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Pseudomonas respiratory infection

22 10:12:31

Question
QUESTION: My rabbit Snowball had a culture about 6 weeks ago showing she has pseudomonas.  Our vet began a 2 week prescription of baytril twice a day.  After the 2 weeks Snowball was still sneezing.  The vet prescribed another week of baytril with the same results.  We then began a very expensive two week run of marbofloxacin.  This hasn't had an affect either.  What are my next steps?  I know its difficult to treat but is this curable?  Are we taking the right action?  Are we being aggressive enough?  Is it time to shop for a new vet?

ANSWER: Dear Michelle,

I don't think it's time for a new vet.  The treatments prescribed are quite reasonable and sound (you don't say what dose the bunny is getting, but this information would help me make recommendations).

Pseudomonas is one of the hardest bacteria to eradicate.  They are highly resilient, and often evolve resistance to antibiotics quickly.  It may help to add amikacin, either via nebulizer or by injection, twice daily.  This works synergistically with the fluoroquinolones (e.g., Baytril, cipro, marbofloxacin) and can be very effective even against Pseudomonas.

But don't be surprised if bun continues to have a wet nose and sneezing.  We have some bunnies with chronic Pseudomonas, and it is just impossible to kill.  Fortunately, we haven't had any cases (knock wood!) in which the bacteria invaded the lungs.  In most cases of which I'm aware, Pseudomonas tends to stay in the sinuses.  This is a nuisance, but not really life-threatening.

I hope this helps.

Dana

---------- FOLLOW-UP ----------

QUESTION: Dana,

The baytril was .5 ml 2xday, total of 3 weeks.  The marbofloxican is .8 ml 2xday total of 2 weeks.  Snowball is a mix, 1 year old spayed female weighing approx 7 lbs.

Her vet mentioned possibly going to injections if the marbofloxacin did not work.  If she turns out to be a chronic case what am I looking at for her care?  If its continuous antibiotics does this pose a problem with her intestinal tract?  What are the risks to her bonded mate?  So far he has not shown any sign of infection.

Answer
Hi, Michelle

Without knowing the concentration of the suspensions you used (i.e., mg/ml of Baytril or marbofloxacin), I still can't calculate the dose your bunny got.  The therapeutic dose we use for either is 20mg/kg (2x a day for Baytril, 1x a day for marbo).

Not sure what injections the vet was suggesting, but if it's amikacin, this is a good idea.

If this is chronic, treatment might be necessary only when she's really bad.  You might try a bit of echinacea (7 days on, 7 days off), which is said to boost the immune system.  A dropperful a day might be worth a try, but let your vet know in case she is concerned about any drug interactions.

Antibiotics that are rabbit-safe should not harm the intestinal flora, and the fluoroquinolones and aminoglycosides (e.g., amikacin) are fine.  Her bonded mate is already exposed, so I would not worry about him contracting an infection.  He may already be mounting an immune response to the slight exposure he's getting from her, and this might even afford him protection in the future.  But separating them is not an option, as it will make both of them stressed and miserable, and far more likely to get sick.

Hope this helps.

Dana