Treatment of canine leproid granuloma syndrome: preliminary findings in seven dogs

Objective To determine effective treatment strategies for patients with ref ractory canine leproid granuloma syndrome. Design Multi-institutional retrospective/prospective case series using clie nt-owned dogs. Procedure Seven dogs (four Boxers, one Dobermann, one Bullmastiff and one B ullmastiff cross-bred; ages 3 to 11 years) with leproid granulomas were tre ated successfully using a variety of treatment regimens. These cases were r ecruited because: lesions were either widely distributed over the dog; prog ressive, despite routine therapy, or were associated with particularly disf iguring lesions. The treatment regimen evolved during the course of the cli nical study. Results Combination therapy using rifampicin (5 to 15 mg/kg PO, every 24 h) and clarithromycin (8 to 24 mg/kg PO daily; dose divided every 8 or every 12 h) was used most frequently and proved to be effective and free from sid e effects. Total daily doses of clarithromycin in excess of 14 mg/kg were c onsidered optimal and long treatment courses, in the order of 1 to 3 months , were used. Combination therapy using rifampicin (25 mg/kg; that is, highe r than the recommended dose) and clofazimine was effective in one case, but resulted in hepatotoxicity. A topical formulation of clofazimine in petrol eum jelly was used as an adjunct to oral rifampicin and doxycycline in anot her patient treated successfully. Conclusion Based on our evolving clinical experience, a combination of rifa mpicin (10 to 15 mg/kg PO, every 24 h) and clarithromycin (15 to 25 mg/kg P O total daily dose; given divided every 8 to 12 h) is currently recommended for treating severe or refractory cases of canine leproid granuloma syndro me. Treatment should be continued (typically for 4 to 8 weeks) until lesion s are substantially reduced in size and ideally until lesions have resolved completely. A topical formulation, containing clofazimine in petroleum jel ly may be used as an adjunct to systemic drug therapy. Further work is requ ired to determine the most cost effective treatment regimen for this condit ion.