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Head tilt - ponazuril and ciprofloxacin

22 10:53:47

Question
Hi,
I am wondering about medications for head tilt. My rabbit has had head tilt and has been on ciprofloxacin for several months and had been doing great. He recently got very bad so I am wondering about medications. He has been to the vet but I don't understand everything.
1.) My vet has had my rabbit on ciprofloxacin just once a day. I read that it is supposed to be given twice a day. Is this a problem? I've also heard that enrofloxacin or other -floxacins are more effective.
2.) My vet had my rabbit on Ponazuril for two weeks, then because we weren't seeing a benefit, decided to stop it. (She said to start Albendazole instead.) I have read that  Ponazuril doesn't reach peak concentrations in the CSF until day 15 and that treatment should last for 28 days. Would we have already seen results if the Ponazuril were working.... or does the medication only start working after 15 days?

Thanks for any help you can give!!!!! I'm just a little confused about the medications and want my little bun to feel OK!
Thanks!!
Julie

Here's the history if you're interested:
Got my rabbit from a shelter. Had ear mites and developed head tilt in January (at the shelter). Was given ivermectin. Has been on ciprofloxacin once a day since February. After 3 weeks on the meds he was doing good and looking stable, so we stopped him and he got worse so we started up again. Once restarted he had been on the cipro for 5 weeks and his head was almost straight. Then within 48 hours he was all off balance and his head was very tilted again. Took him to the vet where they started Ponazuril once a day to be given along with the ciprofloxacin. My rabbit was found to be positive for E. cuniculi. Went back for a recheck at 2 weeks. Vet decided to switch from Ponazuril to Albendazole, started subcutaneous PenicillinG-Benz-and-Pro every other day, and continue the ciprofloxacin.


Answer
Dear Julie,

It sounds as if your vet knows what she's doing, and has tried all the best treatments first.  Ponazuril is a fairly new drug, and little is known about its efficacy against E. cuniculi.  But I would certainly ask about putting the bunny back on it because of the long time it takes to build up therapeutic levels in the affected tissues.  We've given Ponazuril long term with no ill effects (for coccidia in a population of sanctuary jackrabbits--not for E. cuniculi), so it's certainly worth a try.

Most experienced rabbit vets use either oxibendazole or fenbendazole for E. cuniculi, not albendazole.  Of the three, albendazole is the most toxic, and has had the most anecdotal reports of adverse side effects in rabbits, though these have not yet been published.  (I'm privy to them only because I'm on many internal rabbit medical listserves.)  You might want to ask the vet about switching to Panacur (fenbendazole).

No one is really sure whether *any* of these drugs effect a permanent cure, since many rabbits taken off Panacur (or whatever drug they're taking for the E. cuniculi) have a recurrence.  It's not certain whether this is due to re-exposure via infected urine, or because the parasites are not killed, but only inhibited by the drugs.  This is why fenbendazole was so promising:  it apparently really does kill the parasites.  

www.bio.miami.edu/hare/fenbendazole.pdf

If the bicillin is not effective, and there's no pus to culture, you might ask the vet about using zeniquin (marbofloxacin), which has a longer "hang time" in the body than the other fluoroquinolones.  It's given once a day only.  (Some vets use ciprofloxacin only once per day, but I'm not a big fan of that, since its blood levels decrease significantly after about 12 hours, and you want to keep levels UP to kill any marginally resistant bacteria.)

I hope some of this helps with a few ideas.  Hang in there, because the tilt *can* be controlled or even beaten with the right protocol.  I hope your bunny will be well soon!

Dana