Bicillin and Zithromax

[Maureen Las]

somebunny wrote:

Maureen & Tracy,

You've both taken a lot of effort to help me, I'm so grateful for that

I did print out information on administration of bicillin for my vet to read. She gave me a bottle of sodium chloride to mix the drug with. I draw the bicillin into the syringe first, then draw in an equal amount of sodium chloride to dilute it. You're probably right, angieluv, about the needle possibly being blocked by the thick drug. I will dilute it further when I do the next injection.

Thanks for your explanation and the medirabbit article. It's really helpful. I didn't know I wasn't supposed to shake the bottle. That's what the vet did yesterday yikes!

Actually sometimesI shake it (guilty)and then let it sit awhile because the rolling is so hard to keep doing

but technically it should be rolled.

 

[Maureen Las]

Any news on this bunny? :expressionless

 

[JadeIcing]

Ringo takes Zithromax and has done just fine. He has taken it about two years now on and off. He has never had an adverse effect from it.

I also did a LOT of research with about it. I was the one who chose it for Ringo.

 

[Maureen Las]

I know Ali that recently a few buns have had issues with it ??? I know that Randy has used it all the time.........:expressionless

 

[JadeIcing]

angieluv wrote:

I know Ali that recently a few buns have had issues with it ??? I know that Randy has used it all the time.........:expressionless

Thanks to Ringos amazing progress with it the rescue uses it and it has helped several rabbits. I am seeing one but not sure that it is the zithromax.

 

[JadeIcing]

I forget butConnor also used it and thanks to it recovered and has never been ill again. He was on meds for 7mnths straight before it.

 

[12354somebunny]

Angieluv, I've stopped the Zithromax and the lethargy, appetite loss and watery stool have all stopped.

Right now, Hans is only getting the Benacillin. 3 daily doses the first 3 days, then every other day. He's getting 0.2ml of the Benacillin, until I hear from Randy or anyone else who knows the proper dose based on the 150mg/ml concentration of procaine & 150 mg/ml benzathine.

I'm a little worried that if the dose is incorrect e.g. too low, it may cause the bacteria to become resistant. The vet prescribed 0.2ml based on the dosage of 35,000 - 40,000 units/kg (this dosage is for bicillin with 150k unit procaine & 150k unit benzathine - the vet assumed that 150mg/ml is the same as 150units/ml but I still can't find anything that supports this )

 

[12354somebunny]

When I gave Hans his injection last night, the injection site was slightly swollen because of the drug beneath the skin. The swelling went down after just a few minutes. Is that ok? There was no swelling when the vet gave Hans his first injection.

 

[Maureen Las]

I deleted an entire long post becauseI read the original post wrong so if anyone read it please dismiss it.

The dosage is correct assuming we are dealing with the correct amount for" K" which is also unknown to me.

It is not normal to have swelling under the skin but it could be due to the procaine hydrochloride in the drug of which I have no knowledge.

I want to stress that I do not have Randy's massive knowledge base and have learned most about rabbit's through this site, etherbun and also Randy. I am also feeling my way along with this.

I have been wracking my brain trying to figure out why there have been so many rabbits that have been unable to tolerate zithromax recently. I am wondering if it is the preparation . In the childrens version the powder which is mixed with water is heavily laced with sugar and syrup so a child will take it ; I am wondering if this is what is affecting the rabbit?I had to give this type also , gave too low a dose and still myrabbit lost some of her appetite and did lose a little weight. Zithromax is usually anexcellent drug for this problem and it is shame that we cannot use it here.

 

[tonyshuman]

I am guessing that 150K=150units/mL=150mg/mL

Bicillin and Benacillin seem to only be sold at that concentration.

The procaine hydrochloride I have only heard of as a topical anesthetic, but wikipedia says it's commonly used to reduce the pain associated with a penicillin injection. http://en.wikipedia.org/wiki/Procaine

I am guessing that the swelling was due to slow absorption of the drug--it may have made a pocket in the subcutaneous layer if it wasn't injected properly. I am assuming you're doing sub-q injections? It's possible it got in the wrong layer, such as between the fat and skin. I don't have any practical experience giving injections, so I don't know.

This site is a good study of bicillin: http://www-unix.oit.umass.edu/~jwmoore/bicillin/bicillin.htm

I wouldn't worry from that site that Hans isn't getting enough--they give a dose of 75,000 units/day, which would be 0.25mL of your stuff. 0.3mL might actually be too much. The dose seems to be determined by adding the two drugs' concentrations, ie 150,000units penicillin procaine and 150,000units penicillin benzathine=total concentration is 300,000 units.

Saline dilution will help with pain as well.

 

[Maureen Las]

tonyshuman wrote:

I am guessing that 150K=150units/mL=150mg/mL

Bicillin and Benacillin seem to only be sold at that concentration.

The procaine hydrochloride I have only heard of as a topical anesthetic, but wikipedia says it's commonly used to reduce the pain associated with a penicillin injection. http://en.wikipedia.org/wiki/Procaine

I am guessing that the swelling was due to slow absorption of the drug--it may have made a pocket in the subcutaneous layer if it wasn't injected properly. I am assuming you're doing sub-q injections? It's possible it got in the wrong layer, such as between the fat and skin. I don't have any practical experience giving injections, so I don't know.

This site is a good study of bicillin: http://www-unix.oit.umass.edu/~jwmoore/bicillin/bicillin.htm

I wouldn't worry from that site that Hans isn't getting enough--they give a dose of 75,000 units/day, which would be 0.25mL of your stuff. 0.3mL might actually be too much. The dose seems to be determined by adding the two drugs' concentrations, ie 150,000units penicillin procaine and 150,000units penicillin benzathine=total concentration is 300,000 units.

Saline dilution will help with pain as well.

Thank you Claire

 

[Maureen Las]

I was thinking that the head of our forum ( Pipp)who lives in Canada has successfully used the combination of chloramphenical (sold as Chlor-palm) in Canada and benzathine pencicillin(they don't sell bicillin there ) for abscesses.



Chloramphenical has been banned for human use in the US due to it's ability (in a small % of people to destroy bone marrow simply from skin contact with the drug. ). Rabbit owners who use this drug simply wear gloves when administering it. I have used a weak form as an eye antibiotic for my rabbit very successfully. it is a powerful drug that is one of a few that has the ability to pass the blood-brain barrier thus very powerful in getting into the core of an abscess and destroying bacteria .
I have never used chloramphenical as an antibiotic orally for a rabbit because many vets are not willing to deal with the possibility of the human owner being affected by the drug .

I would pm Pipp and ask her about her experiences because it may be that your current vet would be willing to try this drug for your rabbit in addition to the penicillins

http://www.medirabbit.com/Safe_medication/Antibiotics/Safe_antibiotics.htm

I just noted that this drug also leads to loss of appetite which would make me more interested in learning if Pipp ever had problems with it.

Thisjust occured to me today as i was thinking about your situation.
I also would be more interested in more details re. the abscess on your bun...ex location , size , etc.

Maureen

 

[12354somebunny]

Tonyshuman, I was afraid that the swelling meant that I had injected in the wrong layer I hope I get it right soon, it's really hard to tell which layer I've put the needle in. I don't dare to poke too deep, in case I hit muscle/flesh.

Angieluv, is it a must for bicillin to be complemented by another drug in order for it to successfully eradicate the abscess?

About the abscess, it's located on Hans' right lower jaw. Hans used to have malocclusion. His teeth were also growing in odd directions e.g. on his lower jaw, the left incisor grew to the right and it blocked the right incisor's growth path. So the right incisor was kind of 'stunted'. I suspect that the abscess could be due to the right incisor's stunted growth, resulting from irritation of the incisor root. But that is just my guess. I've discussed it with Randy before and he mentioned there could be other causes of the abscess although its difficult to determine what the exact cause is.

Hans had his incisors removed in April. At that time, the abscess was already there. After incisor removal, Hans was on oral Baytril for about 3 weeks. I wanted to use bicillin then, but the vet was reluctant to try it and thought that Baytril will do the job.

The abscess went away, but returned a few weeks later.. which brings us to today and our current treatment with Benacillin.

 

[Maureen Las]

I would feel that you could try benacillin alone and see if the abscess clears up and. ..as long as the incisors were removed then the source of the infection would begone

how is your rabbit?. How does the abscess seem after just a few days of the benacillin. My experience with the bicillin alone is that for some infections it does the trick but for some other more difficult infections it is not enough.
You could always add a 2nd drug at a later date . i would make sure that your rabbit was kept on the drug for a lengthy period (6 weeks) and if there is any change for the worse and not for the better then a 2nd drug would be tried to complement the bicillin.

 

[Maureen Las]

When I give sub q injections I pull up a lot on the skin ( sort of like pulling the top sheet up on a bed ) ; my rabbit puts up with a lot as his skin is loose and it is very difficult to find the "mouth" of a tent and successfully place the needle inhorzontally with the bevel of the needle upwardwithout it poking out the other end and shooting all over him.
i will try to find the other video as there is a better one than I posted originally. It really takes experience and patience to get this right and you will get the experience

Just think of a raw piece of chicken ..you want to get the needle between the skin and the muscle.
I cannot find anything on an injection alone but this sub q video is better than the other one

[ame=http://www.youtube.com/watch?v=Wdf-M9miFzE]http://www.youtube.com/watch?v=Wdf-M9miFzE[/ame]

 

[tonyshuman]

The benacillin alone may do the trick. Especially since Hans had such difficulty with Zithromax, it would be best to try just the one drug for a while. If there is no improvement in a few weeks, you may need to do the double treatment.

 

[12354somebunny]

So far, Hans has only received 3 shots of benacillin. The first shot was done by the vet, the second and third shots were done by me and since I had some problems with doing it properly, maybe he got a little less than the dose he's supposed to get. I haven't noticed any changes yet. The size of the abscess appears to be the same (but at least it didn't get bigger). The good thing is that the benacillin has zero effects on Hans' appetite/poop/behaviour. He is as normal as always.

 

[12354somebunny]

angieluv wrote:

When I give sub q injections I pull up a lot on the skin ( sort of like pulling the top sheet up on a bed ) ; my rabbit puts up with a lot as his skin is loose and it is very difficult to find the "mouth" of a tent and successfully place the needle inhorzontally with the bevel of the needle upwardwithout it poking out the other end and shooting all over him.
i will try to find the other video as there is a better one than I posted originally. It really takes experience and patience to get this right and you will get the experience

Just think of a raw piece of chicken ..you want to get the needle between the skin and the muscle.
I cannot find anything on an injection alone but this sub q video is better than the other one

http://www.youtube.com/watch?v=Wdf-M9miFzE

Argh, I can't watch it now as youtube has been blocked by my office. And the internet at home is down at the moment.

I think I understand from your description. Tent the skin, then inject from the 'entrance' of the tent, right?

Hans doesn't have much skin, lol. Each time I try, I can only make a tiny little tent. I hope that when I push the needle it, it actually goes between the skin and the muscle. Will I know if I hit the muscle/flesh? Will there be more resistance? I don't want to inject him at the wrong site.

 

[tonyshuman]

That is good that his appetite and behavior are normal. I think watching the video if at all possible will help a lot. It can be really painful to get penicillin in the muscle. I don't have any experience giving injections, so I'm sorry I can't help with that.

 

[Maureen Las]

somebunny wrote:

angieluv wrote:

When I give sub q injections I pull up a lot on the skin ( sort of like pulling the top sheet up on a bed ) ; my rabbit puts up with a lot as his skin is loose and it is very difficult to find the "mouth" of a tent and successfully place the needle inhorzontally with the bevel of the needle upwardwithout it poking out the other end and shooting all over him.
i will try to find the other video as there is a better one than I posted originally. It really takes experience and patience to get this right and you will get the experience

Just think of a raw piece of chicken ..you want to get the needle between the skin and the muscle.
I cannot find anything on an injection alone but this sub q video is better than the other one

http://www.youtube.com/watch?v=Wdf-M9miFzE

Argh, I can't watch it now as youtube has been blocked by my office. And the internet at home is down at the moment.

I think I understand from your description. Tent the skin, then inject from the 'entrance' of the tent, right?

Hans doesn't have much skin, lol. Each time I try, I can only make a tiny little tent. I hope that when I push the needle it, it actually goes between the skin and the muscle. Will I know if I hit the muscle/flesh? Will there be more resistance? I don't want to inject him at the wrong site.

Sometimes you can get resistance because you are in the dermal layer rather than underneath it. Pull up the skin imagining that you have a pup tent..I tend to try to pull it up high to see where I'm at; but my bun is older and likeI said he has loose skin and puts up with it .......then just insert the needle with bevel upwards into the" front of tent" so to say . Sometimes if there is resistance you can pull the skin up a little higher . if you were in a muscle your bun would jump...

Also can you read the label off the needle ? What size you are using ? Could be too long or thick which would make this very hard

you want to make sure that you are not in a vein so pull back on the plunger to make sure there is no blood return
How is he doing/?
I saw Christine's response on etherbun; Randy hates baytril and would not want to combine that with anything... but if you wanted to reply to Christine you could ask her if her bunny's abscess disappeared from that treatment.
In other words you want to get rid of the abscess bottom line