterial folliculitis (2014).
• Borio S. et al. Randomized controlled trial comparing 4% chlorhexidine protocol with systemic antibiotics (2015).
• Santoro D. Topical therapy for canine pyoderma: what is new? JAVMA (2023).