Long-term hock abscess

[rabbit_friend]

The bunny: spayed female, 5 years old, 10 pounds, black/brown, found as a stray when approx 6 mos old. Eats a mix of pellets, two big salads a day, oat hay and orchard grass. Drinks only dilute apple juice. Looks healthy, sleek glossy coat that all vets have commented on. Lost her female bondmate 3 years ago (probably to e.c.) Now bonded with a 6 pound male who takes good care of her. Never been sick, though had high pasteurella titer two years ago. Xrays show some spondylosis and hip arthritis.

The problem: Trouble hopping and wasn't using litterbox. Discovered ulcerated left hock in late January. Vet said it looked like it was healing, prescribed soaks and metacam. Pink, almost completely closed skin by late May, noticed swelling, squeezed, and out came some thick white pus. Went to new vet who insisted on reopening it to clean and culture. Wound would not heal, back to first vet again, and now wound is closed again but still looks somewhat swollen and inflamed.

Tests run:
March: basic blood panel, normal
June: culture (included part of abscess wall) showed only staph aureus, susceptible to nearly everything. Xray showed no bone involvement.
August: xray, no bone involvement
late Oct: culture (needle aspiration), showed only methicillin resistant staph schleiferi (subsp schleiferi)

Treatments tried:
Feb - May: two weeks of metacam .75 ml/day, then only as needed, with epsom salt soaks and Healx Soother Plus till ulcer almost completely closed. No abx.
June (after infected and reopened): one month baytril 50 mg/day oral concurrent with chlorhexadine flushes and silver sulfadiazine cream.
July: one month SMZ/TMP 120 mg 2x/day oral, switched from chlorhexadine to Vetericyn to flush halfway through.
August: back to baytril (same dose as before).
Sept: pulsing baytril on and off weekly per vet's instructions (though mostly I kept her on since hock got inflamed when off).
past Friday: after culture, started on tetracycline 250 mg every 12 hours.
Benebac gel (1 g) given once or twice weekly since mid-July, every other day since starting tetracycline. Fluids given two days ago. Metacam last night.

Other symptoms:
Red rash on ears, worse on right ear, developed 2-3 weeks into baytril in June. Vet thought allergy, maybe to baytril, but when off baytril it would often get worse. Cleared when I upped the baytril to .75 mg/day for a week, came back with lower dose. Cleared after first dose of tetracycline, back now.
In mid-August, the other hock (right) developed a small hard bump on the bony point, almost like a red bony protuberance. Xray showed no bone infection. Vet did not know what it was. Was a small pink bare spot prior to that.

Concerns:
-liver and kidney health after 5 months on abx (adding milk thistle a good idea?)
-risk of enteritis/clostridium overgrowth on tetracycline
-calcium in GI tract inactivating tetracycline (Frances Harcourt Brown)
-decreased number of antibiotics now available after resistance developed
-anaerobic bacteria, or others not cultured
-latest culture report returned after only 2 days -- doesn't seem enough time to grow all that might be in there
-10 days of tetracycline enough?
-so far tetracycline doesn't seem to be doing anything. Hock red and inflamed.
-appetite suppression: hardly any appetite yesterday and isn't eating/drinking anything sweet. Still munching hay and some greens. I know this is common 48-72 hours after starting abx though. Gave more benebac last night. Appetite improved some this evening.
-hot/cold ears. They seem to be alternately on fire and then ice cold. She seems to be cold at times, hunched up. Loved being wrapped in warm towel from dryer. Have taken temp a few times over the last few days and seems steady at 100.5. Seems to have some difficulty regulating body temperature though (due to not eating much?).

I've read many (all?) of Randy's posts about abscesses with great interest. Especially interested to read that pasteurella rarely shows up on culture, since that is what I suspected in June. I mentioned bicillin to the vet in June. When culture came back staph, he said "good thing we didn't try the penicillin since it wouldn't have worked on the staph." I said I had heard from others that their vets prescribed bicillin in addition to baytril in the assumption that anaerobic bacteria were present (which he admitted would not be cultured), but he said hock abscesses rarely involved anaerobic bacteria and that they were mostly found in facial abscesses. Didn't want to subject my girl to anything unnecessary, so dropped the bicillin subject. Now I wonder if we should have tried it, and whether it would help now. Also wonder if the MRSS is the prime culprit, or just one of those "tagalong" bacteria Randy has posted about.

Sorry about the length -- I wanted to include as many details as possible. Any advice or comments highly appreciated. If you've made it this far, thanks for reading!

Petra

 

[tonyshuman]

This is a serious issue and I wanted to let you know I'm taking it seriously, but for that reason I can't respond yet--I need to do some research.

I want to throw out a few quick suggestions to see if you've considered them: the antibiotics chloramphenicol and Convenia? If it was susceptible to Baytril, Convenia may be a good choice as it is a newer version of the compound in Baytril.

 

[fuzz16]

i cant add a lot of help to this, but i hope she gets better.

best thing to do though is keep it as clean as possible...i have mrsa, dont know how it compares to mrss. but i have to use an anti bacterial soap twice a day and it still comes up now and then.

clean her cage as muh as possible daily, make her take plenty of fluids.

 

[rabbit_friend]

Thanks fuzz16 -- sorry to hear you have mrsa. I've done a lot of reading about it in the last week, and it seems hard to beat. It's the staph aureus species, while mrss is the staph schleiferi. Unfortunately, she doesn't drink much, but I have given her subQ fluids twice in the last few days. I'll have to try antibacterial cleansers. Since it was found inside the abscess I didn't think about cleaning the outside since the skin isn't broken, but it may help her ear rash.

 

[rabbit_friend]

Thanks Tonyshuman -- I'm glad to hear someone as knowledgeable as you is looking into it! This is unfortunately now resistant to baytril and a lot of the usual abx, including the Zeniquin that Randy speaks highly of. But it did come up sensitive to chloramphenicol, and I'm wondering after reading some studies if that wouldn't have been a better choice than tetracycline. I am worried about the bone marrow suppression and other side effects of that though. What experience do you have with the chloramphenicol?

 

[rabbit_friend]

She had a bad day yesterday, wouldn't eat or drink most of the day. Midnight munched some salad and had full appetite this morning, so I'm relieved a bit. Gave more fluids today warmed to body temp since she was very cold - wrapped her in warm towel till her ears were warm and she was contentedly chattering.

For the record, here are the drugs tested for this staph infection:

resistant: ampicillin, clavamox, cephalothin, methacillin, enrofloxacin, trimethoprim/sulfa, marbofloxacin

susceptible: chloramphenicol, clindamycin, erythromycin, gentamicin, neomycin, tetracycline

In June, the only resistance was to ampicillin :-(

 

[tonyshuman]

What I'm finding is that S. schleiferi is really rare, but can be susceptible to penicillin.

Based on the resistance/susceptible data you showed, I think a course of chloramphenicol and azithromycin would be a good idea. The resistant drugs are the beta-lactams (ampicillin, methicillin, clavamox, cephalothin), the fluoroquinolones (enrofloxacin=Baytril, marbofloxacin), and sulfa drugs (trimethoprim/sulfa). For this reason, something like Bicillin (penicillin G procaine/benzathine) or ciprofloxacin won't help. Convenia (cefovecin) also has a related mode of action to the the beta-lactams, so it probably won't help either, and Zeniquin is a fluoroquinolone so it too may not be helpful.

I think trying some of the other classes of antibiotics will help. The ones that it is susceptible to act on a different cell pathway to kill the antibiotics--they are protein synthesis inhibitors as opposed to compounds that destroy the bacterial cell wall (like beta-lactams).

At the bottom of this page there's a really helpful table of different types of antibiotics
http://en.wikipedia.org/wiki/Macrolide

Choosing from different categories is a good idea. I think chloramphenicol and azithromycin is a good idea.

They are both on the safe list for rabbits:
http://www.medirabbit.com/Safe_medication/Antibiotics/Safe_antibiotics.htm

(these are the unsafe antibiotics for rabbits)
http://www.medirabbit.com/Unsafe_medication/dangerous_antibiotics.htm

With chloramphenicol, the bone marrow issue can be avoided by you not handling it directly (wearing gloves). I have not heard of it causing issues in the rabbits it is administered to.

Tetracycline may be one of the susceptible antibiotics, but it is usually not dosed correctly for rabbits and does cause more harm to the GI bacteria than other antibiotics.

About the ears--was she really hot on those days? I wonder if it's a result of trying to lose some body heat by pumping extra blood into the ears? It may be good to give her aspirin to help reduce the fever so she doesn't have the hot/cold alternating episodes, and maybe it will reduce the rash.

I do think there may be anaerobic bacteria in there too, but you will have to start with the bacteria you can find and hope that treating that will take care of the anaerobes as well.

A topical ointment may help too, including on the other hock. I use bag balm a lot on sore (non-infected) hocks, and neomycin is an ingredient in triple antibiotic ointments like neosporin. Another really good topical antibiotic is Silvadine cream. Using a topical one might help a little at least.

You can give the Bene-Bac 1g daily if she's not eating well. Another product some people like to stimulate appetite in rabbits is Nutri-Cal. It's made for carnivores, not rabbits, but it does contain B vitamins that can stimulate appetite and it has a lot of calories.

Is there any chance you might be able to find a vet specialist in bacterial infections? It's clear that your vet is doing the right things, but a consult at a nearby veterinary school may be helpful.

 

[rabbit_friend]

Here's an interesting article about s. schleiferi in pets I ran across while researching:
http://www.wormsandgermsblog.com/20...nresistant-staphylococcus-schleiferi-in-pets/

That's a great chart on the Wikipedia page -- very helpul! One thing I'm confused about: since erythromycin is unsafe for bunnies, how is it that azithromycin is safe? Just curious. I see it can cause diarrhea. Unfortunately, it wasn't tested on the C&S, but I agree it might work since it's in the same class as erythromycin.

The Zeniquin was on the resistant list (marbofloxacin). I was sorry to see that because I was excited about Randy's successes with it.

I didn't know the bone marrow suppression with chloramphenicol was only for the human. I was going by the chart in "When Your Rabbit Needs Special Care" where it was listed as a side effect for the rabbit.

The tetracycline is being dosed at the recommended doses I've seen (50 mg/kg every 8-12 hrs) -- do vets go above that for abscesses? I wouldn't want to risk that given what I've seen at this dose.

I've taken her temperature when her ears are hot and flushed, and she hasn't had a fever. But she does feel hot at the back of the neck too. I have given metacam a few times when the ears seemed really inflamed -- wouldn't that reduce a fever too?

I still have some silver sulfadiazine cream(same as Silvadene, I think) that I put on it when it was more open. Given the new culture, it's a good idea to go back to it. I've been using topical creams, but only calendula gel or Healx soother since the wound has been closed. The ears are a much larger surface area, and licked by her partner a lot, so I would worry about using it there. Bag balm didn't seem to help as much as the Healx or calendula.

I'll check into the Nutri-Cal. Closest vet schools are 2 hours away, so a trip would stress her too much, but a consult is a good idea. Wish he'd done one 5 months ago!

About the azithromycin and chloramphenicol -- I see they can both be given orally once a day. Should one be given in the morning and the other in the evening then? And just keep giving it till the abscess is gone, plus some extra? I see they both have good penetration and the azithromycin gets a lot of anaerobes too. Seems like a good call. Could I switch immediately from the tetracycline or have to wait (or finish the 10-day course)?

Thanks for your time!

 

[fuzz16]

why wont they do penacilin...just wondering because dogs wit mrsa get penacilin to help clear it up. and the infection is on the skin forever pretty much, how it was explained to me. and on anything you touch.
when it gets in the bloodstream theres nothing you can do which is whystaph an be so dangerous. not eating could mean she isnt feeling well. are her ears hot at all?

put some anti bacterial on her hock maybe and wrap it with something. will be hard to get her not to chew on it...but its an idea to try to keep the area clean

 

[PixieStixxxx]

When I picked up my stray Uvic bunny.. she had two mass abscesses hanging off her right hind ankle. Xrays showed it had seeped into the bone. At the time, the option was to amputate.. but my vet wanted to try and save her leg.

He had told me a combination of penecillian injections + zithromax oral antibiotics has proved to go inside the bone and kill a staph infection. After one month, the abscesses shrank an enormous amount. Then I had cold laser therapy done on the leg, but I don't know if that played a role in the abscess shrinkage.. the therapy was for the fact that the hock was fused together and it was to stimulate break down of the damaged bone cells. She can move her ankle now thanks to cold laser therapy.

So I continued the injections and antibiotics and the abscesses are so small that when we went to do a FNA, we werent able to draw any pus out. So I'm just going to continue until both abscesses are gone.. they're about the size of my pinky. And I used to be able to hold these abscesses in my hands. She doesn't need a leg amputation anymore =]

 

[rabbit_friend]

Fuzz16 -- she's not eating just since the tetracycline, and that's a known side effect and mostly just the third day. Her appetite is getting better and she's eaten pretty much salad today (yay). Her ears are hot sometimes, cold sometimes. May just be the antibiotic messing her thermostat up. She's feeling better this evening -- just did a bunny flop beside me as I write this.

I haven't seen any stories about penicillin with dogs, but as Tonyshuman pointed out, it's in the same class as methicillin so probably wouldn't do more than maybe control it a bit. I did see some interesting stories about Zeniquin and other abx in German Shepherds:
http://www.germanshepherds.com/forum/health-issues/98156-staph-infection-mrsa.html

What you say about the "bug" getting on anything you touch worries me, since my bunny is free roam and so that would mean it's on the carpet everywhere with no way to sanitize, and she'll just keep getting it (and maybe my others too).

I've put antibacterial cream on it today. I'll try a bandage, but she doesn't leave those on for long I feel like I clean her litterbox constantly, but she also licks it so that helps keep it cleaner.

 

[rabbit_friend]

PixieStixxxx -- what an inspiring story, and what a great vet you have! I wish I had someone that dedicated and knowledgeable in my area. Luckily, my bunny's abscess isn't nearly that large.

I would like to try the Zithromax - sounds like a good antibiotic. Never heard of the cold laser therapy -- sounds cutting edge. How long have you had her on the injections and Zithromax, and how has she tolerated those? And did your original culture show sensitivity to penicillin?

Hope your success continues and she gets completely cured. You're a very dedicated bunny mom!

 

[rabbit_friend]

She just ate another big salad, and had a lot of poos -- first large batch I've seen in several days. Very elongated and some dried out while others soft, but it's good to see her pooping again. Maybe her system is getting more used to the tetracycline. The abscess seemed to be getting larger the first few days, but now seems back to where it was while on the baytril. Maybe it'll start getting smaller now (I hope).

 

[rabbit_friend]

Fuzz16, I meant to ask -- has anyone mentioned microcyn (human form) or Vetericyn to you? Seems to do wonders with skin infections and other problems, and is supposedly effective in reducing bacterial colonies including mrsa. I used it on my bunny's abscess when I was flushing it and it seemed to work well with no irritation. May get some more and try cleaning her ears with it, though it's expensive stuff.

 

[tonyshuman]

There should be improvement on any antibiotic within 3-4 days of starting it. If there's improvement, it should be taken for 14 days or as long as symptoms persist (with an upper limit being considered if it's been 28 days or something).

I would stick with the tetracycline since you have seen some improvement and take it to at least 14 days. You can add the chloramphenicol but it might be better to wait to see if the tetracycline finishes off the infection. Zithromax does have some GI side effects, althouhg I think they're less than tetracycline, so if she's gotten acclimated to tetra, stick with it.

Probiotics should be given 1hr before or 2 hrs after an antibiotic dose.

If she fusses with the wound a lot you can make a sock out of a cotton glove finger, and have it kept on by an elastic band (not too tightly). Angieluv did this for some bad hocks--you could PM her to ask about it.

The Silvadine is good stuff. I'm not sure what is going on with her ears. Is there a chance it might be mites? The stress on her system could allow other common diseases to come up. I am really stumped about the ears. Yes, meloxicam (metacam) should bring down a fever too--it's a lot like ibuprofen.

 

[Pipp]

I think its common for the rabbit to go off food and look miserable for the first 24 to 48 hours on antibiotics but I agree that the infection should start healing.  And my vet says to give the pro-biotic 3 hours after the antibiotic, but I'd prefer one hour before, didn't know that was an option.  Good to know.

What's her weight like?  The diet sounds like it could be packing on some pounds.  She may not appear obese, but the fat gathers under the skin and around the organs.  Given the other problems as well as the sore hocks, sounds like she'd do better at a lighter weight.   Healthier for her organs, too.

What's the flooring?  Certain kinds of carpet and other flooring can be really tough on the feet. 

My mini-rex went through a similar regime, at least in terms of a mildly ulcerated hock that caused me great concern.  I had surgery done on it while he was under for his neuter and he was put on betadine, ointment, chlor palm and penicillin shots regime.  He almost stopped eating (this guy is a food shark, he'd eat with his last breath), and he was miserable. 

The cure was looking worse than the problem.  It wasn't in the bone and although there was a pus pocket and a bit of an open wound, it didn't look life threatening, and I honestly couldn't say the same for the treatment.  So I stopped.  He perked up and I never had a problem with him again.  The foot cleared up nicely on its own.  Sometimes it comes back, but it clears up with no treatment. 

I had put rock mats down over the parts of the carpet he was using as a launching point for jumping onto his second level, which I'm sure helped a lot.

I'm really wondering if sometimes our treatments are overkill. We're conditioned to panic when we see bunny abscesses, and nobody wants to test a theory with under-treating and ending up with infection in the bone, so its a tough call, but I'd like to hear more experiences.  

With the opportunistic nature of these pathogens, I keep thinking the stress of grabbing, clutching, poking, cleaning and medicating twice daily has to be detrimental. 

Regardless, I'd like to see a bit more emphasis on giving the rabbits' natural immune systems a chance to work, making positive changes to the environment and diet, reducing stress, etc., and not just blasting them with chemicals.   I'm not sure how to boost an immune system beyond the obvious, but its something I'd like to look into.

sas  :clover:

 

[rabbit_friend]

Tonyshuman, she does seem to be acclimating to the tetra -- she's eating up a storm this morning and she was drinking a lot of the dilute apple juice. Still avoiding her apple and carrot bits -- seems to know that sugar isn't good for her tummy right now! I also haven't seen her eating pellets in the last 5 days, but gave her some pellet mush last night and she ate some of that. The abscess does look some better, though it took 5 days to respond at all, which worries me.

She doesn't fuss with it, as it's not an open wound. Just licks it occasionally to clean it. It's only about 1/2 inch in diameter, but has looked like fluid (pus) collected under surface rather than solid flesh underneath. I'll see if I can get some pictures. I have some from earlier stages, so it would be good to compare. The glove finger might be good just to keep it clean and prevent any abrasion, though I'd worry about it getting wet with urine.

My thought after reading about MRSA rashes is that her ear rash is similar to that and caused by the bacteria. A red bumpy itchy rash is the first symptom they look for in MRSA from what I've read, and they've had to educate doctors to look for it and think possible MRSA, so I'm sure no vet (at least around here) would look at it and think MRSS. But the sites I've seen about dogs with MRSA talk about itchy rashes that were mistaken for allergies. No sign of mites. Vet took a swab of ear and looked under microscope and didn't see anything. It does seem to be getting better on the tetra -- it hasn't been flaming red since two days ago. That's been the pattern in the past -- rash gets worse first 3-4 days on a new antibiotic, then gets better. Weird. I'm going to try cleaning them with a pad soaked in Vetericyn -- should reduce any bacterial colonization on the skin if that's what it is. I've seen bleach water soaks recommended for MRSA patients for that purpose.

I'll phone and get a refill -- I only have enough for 10 days right now. As slow as it was to respond, I'd like to go 20-28 days actually, if you say it can be given that long.

I've been giving probiotics about midway between doses, 6 hours before or after. I figure that gives the little buggers the best chance to survive. I've never really understood about giving it just an hour before -- seems like the antibiotic would immediately kill them off before they could proliferate. But I have seen that mentioned in other places.

 

[rabbit_friend]

Pipp -- you make some excellent points, but first I'll address the questions about my bunny.

Her weight is actually a bit lower now than I'd like after 11 months of dealing with this hock. She was overweight and on a hard indoor-outdoor carpet at the start, which I'm sure is what caused the problem to begin with (in conjunction with some spondylosis of the spine which shifted her weight from toes to hocks). After discovering it, I moved her to a room with softer carpet with underpadding and put down lots of soft cotton rugs. What do you mean by rock mats -- those shower/bath mats with the pebbles on them? Can he get a grip on that?

My vet, fortunately (or maybe unfortunately in some cases), believes very much in letting the natural immune system work. That's why he didn't give antibiotics the first four months even though she had an open cratered hock wound with crustiness. I did epsom salt soaks to remove the crustiness and dead tissue and he said her licking it to keep it clean was the best thing for it. There wasn't any pus, and there were no pockets. It granulated and started filling in and the skin started growing over. I do think now that if he'd given antibiotics during the time when it was closing up and she couldn't get in to clean it any more, it would have healed fine (5 months ago). That was a case of undertreatment, in my opinion.

When it did become infected, I think just trying the antibiotics first would have been the right treatment, but the second vet we went to insisted on doing the same as yours -- "surgery" to clean it out and culture it. The "textbook" approach. But I think surgery on a hock is a mistake. There's always weight on the wound, it's hard to keep clean without bandaging, it's too close to tendons and bone. My first vet wouldn't do it for all those reasons. I allowed the second vet to do it with grave misgivings, and it was a huge mistake. Then on top of that, he prescribed chlorhexadine flushes that I think just ate up any healing tissue and destroyed the wound bed. All of that was definitely overkill, and has cost us 5 months (and more to come) and heaps of dollars and time. Not to mention the pain for my bunny.

But then prescribing baytril at 50 mg/day was undertreatment again. I think that's what is recommended every 12 hours. Plus I've read an interview about resistant staph in pets, and the comment was that staph becomes resistant to baytril very quickly (and we had staph aureus in the initial culture). My theory is that it only took 2 weeks, since that's when that ear rash started appearing that I attribute to the resistant staph. So starting with a better drug might have wiped it out quickly while it was still susceptible.

My first vet believes in letting the immune system handle many things. One of my bunnies has been in a fight three times and gotten three wounds, and I trusted the vet when he said she didn't need antibiotics. One was a very nasty hole in her paw that did get some pus. Everyone on a list I posted to at the time was urging me to get her on antibiotics. The vet said leave it open and let her clean it. No flushing, no abx. And she did clean it out thoroughly more times a day than I could, and it healed fine. So did the other two wounds. But these were all open and not abscessed. In fact, when the skin healed over on the foot wound and I saw a yellowish spot that looked like pus underneath, she broke it open and cleaned it out.

I still remember an episode of Meerkat Manor which I found while channel surfing and thought "what a neat program." One of the meerkats got a scratch on his face in a fight. A minor scratch, but it got infected, and he couldn't reach it to clean it. They followed him around with the cameras apparently until he died of the infection. I haven't watched it since then. I was so mad, though I know that's nature. Animals don't always miraculously heal themselves. So I'm glad for antibiotics and all that, but not glad for vets (or doctors) who want to jump in with the entire arsenal for everything.

The treatments twice a day were stressful at the beginning, but we found some less stressful ways of doing things and I think she actually started enjoying all the attention. But she is a big, laid-back bunny. If I'd had to do that with one of my dwarves, I don't think he would have survived. The stress would have killed him outright or really compromised his immune system. So I think it depends on the bunny. And also on developing some less stressful techniques, like:
1. I never grab her -- I put the carrier in front of her and gently urge her into it. Much less stressful than grabbing and picking up.
2. Everything is warm and ready -- meds, rinse water, towels.
3. At first I was trying to lift her hind leg to work on the hock, or trying to turn her on her back, and she was struggling against me. Then we found a way to just gently stretch her out with her hind end twisted like she lays on the ground. She would lie there for 30 minutes while I cleaned the hock and only jump if I hurt her a lot or she needed a potty break.
4. I give meds only with a 1 ml syringe. Anything bigger she really hated, and this is easy to slip in the corner of her mouth and I don't worry about squirting too much at one time.
5. Lots of massage and petting time afterwards. I think she actually was calmer and moved easier after than before.

Anyway, I agree completely about boosting the immune system, making positive changes in the environment, and reducing stress. The first thing I did when she was in a lot of pain and very morose from the ulcerated hock was to bond her with an upstairs bunny she had been visiting only through a fence. I think his grooming and comforting her made a lot of difference. Chemical-free immune system boost!

 

[rabbit_friend]

Well, she was dancing around and standing on hind legs today for her morning salad -- so good to see her perky again after the first days of tetracycline. I picked up a refill of the tetra and will keep her on it.

One question -- does anyone know if giving her some milk thistle will interfere with the tetra? Or have any other suggestions for supporting liver and immune system that won't interfere with the treatment? Since she's been on abx for 5 months, I'd really like to get some supplement support going.

 

[fuzz16]

i wouldnt give any milk thistle along with the antibiotics, the compounds could interact and you could not get the same effects

good thought hat shes feeling better.

and yes staph gets on blankets and couches and anything...for the carpet not a lot you could do. ask the vet how easily it could be transferred to you. vaccumm plety and keep the place clean, do laundry when needed and youll be fine.

i have not had an outbreak for two months, but due to ack fo insurance i stick with two types of antibiotics that work fine to kee it in control. the antibacterial soap i use is meant specifically to kill germs, so it helps. and because my immune system is so compromised from it i eat good to give my body a fighting chance.

so keep her healthy, litte stress as possible, and she will be able to fight it off.