Pseudomonas

[RosL]

This is not an emergency as such. It's a chronic infection, pretty well under control, for now at least, but I'm always open to new advice.

Cinnamon, my almost 5-yr-old lop girl has a chronic pseudomonas infection in her nasal cavity. She's had a sample cultured for sensitivity, as a result of which she has 3.2ml daily of enrofloxacin (Baytril) orally and gentimicine (Tiacil) nasal drop twice daily.

This is working very well and she is a happy bunny with a good appetite, bright outlook and playful nature. She doesn't suffer from gut issues so the Baytril can't be playing havoc with her gut flora. But I keep bunny probiotic paste (Fibreplex) to hand all the time, just in case a problem should arise.

I'm well aware of the dangers of it tracking down into her lungs and also into her inner ear and causing tilt.

I was advised by a breeder to also drip strong tea into her nostrils as the orgnism is sensitive to tannin. However, my cousin works in a hospital lab and she asked the bacteriologist how effective this was likely to be. He told her that the dose to kill the organism would need to be so strong that it would also kill Cinnamon, so that is obviously not going to be something to pursue.

The vets and I believe that the whole thing has arisen because of problems set up by teeth root overgrowth. Cinnamon has a dreadful molar malocclusion, especially on the right. When she was very young and it was first discovered, we were referred to Frances Harcourt Brown who practices less than 2 hrs drive away and even she was impressed with how bad it is. So all her life Cinnamon has had to have very regular dentals, currently about 8 weeks apart. (We had a glitch in the middle when I tried out a different vet who is much closer to me geographically and they kept saying her teeth were fine, no need for a dental. I went back to my own vet when the pseudomonas started up and she actually needed a tooth extracted! Needless to say I no longer use the local vet.)

So, that's the situation. If anybody here has any advice, I'd be very interested to read it.

 

[JadeIcing]

One of my guys tested postive for it. He was a snot nosed little thing for almost a year. Than I put him on Zithromax and now it is a year and half and not one flare up!

 

[ra7751]

Hmm....pseudomonas is a tough nut to crack. It is resistant to lots of drugs. It's a gram negative aerobic rod but it's also considered to be a faculative anaerobe which means it can live in low oxygen or no oxygen environments. That presents some interesting challenges since we generally use penicillin against many anaerobes but this bug it nearly totally resistant to penicillin. Zithromax does have some coverage and I use a penicillin/zithromax combo when treating mandibular abscesses. I am leaning toward some type of mandibular abscess here in which pseudomonas may be present but not the primary pathogen. I recently treated a rabbit that had peptostrepococcus in a mandibular abscess.

Prior to my continuing my post, I am not a vet. I treat very sick rabbits with very advanced protocols. I can do things that vets can't due to legal considerations within a practice but my work has proven beneficial as quite a few vets are now using protocols I use here. My comments here are strictly my personal opinion and not intended to diagnose your rabbit's issues. I offer my comments only as points of conversation to bring up with your doctor.

A few words about Baytril....and those that have seen my posts on this forum know my complete disdain for that drug. It would not be effective against anaerobic bacteria. I do not use Baytril at all in any rabbits...for anything...and that includes domestic and wild rabbits. If I were to use Baytril (and back when I did) it was always used as an injectable. We have seen some bacteria show sensitive in a dish but Baytril (and Sulfatrim) didn't work in the real world. If I were to use that family of drugs, I would use their cousins, Cipro as it has a little different coverage and effectiveness. I am really concerned about the amount of Baytril being administered and I am hoping either this is a very large rabbit or it's a weakly compounded suspension. Baytril does carry some side effects....but then again, so do all drugs.

I am going to offer a suggestions here to run past your vet. If this were my rabbit.....I would be doing some serious rads of the skull looking for possible molar impactions and resulting abscess. Bacteria such as pseudomonas and pasteurella are opportunisitic bacteria and will be present as "tag alongs" with more serious infections. With the rabbit with the jaw abscess I have here, we cultured several bacterium but I knew they were secondary to the real problem. JoJo is now healthy. Andthe drug I would ask about is called Convenia. It has just been approved in the US for use in dogs and cats but shows great promise for rabbits. We will see but I think it has been available in Canada and Europe for quite some time so the doctors thereshould be more familiar with it.

Just a few thoughts based on my experiences with these pathogens.

Randy

 

[RosL]

Thanks for your responses

JadeIcing- that is good about Zithromax. I know it's having a lot of favourable reports over here for abscesses. It wasn't mentioned on the sensitivity culture but perhaps the lab didn't include it in their test - though I suspect they ran a full test as there is quite a list of things that it is sensitive to

We tried oxytetracycline injections for a while, but they made her so ill, so had to stop that abd go back to Baytril, which, to be fair, showed up on the sensitivity as a very good one and it is controlling it, but it means she has to have it all the time.

ra7751 - that is some specific knowledge of the nature of bacteria you have there!

I don't dismiss Baytril for several reasons. First, it showed up as effective (actually the most effective after gentimicine) on the sensitivity test. Secondly, it's working. She has no symptoms as long as I keep her on it and gentimicine drops. Thirdly, I am using the maximum dose and giving it as a single daily dose (as recommended by the British Small Animals Veterinary Association) rather than splitting the amount into 2 doses. This not only makes it more effective, it also lessens the stress of medicating. Unfortunately my vet has a policy of not allowing clients to inject Baytril themselves. I would prefer to do that to ensure she gets the lot. I do understand the danger of benign abscess at the injection site and know that the site has to be varied and the drug may not cause it if mixed with hydrating water. However that is a moot point in this case. She is being dosed orally. (When she had oxytet I injected. I had got that from a specialist rabbit vet following initial diagnosis - but of course that is in the past)

I think that a great many of the failures attributed to Baytril stem from not giving a high enough dosage to properly overcome the organism, from splitting the dose which the BSAVA says lessens its efficacy dramatically and from not using it for long enough so that the bacteria are able to build some resistance, and when it is used again they can fight it. Cinnamon gets it every day.

We've had all the x-rays already. Yes, she has overgrown roots but nothing is looking too bad at present. My vets are pretty thorough - I just wish I'd never tried that other local one. (I have mobility problems and had hoped that a local vet would be up to the job - but they couldn't recognise her teeth overgrowth. I know that their main branches have good rabbit savvy vets but sadly this local clinic seems not to....the clue came when I took in a rabbit with gassy gut and the vet suggested he might vomit........ At that point I started back up travelling with my rabbits to the nearest surgery of the vets I trust and they found her teeth had suffered from the neglect.)

 

[purplepeacock]

this is kind of an odd question...but, when your bunny has pseudomonas does your bunny smell? the reason i ask is that i used to work as a wound care nurse and had many patients with pseudomonas and the smell would clear out a room in seconds. literally our practice was in it's own section of the hospital and even behind closed doors when i changed a dressing with that the cardiac unit down the hall would call complaining---that's how horrid the bacteria smells. So if your bun has the bacteria in her mouth or nose can you smell it?

bec

 

[RosL]

Hello, Bec

No, I didn't detect any smell at all when she had symptoms. There's no lesion so I wonder if the smell happens when the bacteria are eating at an open wound?

When Cinnamon has shown any symptoms it's been a sense of being 'off' - something that anybody who didn't know her well would probably not notice - till you saw the difference in her demeanour once she's on the meds that is - and a very slightl wetness round the nostrils, with an occasional sneeze. Within an hour of finding the wet nostrils initially, I had her at the vet's, suspecting pasteurella and it was when her dental was done a week into her first course of Baytril (the wetness under control by then) that she was x-rayed and had the mucous sample taken for culture and sensitivity. She stayed on Baytril and gentimicine until we got the referral to the specialist, exchanged Baytril for oxytetracycline which she stayed on for 2 weeks before it made her ill then changed back to Baytril. She was on that for a further 3 months then because the symptoms had not shown at all for the whole period of the treatment, we tried her with only gentimicine for a further 3 weeks, then nothing.

She seemed fine at first but after 3 weeks she was 'off' - I can't put my finger on what was wrong, but she wasn't herself. Then one morning her nostrils were damp so she went back onto both antibiotics and has remained on them since.

There has been no smell at all.