When (& WHAT) to change the antibiotic or anti-protozoa if illness still regressing

[ts786]

I have an 8 year old rabbit with head tilt that began about a week ago. I would like input as to when I should ask to have the treatment regiment changed.

A few hours into the start, the rabbit got emergency care and was given Baytril, high-dose Panacur, cesapride, meloxicam, and Bonine. I have not been using the meloxicam, and have added VSL#3.

In the past 2 days (after 7 days of being on the medication), the dizziness has gotten worse and the head has become more turned. At no point in time has the rabbit stopped eating hay, pellets, vegetables, and is still consuming water, making normal poop output, and consuming cecetropes. If I am going to change the regiment, now is the time given we all know what the prognosis can spiral to when a rabbit stops the above.

I know that both the protozoa and (multiple suspected) bacteria causes of head tilt take a period of time to respond to treatment, but my concern is that after 9 days of treatment than worsening balance indicates that one or both causes are still advancing the attack, and it is probably on her spine. I am also aware of concern of developing quinolone resistance to one of the strains of bacteria that has been noted as having some degree of relationship with head tilt.


MY ASSUMPTION ON CAUSATION
It appears some parties feel that certain strains of bacteria are the cause, where others feel it is the secondary infection, and multiple different strains have been associated with head tilt. I have to work off of the assumption that my rabbit has both a serious protozoa (e. cuniculi) and an serious and unknown bacterial infection, simultaneously.


FOR THE BACTERIA
My rabbit has never had an ear infection and her ears are clear...so I presume if this is indeed bacterial, it is somewhere between deep within her inner ears to her brain...either way, a biopsy and susceptibility testing are limited, if not useless. If I am going to change the antibiotic, it needs to be something that will rapidly kill as many of the possible bacterial as possible given multiple rounds of antibiotics (with people and rabbits alike) can easily end up badly.

In place of the enrofloxicin, I am thinking doxycycline because of how it rapidly crosses the blood-brain barrier, it's tendency to be pH resistant, how it is considered an antibiotic of choice to treat CNS infections and cross the blood-brain barrier when there is inflammation (even in its oral form), its widespectrum activity, and its limited anti-protozoal effects. Could doxycycline's limited anti-protozoal affect act as a potentiator to other anti-protozoa medications or make the body less hospitable to the parasite's ability to survive?

I am also very interested in a specific antibiotic, cefepime. Has it been used (obviously IM/IV) in rabbits and is there any outcome data?


FOR THE PROTOZOA
I am still reading on differences of thought with a high-dose Pancur versus a cocktail of panacur plus several other medications used with it. I am not having luck finding efficacy data regarding e. cuniculi in specific. It seems some Vets like to combine it with Ponazuril. Is there any data suggesting the outcomes of the different management?

I am also starting to read about albendazole and fumagillin.


Do you think it is time to change the regiment?
If so, would you change the antibiotic, the antiparasitic, the gut motility agent, none, or all?

Thanks much

 

[JBun]

Is there a reason you opted out of using the meloxicam? It's actually quite an important part of treatment as it helps reduce the inflammation caused by either an infection or the parasite, which inflammation causes cell damage and the symptoms that are exhibited. Bringing down this inflammation will help prevent further cell damage occurring and can help ease the head tilt symptoms, as well as help prevent permanent cell damage.

Baytril is a basic antibiotic that vets like to use in rabbits because it has been proven to be safe for them, but it is not always the most effective one, especially where ear infections are concerned. Some antibiotics that seem to be very effective are zithromax and injectable pen g, though both do carry a higher risk of possible digestive problems occurring, especially with the zithromax. Doxycycline may be effective as well, but it really just depends on if your rabbit does actually have an ear infection and what bacteria are involved. And since that can't always be determined, it's somewhat of a guessing game. I would say after 9 days of no improvement, I would be considering switching to a different antibiotic. As for the cefepime, I don't really know anything about it's use in rabbits.

With regards to the antiparasitic, fenbendazole(panacur) is the primary treatment used for e. cuniculi, because of a study that was conducted and it was found to be effective in treating it. There are other treatments that vets have tried and are trying, but there is really very little information available to read about it. I know of a well known rabbit specialist in the UK that seems to be using different antiparasitics for treating EC, but as to what has lead to the vet deciding why these would be more effective than the standard panacur treatment, I don't really know. I have read of ponzuril being tried, but I don't know if it has ever been proved to show any effectiveness in treating e. cuniculi. With the albendazole, I personally wouldn't ever use it because of the negative effects I have read of it possibly causing in rabbits.

I don't know where you are located, but if I was looking for the most up to date treatment options for head tilt, I would consider having my vet consult with one of the rabbit specialists in the UK. They seem to have some of the best and most up to date knowledge when it comes to treating rabbits.

If you haven't already read some of these links, take a look as there is some good info regarding head tilt treatment.

http://www.medirabbit.com/EN/Neurology/Otit/otitis.htm
http://www.medirabbit.com/EN/Neurology/cuniculi/pyrimethamine.htm
http://wildpro.twycrosszoo.org/S/00dis/Parasitic/Encephalitozoonosis.htm
http://wildpro.twycrosszoo.org/S/00dis/Bacterial/BacterialOtitisMediaInterna.htm

 

[squidpop]

Dana Krempels who has a Phd and is a rabbit specialist and writes for the house rabbit society recommends the Ponazuril for EC if Panacur doesn't work. I emailed her once and she answered all my questions about it, (you can look up her Email address on the Bio Miami University website and email her and she answers) Also, I have used the zithromax/azithromycin pfiezer brand on 3 rabbits with respiratory infection and they got better— none of them had any gut issues, zithromax is supposed to work well on deep tissue infections. My vet said if the Zithromax didn't work next thing she would try was the penicillin injections (Oral Zithromax was much easier than injections tastes like bananas so I was so relieved it worked. Here is a post of Dana Krempels giving someone advice about Ponazuril for EC. http://en.allexperts.com/q/Rabbits-703/2008/12/Marquis-Ponazuril-dosage.htm

 

[ts786]

I appreciate the responses but am sorry to report that last night I saw in her eyes that she was just exhausted and had stopped enjoying life. At this point she could not even get her balance even in the padded cage and would just thrash around unable to get up. She told me she was done and the least I could do was that last act of mercy. I went with her to the vet who agreed she wanted to stop fighting, gave her the drugs, I held her while she died, and I was the last image she saw before passing on.

I tried and I failed. I lost my beautiful baby girl who's name I cant even say right now without falling apart. I've lost people close to me, I've lost other companion animals, I've lost family members, but the grief from this is so much worse.

Even as she was dying, all she wanted to do is to lick me and have me pet her. God I hope I made the right call. I miss her so, so, so much.

I stopped the meloxicam because it caused her some stomach issues. Did I kill her by not administering it?

 

[majorv]

I'm sorry it had to end that way, but the prognosis didn't sound good at that point. When giving rabbits meds which will cause stomach issues you usually can give probiotics to counteract that side affect. The most common probiotic is Benebac and can be purchased at a pet store or feed store.

The only way to know what might've been causing the issues is to have a necropsy done.

 

[Aki]

If you really need to know what happened, you'll need an autopsy. But considering the fact that your rabbit's condition worsened despite the treatment, she probably had e cuniculi as you said. Sadly, in that case the prognosis is never good. I think you did what you could - your post shows that you researched a lot about your rabbit's problem and really did everything in your power to help her recover. I understand your grief, one of mine passed away two years ago and I still think about it quite often. I know it's hard to see a 'bright side' in this situation, but at least your rabbit lived to be 8, which is older than a lot of rabbits live, and she was clearly dearly loved. It's hard to not doubt yourself about euthanazia, but I often hear people say that a bit too early is a lot better than a bit too late. You knew your rabbit and if you could see she had enough, you were probably right. You took a difficult decision, but you spared her a lot of suffering and it's what matters in the end.

 

[squidpop]

I think you did the right thing, she had 8 good yrs with you and you should feel good about that. Bunnies are very fragile and 8 yrs is an accomplishment.

 

[flemishwhite]

I've had to put down two dogs and one cat. Bunny's passing was a great deal more of an emotional experience. Like the previous pets, she relied upon me to take care of her, but for her being a rabbit she really relied upon me protecting her.