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.

Safe Antibiotics

www.medirabbit.com

Common drug dosages for rabbits

wabbitwiki.com

Bicillin Study

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: