Nasal congestion and sneezing, culture done, what meds?

[rabbit_friend]

My 6-year-old female dwarf bunny has been sneezing since February. I put it down to some very dusty hay we got in since all my buns were sneezing. Got new hay and everyone quit sneezing except her. In May she also developed some clear discharge from her nose, so she went to the vet.

Xrays showed lungs clear, but enlarged bulla in her right ear. Culture was done (results below) and she was prescribed SMZ/TMP which we discontinued after 5 days since it was bothering her stomach and she developed white discharge from her eyes. The discharge only started after we gave sulfa and stopped after taking her off it. The vet did find a small ulceration in each eye so we gave oxofloxacin eye drops for 10 days, though the discharge cleared up the day after the sulfa was discontinued.

She has been off the sulfa for 3 weeks and still sneezing/congested occasionally. After 5 days of coccidia treatment that ended Monday, the congestion is worse and she was scratching her right ear a lot two nights ago. Not so much since I gave her some metacam. Appetite is somewhat reduced, poop is still good.

Culture showed the following:
>500 colonies gram negative rods (2 fastidious types)
>100 colonies alpha-hemolytic streptococcus
10 colonies bordetella bronchiseptica
>200 colonies gram-positive coccus (resembles streptococcus)
~50 colonies capnocytophaga, nos

I'm not sure if the other colonies are unimportant (seems there are more of them!), but susceptibility tests were done on the bordetella only. It was susceptible to amikacin, amox/clav, chloramphenicol, enrofloxacin, gentamicin, marbofloxacin, tetracycline, ticarcillin (timentin), trimeth/sulfa

resistant to ampicillin and ceftiofur (and cephalothin had an I rather than S or R next to it)

I have read lots of Randy's and TonysHuman's posts about baytril, sulfa, zithromax, bicillin, etc. I was not in favor of the sulfa since I had read that respiratory illnesses usually come back worse after discontinuing it, but since we had some clostridium too at the time, we went with it.

I would prefer something injectable since she stresses a LOT with syringes (and even being caught and handled twice a day). I know bordetella is resistant to bicillin but am thinking the ear problem might respond to it, so some combination of meds maybe? Nebulizing might be less stressful to her than syringing, though I don't know since I've never tried (have only watched the online videos). I'm sure she would not go for nose drops!

She eats timothy, orchard grass, and oat hay, plus salads and a mix of Kaytee Forti-Diet Pro and Oxbow Bene Terra. She weighs 3 lbs 10 ounces and is bonded to a sweet little dwarf boy who takes good care of her. Any thoughts appreciated!

 

[tonyshuman]

The combination might be a good idea, although the amox/clav might be a good injectible treatment. I am not able to do the detailed research right now to say what is best based on those results, which are very helpful, but a combination is usually good, and azithromycin is usually very good for URIs, though it usually has bad GI effects and is usually given orally. Was it tested? Chloramphenicol is also a "big gun" that many have had success with.

 

[Maureen Las]

I have not every heard of amox/clav being use as an injectable on a bun but do know that it is a big NO orally.
I too know that oral chloramphenicol is supposedly a great drug but that the person administering needs to be careful in not having physical contact with the drug ( easy if you just use gloves!!) it could be compounded with a flavor so that the bun may take it orally willingly.
I do not know if Randy will respond as I know that he is very busy but you may want to email him directly at [email protected]. Go into a lot of detail to give him more info.
Maureen

 

[rabbit_friend]

Thanks to both of you! My vet gave me a choice of baytril, chloramphenicol, or nebulizing with amikacin. She also mentioned the timentin, but I have not been able to find hardly any mention of anyone using it in a pet bunny for uri's so am not comfortable using it. I chose the chloramphenicol. Unfortunately, she called it in as powder in a capsule, since that's how we ended up getting our last prescription due to me not liking the sucralose in the suspension. It didn't matter for that one, since it was ponazuril, but I can imagine that my not having contact with the powder in a capsule while trying to mix it will be difficult! What sweeteners/fillers do you guys think are acceptable in a suspension (likely to be given for weeks)? I've just read not to give aspartame, xylitol, maltitol, sucralose, etc to bunnies.

 

[rabbit_friend]

Oh, TonysHuman, I was surprised to not see azithromycin on the susceptibility list (would have liked to see the results). I've been doing plenty of research myself, so maybe I can just run things by you as I find them.

In particular, I've been looking at what bacteria might be doing the ear thing (not likely to be bordetella), and which drugs or combos are likely to hit bordetella and pasteurella (since I've read that bordetella in the nasal passages predisposes to pasteurella and the latter is likely in the ear infection, if that's what it is).

This website has some helpful information about amoxicillin and the ticarcillin/clav (timentin):
http://cpharm.vetmed.vt.edu/VM8784/antimicrobials/Classes/penicillins.cfm

I really am not very keen on the chloramphenicol, because I read Randy's advice to someone else (in 2009) to "save it for another day" since it is, as you say, a "big gun." I'm not sure we need to go to that extent right now (and it does have bone marrow suppression in rabbits, though reversible). By the way, I think I remember reading also that Randy said not to use chloramphenicol and bicillin together. Is that correct, and do either of you know why?

http://cpharm.vetmed.vt.edu/VM8784/antimicrobials/Classes/penicillins.cfm

 

[rabbit_friend]

From medirabbit's page on otitis media:
[FONT=&quot]Chloramphenicol and penicillin (bicillin) antibiotics pass the blood-brain barrier and have successfully treated middle or inner ear infection in rabbits. Trimethoprim sulfate is sometimes advised, but appears to bring poor improvement in rabbits. This could relate to the fact that half-life of this drug is about 40 min in rabbits. ...[/FONT][FONT=&quot]Combined antibiotic therapies can be administered, such as enrofloxacin/chloramphenicol or marbofloxacin/penicillin.[/FONT]
I have seen marbofloxacin recommended on here, in preference to enrofloxacin.

Also: [FONT=&quot]Pasteurella multocida[/FONT][FONT=&quot], a natural host of the nasal cavity of rabbits, is often associated with middle and inner ear infection....[/FONT][FONT=&quot]Staphylococcus aureus[/FONT][FONT=&quot] is considered an opportunistic pathogen of the nasopharyngal cavity of rabbits. Its presence in the ear can lead to severe middle or inner ear infection....[/FONT][FONT=&quot]Further bacteria known to cause inner ear infection include Streptococcus sp., Escherichia coli, Enterococcus sp, Proteus sp., Pseudomonas sp..


[/FONT]

 

[Maureen Las]

I did not pull up the thread but I also remember that Randy felt marbofloxicin (Zeniquin) was far more effective than enrofloxicin.

I am wondering if you could talk with a compounding pharmacist re. acceptable methods of creating a suspension for chloramphenicol ; I don't even know if a pharmacist will compound it.??
We have a pharmacy in my town that compounds for a lot of veterinarians. Maybe your vet could recommend someone for you to talk to.

 

[Maureen Las]

I also remember someone stating that chloramphenicol and penicillin should not be used together but then I also recall that Sas's vet , Dr Martinez uses chloramphenical (chlorpalm ) and benzathine penicillin for a lot of bunny infections.
As I recall one drug decreases the potency of the other , however, I do not recall the source of this info .

 

[rabbit_friend]

I had read a post by Randy that marbofloxacin was more effective (but it was several years ago) and asked my vet about it today. She said more recently it has been found to be less effective and should not be used in rabbits because it is poorly absorbed. I got some injectable baytril from her to give while awaiting the chloramphenicol (and possibly continued in conjunction with it).

Here's the page where Randy says not to use chloramphenicol and bicillin together (at end of post #2): http://www.rabbitsonline.net/f27/pen-g-vs-bicillin-29133/ That was in 2008, so perhaps some of the vets like Dr. Martinez have discovered how to combine them successfully.

I spoke to the head pharmacist at the online pharmacy that is sending me the chloramphenicol, and he said the powder is pretty heavy, not the sort of thing that would get blown around, and if I mixed it in a deep bowl and wore a face mask and washed my hands thoroughly, I shouldn't have any problems. You can bet I'll be wearing disposable gloves (maybe even a hazmat suit!). I'm starting to wish I'd just ordered the usual suspension with the sucralose in it ;-)

 

[rabbit_friend]

Update: Started her on baytril (10 mg/kg injected 2x per day) on Saturday as I was concerned about her breathing sounding worse and the chloramphenicol wasn't due to arrive for another several days. Since then her breathing and eating are a lot better, so I am considering holding off on the chloramphenicol until she goes for followup xrays in 8 days with the exotics specialist vet.

I've seen a lot of posts on RO about respiratory infections coming back even worse after baytril treatment, so I'm worried about possibly developing resistant pathogens while giving just baytril. Should I be more aggressive and add the chloramphenicol now?

 

[tonyshuman]

If it can be treated with baytril without any GI issues, then I'd do that and not add the chloramphenicol. It sounds like administering that will be a huge pain, plus maybe it is best to save for another day. Ideally, the infection should not come back, and if it does, you will want to try baytril again first. If you dose properly, as it sounds like you're doing, then the bacteria should not come back with resistance to the drug. Usually we expect to see improvement within 4-5 days, so the improvement you're seeing is good. There are also stronger meds in the same family as baytril, like marbofloxacin as previously mentioned, so you're not exhausting what's available to you by treating with Baytril.

 

[rabbit_friend]

Just wanted to update: so I continued the injectable baytril for a total of 5 days before noticing that she had some nasty necrotic injection sites (ugh). My fault entirely, since I had forgotten to change needles after drawing up saline and meds. Felt so sorry for her. Held off for a day and a half, but then thought she should continue on some antibiotic for both the necrotic sites and the uri, so diluted well and changed needles for a couple more days of injections (with no issues), then got some liver flavored baytril from the vets and continued for another day or two with that orally before our scheduled visit to the exotics specialist 2 hours away.

Her symptoms seemed gone and I asked the vet at the outset if the enlarged bulla might be gone as well. She said not likely, since that indicated a long-standing issue that would need longer treatment. But xrays showed the right bulla was not enlarged any more, so they said to take her off all meds. That was a shock to me, since she had only been on the baytril for a total of about 8 days. I was expecting they would give me a better-flavored version to continue for at least a total of 14 days, since that's what I've read (and in particular, to continue abx for uri's at least 1-2 weeks after symptoms abate). With some trepidation, I followed their instructions and discontinued meds since it stressed her a lot anyway.

The necrotic sites have healed up wonderfully with SSD cream, and other than an occasional sneeze and slight watering of the right eye, I cannot see any returning uri symptoms. Perhaps since the baytril was injectable, it was stronger and faster-acting? But I am keeping a careful watch, especially since she is also dealing with cecal dysbiosis and coccidiosis, although it's hard to tell if as a primary or secondary disease with regards to the uri.