Maggots: Fly Strike Emergency!

Question
HELP!  Please, my rabbit's anus is crawling with maggots.  I'm giving him baths, but otherwise, what can I do until I can find a vet?
He isn't eating much nor is he moving much at all!

Answer
Dear Paul,

This is an extreme, life-threatening emergency, and you need to get your bunny to a good rabbit vet immediately:

www.rabbit.org/vets

The condition you see is called "fly strike", or technically, myasis.  It can be deadly if not treated aggressively and immediately upon finding it.  Here's what to do:

1.  Hold bunny gently, and get the affected areas under running, lukewarm tapwater.   With tweezers and your hands, remove the maggots.  You must get *every one* off him, and they will try to flee into his fur.

2.  Drench all affected areas with full-strength povidone iodine solution (Betadine).  This will get the maggots to come out of crevices and become available for your tweezers.  

3.  Put every maggot you get into a dish of scalding hot water filled with detergent, to be sure they die and can't crawl around your house!

Once all the maggots are removed, your bunny will need intensive supportive care from the vet, including:

1.  subcutaneous Lactated Ringer's Solution (probably for several days, so please ask the vet to show you how to administer this at home; your bunny will be less stressed and more constantly monitored if you can keep him in his familiar environment)

2.  Antibiotics to prevent infection.  Although the maggots eat away the flesh and leave an apparently clean surface, there are plenty of bacteria there and in the environment that will use the open wounds as a growth substrate.  Our vets prescribe injectible Penicillin-G Procaine and marbofloxacin in combination to effect a broad-spectrum strike against infection.

3.  If the open wounds are extensive, then an excellent dressing, used for burn victims, is Tegaderm, which is available at selected pharmacies that carry hospital supplies.  This is like a breathable, artificial skin bandage that will help control the pain and prevent infection.

4.  Pain medication:  Our vets use Banamine and Tramadol in combination.  Metacam and Tramadol also work very well together.  Because rabbits are so sensitive to pain, this step is *vital* to your bunny's recovery.

5.  The wounds will need to be debrided (scrubbed clean with antiseptic, to remove any nectotizing/dead tissue) every day, and re-bandaged.

6.  Our vets have found that it is *not* advisable to suture the wounds shut unless they are so deep that muscle is exposed.  Anesthesia should be avoided unless there is absolutely no alternative, since the bunny is already shocky and a very poor risk for anesthesia.

We have found that rabbits recover *amazingly* well if just given subQ fluids, antibiotics, and kept dressed with Tegaderm.  Local anesthetic (Marcaine or similar product) can be used if there are extensive wounds that absolutely must be sutured shut.  We have had good success with this protocol.

Areas that cannot be bandaged can be kept moist with a very thin layer of triple-antibiotic ointment.

It can take a couple of weeks for full recovery, but don't give up.  Open wounds that look *horrible* can granulate in very well if they are properly dressed and kept clean.  We just had this problem with one of our outdoor bunnies, and she is doing very well, despite having had a wound about 5" square chewed deep into her bum.  

Keep your bunny warm and quiet.  Once you think you have all the maggots off, check the wounds and *all* body folds (even on the front end; especially at the juncture of the legs and trunk) for maggots that escaped your first strike and are trying to burrow in again.  Check for at least three days for any new sores where escaped maggots are trying to set up shop again.

Please feel free to share this message with your vet, if s/he is amenable to receiving information from a stranger on the internet (some are; some aren't).  We also can put your vet in touch with vets who have treated this problem, but they do use the protocols I've outlined here.  So if there's no time for a consultation, I hope these instructions will help.

I hope this helps.  Get the bunny as clean of maggots as you can, and then get him to the vet immediately for further treatment.  I am sending lots of healing vibes!!

Dana