Head tilt/ EC/ bacterial

[Darojati]

Hi All

I wanna seek your thoughts and advice for any reference of longterm headtilt/ EC..

Bubu (male, HL) started headtilt 21 Dec 2022 with flickering right eye, and we took him to doctor right away. We got him antibiotic, vitamins and panacur. We also had acupuncture to help on the neck.
We give panacur daily, critical care 20-30ml ever 3-5hrs, optimus superfood, baytrill, vitamin b complex, meloxicam.

We were only able to get Meclizine just few weeks ago, 23 Jan 2023. It's not available in Indonesia, so we have got a friend to purchase Bonine.

Bubu can already eat by himself for greens, pellets, hay.. we still continue syringe feed.

We bring Bubu for acupuncture & laser treatment every friday, so it's once a week.
It's now Day 47, we still continue panacur as he still tilting to the left and still has nystagmus on his right eye. His down eye on left is now open a little & more frequent. His body can be straight now on the floor vs just lay to the left.. but the head is still very tilting.

Some references below...

I don't want to be pessimistic. I see Bubu is trying to stand a lot of time, still hungru for food and drinking water from bottle.

Does anyone have any additional suggestions that we should do to help Bubu? We are hopeful that Bubu will be back to us, healthy vs today. Let me know your advice please.

Regards
Annisa


Some references

Day 1:


photos from 4th Feb 2023 when Bubu was sleeping and relaxed

 

[Darojati]

Hi @JBun

I'm going to inject penicillin subQ for possible bacterial treatment. This is the penicillin i can get here locally. Please let me know if 0.15ml/ kg weight is okay?

 

[JBun]

Is his condition worsening at all or has it been stable for a while? If he hasn't gotten any worse for a while and his condition is remaining stable, the remaining head tilt is probably permanent cell damage. In which case it would mean it's a permanent disability that he will need to learn to cope with. This also would mean he likely no longer has an active infection. I wouldn't do these antibiotic injections unless he's still worsening and/or there are indications he has an active infection. Though penicillin injections are generally considered safe for rabbits, there is still some risk it could result in causing dangerous antibiotic induced diarrhea, so it should never be given unnecessarily because of this risk.

But if it seems fairly certain your rabbit does have an active ear infection causing the head tilt, then the recommended injectable dosage for pen g procaine/benzathine (aka. Bicillin) is about 40,000IU per kg of body weight every 2-3 days. 0.15ml of the 300,000IU/ml suspension would be 45,000IU, within the recommended dosage range for rabbits. If your vet is a knowledgeable rabbit vet, they should be able to verify the correct dosage for your rabbit.

http://www.medirabbit.com/Safe_medication/Antibiotics/Safe_antibiotics.htm
https://wabbitwiki.com/wiki/Common_drug_dosages_for_rabbits
https://people.umass.edu/~jwmoore/bicillin/bicillin.htm
If penicillin injections are given, it's very important to make sure if any of the liquid leaks out at the injection site and onto the skin and fur, that it's cleaned off thoroughly, so that your rabbit won't groom it off and ingest any. As penicillin ingested can lead to antibiotic induced diarrhea, which is usually fatal in rabbits. To help prevent this occurring, it can also help to ensure feeding lots of good quality grass hay as this helps maintain a healthy gut balance, and giving a quality rabbit probiotic may also be helpful.

Be aware, I'm only sharing information based on what I've learned through my own research and experience. You should always do your own research based on verifiable medical information, verify the correct dosage calculations, and consult with your knowledgeable rabbit vet.

 

[Darojati]

@JBun it was getting worse.

So we gave penicillin subQ injection to Bubu already. We saw progress on horizontal nystagmus eye stopping after 1st injection, lasted for 2days. It started again in day 3. Then we gave the 2nd penicillin in day 4, and nystagmus stopped again. We observe that penicillin works, but need frequent dose for every 3days. We shall give another shot in day 7.. at least for two weeks.

 

[JBun]

It does sound like it's probably an inner ear infection causing the head tilt then. If you read my link to the bicillin study above, it talks about giving the injection every 2-3 days. If you're seeing improvement for 2 days then it's getting worse again on the third day, I think it would be important to not wait until day 3 to give the next injection. This risks the bacteria developing a resistance to the medication, which can then stop working against it and a new antibiotic will be needed.

So I would give the injection every 2 days. It may be able to be increased to every 3 days once there is sustained improvement. When the antibiotic is showing it's working and there's improvement, it's just important to give the next injection before there are signs of it worsening again.

It's also important to continue to give the antibiotic for a long enough period of time. Treating bacterial infections in rabbits can take a month or longer of antibiotics, to clear it up completely. If you stop the treatment too soon, it risks the infection coming right back and more resistant to that antibiotic.

It's usually recommended that antibiotics continue at least 2 weeks past the last of the symptoms clearing up. Or if there is permanent cell damage leaving the rabbit with a residual head tilt, continuing antibiotics until the condition is stabilized and no longer worsening for at least 2 weeks. So this means that antibiotic injections will likely need to be done for one month minimum, in my opinion.

Medirabbit: ear infection clinical signs and treatment

 

[Darojati]

It does sound like it's probably an inner ear infection causing the head tilt then. If you read my link to the bicillin study above, it talks about giving the injection every 2-3 days. If you're seeing improvement for 2 days then it's getting worse again on the third day, I think it would be important to not wait until day 3 to give the next injection. This risks the bacteria developing a resistance to the medication, which can then stop working against it and a new antibiotic will be needed.

So I would give the injection every 2 days. It may be able to be increased to every 3 days once there is sustained improvement. When the antibiotic is showing it's working and there's improvement, it's just important to give the next injection before there are signs of it worsening again.

It's also important to continue to give the antibiotic for a long enough period of time. Treating bacterial infections in rabbits can take a month or longer of antibiotics, to clear it up completely. If you stop the treatment too soon, it risks the infection coming right back and more resistant to that antibiotic.

It's usually recommended that antibiotics continue at least 2 weeks past the last of the symptoms clearing up. Or if there is permanent cell damage leaving the rabbit with a residual head tilt, continuing antibiotics until the condition is stabilized and no longer worsening for at least 2 weeks. So this means that antibiotic injections will likely need to be done for one month minimum, in my opinion.

Medirabbit: ear infection clinical signs and treatment

Thanks so much for the advice! Yes our plan is to give penicillin for every 3 days.

Is this infectious? We have another bunny, Pochi, that is free roam and always come near Bubu's playpen. Do we also need to give the other bunny the penicillin?

 

[JBun]

What I'm saying is that I would give the injections every 2 days, if symptoms are worsening the third day after the injection. This way you're stopping symptoms worsening and retaining the improvement your rabbit makes with each injection.

It isn't likely to spread to your other rabbit if there isn't any respiratory disease involved. There's no reason to give your rabbit unnecessary medication if there are no signs of illness, in my opinion. Especially when it comes to giving antibiotics.

 

[Darojati]

Hello @JBun

So we have been giving the progressive penicillin to Bubu and have seen progress. His nystagmus right eye has slowed down, almost non existent now, but with cloudy/ ulcer (less cloudy now). A month of pen G's subQ injection now. Bubu has regained strength on his front feet, able to run around now.

We just had blood check few days ago at the Vet, and the result is improving data vs Jan'23 when the condition was quite severe. Great news so far.

We have stopped Bonine (Meclizine) now about a week ago.

We just restarted our weekly acupuncture now as the acupuncture Vet was away for almost three weeks.

Bubu still has headtilt however.. his left down eye is open now.. he tries to straighten his head when he runs around in the open space.. but not long, as he then get tired and lay down again.

How long would you suggest to give Pen G injection? Which situation would you then decide that it's time to stop..?


Here is Bubu's 2.5months journey clip:

 

[Darojati]

We just took xray for Bubu's head, and saw the white bulge in the middle ear area!! This is most likely ear infection!!

I really wish we took xray since the beginning how did we miss this

We have been doing penicillin subQ injection for two months now. Bubu has been very active since the first injection. We give him free time more frequently now, and so he always runs around happy.

We plan to continue penicillin for longer time, probably another 1-2months; with monthly doctor checkup.

 

[Mileybun]

At least you have a clearer picture of what is going on with him now, I'm so pleased he is improving! You are doing amazing things for your bunny

 

[JBun]

Inner ear infections in rabbits can be a very difficult thing to treat effectively and clear up. Needing to treat long term, with antibiotics being given for several months, isn't uncommon. It may even become necessary to add another antibiotic or to change to a different one if this one stops being effective.

Thankfully it sounds like the pen g is working well for now. And hopefully you'll continue to see progress and the continued reduction of the abscess with the pen g injections, and not have to deal with having to switch antibiotics.

 

[Darojati]

Hi everyone!

So it's been 5 months now we have been giving penicillin subQ injection every alternate days. Bubu's headtilt is MUCH improved.. it was severely tilting to the left, and now it's normal tilting and almost straight whenever he runs around and active! And lately i have seen his nystagmus is also almost not there! Bubu has also been active since May'23, able to run (but not jump), and now free-roam in restricted space. And I am happy that he is now bonded back together with Pochi, after several attempts.

We have another problem now however! Yesterday we found lumps under his jaw! So today we brought him to Vet, and found 4 lumps (2 big ones, and 2 small-medium size). As checked, they are abscess!! Ughh.. so we had the Vet to remove the puss, and able to remove from the 2 big lumps... even in 1 of them was not entirely removed as Bubu looked hurting. So now the wounds are open, to ensure the puss can be removed whenever it's visible..and we will clean and medicate at home too.

Questions:

1. what are your experience in treating the open wound at home? Will there be puss coming out? I have not seen any yet... what should i do during maintenance at home? I have already made another vet appointment next week for the control checkup.

2. We still have groomer coming every alternate day for the penicillin subQ injection for the headtilt/inner ear infection.. with the current abscess issue, is it still ok to do this subQ? Yeah i forgot to ask the Vet, as we were so focused with the abscess today!

Appreciate your advice as we move forward on this journey. Bubu has been going through a lot of hurdles in his life.

Some photos... puss, the checkup today, and Bubu in recent days.

 

[Lokin4AReason]

Praying for a speedy recovery

 

[Mileybun]

Poor Bubu has been in the wars lately hasn't he?

 

[JBun]

The pus will likely continue to need flushing out each day. Then packing the wound with Manuka honey or other sugar dressing daily, to inhibit bacterial growth. It's what I had to do for a rabbit with a burst facial abscess.

This goes through the steps of cleaning and dressing an open abscess, shown from another rabbit carers personal experience.

Medirabbit: abscess wound management

With the infection spreading, it likely means that the bacteria has become resistant to penicillin and you need to change to a different antibiotic. My rabbit was on azithromycin for her eye abscess, which did end up clearing up the infection she had. If you do need to change antibiotics and it's available in your country, you could ask your vet about it. Though be aware that it can cause severe digestive upset for some rabbits, in which case it shouldn't be used.

https://wabbitwiki.com/wiki/Head_tilt