Osteomyelitis

Question
Dear Dr. Krempels,

My husband and I adopted Forest, our beloved brown holland lop, from a shelter 2 and a half years ago.  When he came to us his teeth were in terrible shape and my exotics vet felt they needed to be removed to prevent possible complications.  All of Forest's teeth were surgically removed, and once he recovered he has had a fairly normal life.  He eats rabbit pellets that are mixed with water to make them mushy then formed into little "meatballs."

About a year or so ago we started having problems with soft tissue abscesses around his jaw area.  Our exotics vet treated them aggressively, but they have continued to come back.  This time, my worst fears have come to life and the soft tissue abscesses are accompanied by hard abscesses in the jaw bone itself.  Our exotics vet has referred us to a specialist with more experience, and we are seeing her on Wednesday.

My question is this:  do you have any experience with osteomyelitis?  Everything I read tells me the prognosis is very poor.  Can you give me any hope?  Is there anything you particularly recommend for us to do?  Have you ever seen a bunny with this diagnosis recover?  Forest is our whole world and we are going to fight this with everything we've got, but I feel so hopeless.  Any advice or words of wisdom you have would be greatly appreciated.  Thank you in advance!

Answer
Dear Liz,

Yes, unfortunately, I've had experience with osteomyelitis.  It is persistent, but if you're "lucky" enough that the bacteria causing the abscesses are sensitive to several good rabbit-safe antibiotics, the problem can be controlled, and sometimes even cured.

I would strongly recommend that a sample of pus be collected and sent to a lab for culture and sensitivity testing:

www.bio.miami.edu/hare/culture.html

We have had excellent success treating osteomyelitis with some of the following rabbit-safe antibiotics, which apparently have good bone and abscess penetration, and--perhaps very importantly--a longer than usual "hang time" in the body:

1.  bicillin (Penicillin G Procaine plus Benzathine) injections

2.  Zeniquin (marbofloxacin)

3.  Amikacin injections (especially if used together with marbofloxacin); these are usually given with subQ fluids, since the aminoglycosides can be somewhat nephrotoxic.  Amikacin is the "gentlest" of the bunch.

But the right antibiotic to use will depend on what the culture tells the vet, and what the vet thinks will be most effective in this case.  You can find an experienced rabbit vet here:

www.rabbit.org/vets

and read more about treatment of jaw abscesses in rabbits here:

www.bio.miami.edu/hare/jawabscess.html

It's possible that Forest will have to be on antibiotics for the very long term, since osteomyelitis tends to recur.  But that's better than having a jaw full of infection.  I hope it doesn't come to that, but I'm glad to hear he has such wonderful "parent" advocates who are doing their best to get him well again.

Hope this helps!

Dana