foot wound wont heal

Question
Hello.
I have a 9-year-old Holland lop--which I thought was quite old for a rabbit, until I read some of your other questions--with rabbits of 10,12 and even 17 years! So I guess our Dusty's actually middle-aged.

He has had cataracts for about 2 years, but manages to get around quite well, and runs over for treats when I ring a bell. About 8 months ag0, we discovered an infected nail on his right hind leg--which resulted in a toe being removed. All seemed well until about 4-5 months later when we noticed the area was open and inflamed. With our vet's instruction, we've been doing wound care every other day by soaking, cleaning, and using a "BioDres" dressing. There were periods where things would look pretty good and we were hopeful--but eventually would deteriorate or just not progress.

As far as antibiotics, he had a short trial of a floxacin in June--which I admit to not administering regularly, and it may have given him loose stools. Then the vet gave him chloromycetin--which I also did not administer too reguarly at first since I found it difficult to give it as a liquid. However, now I found I can easily give him pills in raisins, bananas or apples, and have been giving chloromycetin regularly for a week now. We used neosporin and then later gentamicin topically.

I'm wondering if it's worth it to give the chlormycetin some additional time? Or, if another floxacin trial might be worth it? The vet is considering a C&S and an x-ray as the next step, and a consult with a surgeon colleague. The wound reminds me of slow-healing diabetic wounds, and I wondered if diabetes might be a possibility.

Dusty is still eating well (pellets and timothy hay), pooping well, using his litterbox, and even has bouts of playfulness where he chews up his wicker baskets, and comes hopping over (on 3 legs)for treats. But I wish we could see more progress with the wound.

Any thoughts or comments you have would be appreciated!

Answer
Dear Mary,

When antibiotics are prescribed, it is absolutely vital to give them consistently and for the full course, until the abscess is gone.  Otherwise, the infection can actually become worse and harder to treat.  This is explained here:

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

I would definitely go for the culture and sensitivity test to be sure you're giving the best possible antibiotic for the bacteria causing the problem.  

Dusty's chronic infection could be due to his senior age (he's not ancient, but he is a senior bunny), as well as to reduced vascularization/blood flow in the area of the wound.  Reduced blood flow will not only allow bacteria to grow more readily (less delivery of immune system cells to the area), but also not deliver antibiotics as effectively.  So it might not be a bad idea to consider a wet-to-wet 50% dextrose dressing that will *topically* kill the bacteria, not relying on circulation to do the whole job.

If you and your vet are interested in this, I can email you the protocol used by our vet, Dr. Kelleher, with great efficacy on nasty abscesses.  No bacteria I know have yet developed resistance to a highly hypertonic sugar solution!  It kills 'em dead, as long as you debride and redress the wound at least twice a day.  This is critical for success.

Please let me know, and I'll be glad to share the protocol.

Hope this helps.

Dana