Abstract
Intertrigo is a skin fold dermatitis often requiring recurrent treatment with topical antiseptics or antibiotics, which can select antimicrobial resistance. To minimize this risk, we tested the effectiveness of medical-grade Manuka honey at treating intertrigo as compared to a placebo hydrogel. We additionally characterized the culturable microbial flora of intertrigo and recorded any adverse effect with either treatment. During this randomized, placebo-controlled, double-blinded, adaptive group-sequential trial, the owners washed the affected sites on their dog with water, dried and applied a thin film of either the honey or the placebo product once daily for 21 days. Cytological and lesional composite scores, owner-assessed pruritus, and microbial cultures were assessed prior to treatment and on Day-22. The fixed effects of time, treatment, and animal-related variables on the pruritus and on each composite score, accounting for random dog effect, were estimated separately with generalized linear mixed models for repeated count outcomes (α = 0.05). The null hypothesis of equal treatment effects was rejected at the first interim analysis. The placebo (n = 16 dogs) outperformed the medical honey (n = 13 dogs) at improving both the cytological score (Treatment×Time = -0.35±0.17; P = 0.04) and clinical score (Treatment×Time = -0.28±0.13; P = 0.04). A microbial burden score higher than 4 increased the severity of the cytological score (dichotomous score: 0.29±0.11; P = 0.01), which in turn increased the severity of the clinical score and pruritus score. For every unit increase in cytological score, the linear predictor of clinical score increased by 0.042±0.019 (P = 0.03), and the one of pruritus score increased by 0.12±0.05 (P = 0.01). However, medical honey outperformed the placebo at alleviating the dog's owner-assessed pruritus after statistically controlling for masking effects (Time = -0.94±0.24; P = 0.002; and Treatment×Time = 0.80±0.36; P = 0.04). Unilateral tests of the least-square mean estimates revealed that honey only significantly improved the pruritus (Hommel-adjusted P = 0.003), while the placebo only improved the cytological and clinical scores (Hommel-adjusted P = 0.01 and 0.002, respectively). Taken together, these results question the value of Manuka honey at treating nasal intertrigo in dogs.
Highlights
For the past two decades, bacterial resistance to antibiotics has emerged as a global crisis that jeopardizes our ability to treat infectious diseases in both humans and animals [1]
Being increasingly part of the family, household dogs share a significant part of their skin microbiota with their owners [2], and can transfer potentially zoonotic bacteria such as Staphylococcus pseudintermedius to both their owners [3] and the veterinary personnel [4]
Intertrigo is a frictional dermatitis that occurs in areas where two skin surfaces are intimately apposed, in which poor ventilation, accumulation of body secretions and debris favour the development of secondary superficial infection [8]
Summary
For the past two decades, bacterial resistance to antibiotics has emerged as a global crisis that jeopardizes our ability to treat infectious diseases in both humans and animals [1]. Being increasingly part of the family, household dogs share a significant part of their skin microbiota with their owners [2], and can transfer potentially zoonotic bacteria such as Staphylococcus pseudintermedius to both their owners [3] and the veterinary personnel [4]. Dogs can disseminate such pathogens throughout the domestic and clinical environments [5, 6], in which canine and human bacteria may exchange their antimicrobial resistance genes [7]. Unless the underlying cause is either controlled or permanently corrected, intertrigo will recur and require periodical treatment with antibiotics or antiseptics [8]
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