Urgent- Rabbit with head tilt (Rolling) , no longer repsonding to treatment

Question
HI Dana,

We have a 2 year old Rex named Benie. About 3 months ago she started to have co-ordination issues and developed a head tilt. We took her to a general vet who examined her and recommended a 28 day treatment of Panacur as well as Baytril ( administered in her ears) after some research. We noticed significant improvements after about 3 weeks. After the 28 days on Panacur she seemed back to normal . 2 weeks later she started to get her head tilt back and we started the Panacur and Baytril again.She did not seem to be responding as she had previously. In addition to the head tilt she started rolling uncontrollably. At this point the vet who was very helpful recommended we see a rabbit specialist as she was in over her head. The new vet recommended we continue with Baytril (oral) , Penicillin and Pancur. Again Benie seemed to respond after several weeks ( less rolling and head tilt) . At this point the Vet recommended we stop the Panacur and continue with Baytril and Penicillin. Once again after about 9 days her symptoms got worse. We then stopped the baytril and went to Sulfamethoprim DS Oral (in case it was Toxoplasmosis) Penicillin (once weekly), Panacur and a Probiotic. Again the rolling was reduced (not stopped)  as was the head tilt. She has started to roll again and we are at wits end. The latest treatment is Penicillin twice weekly, Sulamethoprim ( twice daily) , Panacur and a Probiotic. Getting an MRI is difficult as their is no machine in my city .We would rather not but we are considering Euthanasia if her quality of life does not improve. She has maintained a healthy appetite throughout this ordeal and does move around her pen,which we customized to make her comfortable. We have spent thousands at this point . Can you suggest any other alternative treatments ?

Her current symptoms , heat tilt (30 degrees) , exhibits a Nystagmus only when on her back, rolls ,she can right herself fairly well. Appetite is good as are her droppings.

Thanks

Paul

Answer
Dear Paul,

Our rabbit vets use dual-acting Penicillin G Procaine/Benzathine once every 48 hours.  If you are not using it that frequently, you run the risk of losing your therapeutic levels in the tissues.  This not only allows the susceptible pathogens to proliferate, but you also are performing a little experiment in evolution in your bunny:  natural selection. Only the most resistant bacteria will survive, and those will the the progenitors of the next generation.  This is one reason it's best to hit HARD and FAST with antibiotics if you are going to use them.  

What dose of penicilllin is the vet using?  If you are using only Penicillin-G Procaine, and not dual-acting penicillin, it's even worse, as the former does not last long in the tissues.  It is the Benzathine salt that is long-release, providing bacteria-killing protection for about 48 hours.

For more information, please also read:

http://www.rabbit.org/health/tilt.html

and

http://www.bio.miami.edu/hare/tilt.html


I hope this helps.

Dana