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Vestibular disease - inner ear/EC relapse when off baytril?

Julia123

Warren Veteran
Hi, I'm hoping for someone who has had a similar experience with regard to a relapse in vestibular symptoms after stopping baytril... More info...

My 10yr old bun started showing signs of vestibular illness the day after he lost his partner :cry: he started off scanning and then began to circle and had nystagmus. He is blind and arthritic and already wobbly but the wobblyness got worse.

My vet decided against me taking him in as this would cause more disorientation, so we started on a course of panacur, increased the metacam he is on for arthritis and started a course of Baytril. 9 days later and he was upright and no spinning, scanning or nystagmus. After a two week course my vet said we could stop the Baytril and continue the metacam and panacur.

3 days after stopping Baytril and I noticed a slight scan, but then it stopped. Then on day 6 of being off the Baytril his symptoms got worse, noticeable scanning and the beginnings of circling and nystagmus. I called my vet and she gave me another 2 weeks of baytril. We are on day 5, he hasn't shown any improvement yet (and got worse in the first few days) but it was 9 days before he improved last time so I have everything crossed....

I would have thought if EC then the baytril would not have had such as significant impact - or am I wrong? So now I am wondering if inner ear infection. If the baytril works again then I want to keep him on it permanently, my vet is unsure.

Has anyone else any similar experiences?
 
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From everything that I know of inner ear infections causing this, a longer course of antibiotics is usually recommended, at least 4-6 weeks(continuing for 2 weeks after symptoms stop), though sometimes even longer is needed. Also sometimes more than one antibiotic will be used. You may want to discuss with your vet continuing the antibiotics for at least another 4 weeks instead of 2. If you aren't seeing progress with the baytril, switching or adding another antibiotic is also something to consider.

Here's some additional info if you want to read up on it.

http://www.medirabbit.com/EN/Neurology/Otit/otitis.htm
http://wildpro.twycrosszoo.org/S/00dis/Bacterial/BacterialOtitisMediaInterna.htm

If you aren't currently seeing a rabbit specialist, that may be something to consider as well. A vet that is very experienced and knowledgeable about rabbits can make all the difference in your rabbit getting the best and most appropriate diagnosis and treatment.
 
From everything that I know of inner ear infections causing this, a longer course of antibiotics is usually recommended, at least 4-6 weeks(continuing for 2 weeks after symptoms stop), though sometimes even longer is needed. Also sometimes more than one antibiotic will be used. You may want to discuss with your vet continuing the antibiotics for at least another 4 weeks instead of 2. If you aren't seeing progress with the baytril, switching or adding another antibiotic is also something to consider.

Here's some additional info if you want to read up on it.

http://www.medirabbit.com/EN/Neurology/Otit/otitis.htm
http://wildpro.twycrosszoo.org/S/00dis/Bacterial/BacterialOtitisMediaInterna.htm

If you aren't currently seeing a rabbit specialist, that may be something to consider as well. A vet that is very experienced and knowledgeable about rabbits can make all the difference in your rabbit getting the best and most appropriate diagnosis and treatment.

I agree that a much longer (months sometimes) course of abx is almost always needed. I would suggest that an injecatble penicillin may be something to discuss with the Vet. This can be given alongside Baytril if the Vet considers it to be necessary. A complete change of abx may be necessary now as any bacteria that survived the last course of Baytril (and then multiplied once the Baytril stopped) may well be resistant to Baytril now. Abx resistance is a big issue when dealing with chronic bacterial infection. Lots of short courses of the same abx is a recipe for the development of abx resistance.

Morse was on a combination of abx at various times over the years he fought ear disease. These included Baytril, Septrin, Depocillin and Metronidazole. Depocillin and Metronidazole as an abx combination worked best for him. He was on that for about 3 months at one time. He never had a recurrence of any vestibular symptoms. Although his otitis externa remained a constant battle. At least the inner ear remained unaffected.

Some people have also had success with using Azithromycin (Zithromax). But due to a few concerns I have about the drug me and C agreed we could not risk giving it to Morse.

I am sure your Vet will remain open to suggestions from you as she always seems to be. Sending lots of vibes for Bunny xx
 
Thanks for your input, yes my fear is that the Baytril won't work this time.... I have been told that injectable penicillin can, in itself cause an inflammatory action by the way it works. I will have to discuss with my vet if I don't see any change after the two week course. I was wondering about marbocyl? Being the same family as baytril and that having worked before.

Unfortunately a specialist isn't an option, while he is disorientated I won't subject him to a vet visit. Just moving him to give his meds sets off nystagmus. I can get my own vet to do a home visit if there is no improvement. She can also speak to an exotics specialist and has done on my behalf for other bunnies illnesses.

On a plus he is eating and pooing and weeing as normal. It's just so difficult in a blind bunny - makes it all seem twice as bad for him. So upsetting to have a relapse after he did so well. :cry: I'm just keeping everything crossed it works this time but need a back up plan if not. My vet has said it could be something more sinister - I think she is thinking stroke.... :(

I'm just so annoyed at myself - my gut feeling was to push for more Baytril rather than stop after two weeks, but then if I hadn't stopped then we would never have known, just wish I had asked for more as soon as I saw that first hint of scanning, but again so hard in a blind bun as this can sometimes be a normal reaction....
 
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Just reading that link, pasteurella was something I considered too, being set off by stress and also he had white discharge from his eyes about a week before, this cleared in a couple of days with cleaning and chloramphenicol and I mentioned to my vet but as it cleared so quickly it wasn't considered as a clue to the cause of his vestibular symptoms. He has mucky front paws but probably due to cleaning after the meds ..... But a consideration for sure. There is no smell in his ears and they are clean, but with middle ear I think I'm right in saying there wouldn't be. Either way we are still on the same track.... Different abx if no change....

ETA and yes his nystagmus is horizontal...
 
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Just reading that link, pasteurella was something I considered too, being set off by stress and also he had white discharge from his eyes about a week before, this cleared in a couple of days with cleaning and chloramphenicol and I mentioned to my vet but as it cleared so quickly it wasn't considered as a clue to the cause of his vestibular symptoms. He has mucky front paws but probably due to cleaning after the meds ..... But a consideration for sure. There is no smell in his ears and they are clean, but with middle ear I think I'm right in saying there wouldn't be. Either way we are still on the same track.... Different abx if no change....

ETA and yes his nystagmus is horizontal...

The mucky front paws may be due to him wiping nasal/occular discharge away. Unfortunately ear/nose/eye symptoms can all be related to the same problem. Baytril is effective against many strains of Pasteurella, but as mentioned resistance can develop.

Is your Rabbit having the Baytril once a day or every 12 hours ? Many Rabbit Savvy Vets feel that to obtain and maintain therapeutic levels of the abx within the bloodstream it is better to give the maximum dose every 24 hours. Septrin is also effective against many strains of Pasteurella so if your Vet is not happy to prescribe an injectable penicillin then maybe changing to Septrin could be an option if this course of Baytril does not help.

Oh and one more thing, it is usually necessary to continue abx treatment for about a week AFTER all vestibular symptoms resolve.
 
The mucky front paws may be due to him wiping nasal/occular discharge away. Unfortunately ear/nose/eye symptoms can all be related to the same problem. Baytril is effective against many strains of Pasteurella, but as mentioned resistance can develop.

Is your Rabbit having the Baytril once a day or every 12 hours ? Many Rabbit Savvy Vets feel that to obtain and maintain therapeutic levels of the abx within the bloodstream it is better to give the maximum dose every 24 hours. Septrin is also effective against many strains of Pasteurella so if your Vet is not happy to prescribe an injectable penicillin then maybe changing to Septrin could be an option if this course of Baytril does not help.

Oh and one more thing, it is usually necessary to continue abx treatment for about a week AFTER all vestibular symptoms resolve.

Yes thats what I wondered about his paws....Ben is having the Baytril every 12 hours, he's on 0.75ml and is around 1.8kg. I think thats where we went wrong Jane - stopping the Baytril too early :( Just been out to check on him and hes still circling, he wanted to get to his food bowl as I had just picked some grass and dandies for him, he managed a bit and then went to sit with his head against the blanket at the side of his pen wall. Ive looked back through his last lot of treatment and it was 7 days last time before he stopped circling. We are on day 6.....

I've left him to rest, I think the quiet is what he needs right now. I need to be patient, but I also cant stop myself looking for more answers and options. Last time, my vet said a steroid injection was an option, but she wasnt keen on using prochorperazine due to its sedative effect. She did say I could give him metaclop to help nausea but I dont think thats an issue and while his guts are good I dont want to go down that path. My heart is telling me time and rest is what he needs right now - my head is harder to control and keeps searching for a faster fix!
 
Ben is still circling, he's had a few episodes of frantic spinning in the last few days - enough to make me question what I am doing :( but he now seems to circle rather than spin and is coping. He's still turning his head when sitting, his paws remain at the front and he has to adjust them to stay upright. I've seen him sleep chin down and also on his side, but he often sleeps with his head pressed up against something. It sounds awful and and sometimes it IS awful to watch but he seems to want to fight and has a spark and displays the odd tantrum throwing food.

Today is day 9 of his second course of Baytril, at this point on the first course he was upright and had stopped spinning. So, my question now is which antibiotic to switch him to and when. I'm waiting for a call back from my vet but wondered what opinions were. My gut feeling is to wait until the 14 days are up and then try Septrin as this is the most 'friendly' option.

He's not eating hay and only a few protexin pellets, he eats two bowls of veg and herbs a day and forage in between. I'm also giving him a small amount of turmeric on apple twice a day for its inflammatory benefit. I'm wondering whether to start him on pro fibre paste as well - but its a difficult one as I don't want to upset him and its quite globby and gritty. His poos are dark and small so I'm going to ask about starting zantac. Any other suggestions from anyone?

Also - does anyone know if administering chloramphenecol as eye drops will reach further? I see it listed in the medirabbit article. Will ask my vet but just wondered.....
 
Just to add, I agree on the Baytril once every 24 hours, rather than a split dose every 12 hours.

Not sure that a steroid injection sounds a good idea when there is an active infection. But I'm definitely no expert!
 
Just to add, I agree on the Baytril once every 24 hours, rather than a split dose every 12 hours.

Not sure that a steroid injection sounds a good idea when there is an active infection. But I'm definitely no expert!

Is that for SC or oral Sarah? The absorption and half life rates differ.

Steroid injections are often give with vestibular illnesses to attempt to reduce the severe inflammatory action. I discussed with my vet and she said that she would only usually use it at beginning stages, so we are sticking with metacam.
 
Oral, as I understand it.

I'm really no expert, but I was under the impression that steroids were a potential weakener of the immune system, so should be used with caution during an active infection.
 
Oral, as I understand it.

I'm really no expert, but I was under the impression that steroids were a potential weakener of the immune system, so should be used with caution during an active infection.

Thanks I will ask the vet about the 12 or 24 hour dose intervals. Yes, steroids are only used in severe cases, when my vet mentioned it, it was the first day of symptoms and she suggested a one off injection to try and kick out some of the inflammation. I decided against it then and she says no now, which I agree with. I think it depends on the cause, initial thoughts were EC, but I now feel that inner ear caused by Pasteurella is more likely due to the relapse while off Baytril - so yes you are absolutely right in the contraindication of the steroid, I hadn't considered that. I am very wary of their use, my bun with a thymoma/lymphoma is on metacam only as the exotics specialist felt the risks of steroids were too great.
 
Spoken to my vet and she thinks another 2 weeks on Baytril rather than switch to Septrin which she feels wont work and better to give the Baytril longer. If no improvement we will try depocillin.
I forgot to ask about the 24 hour dosing, I will see if she is there when I collect the Baytril. Does anyone have any links to articles on this? Ive searched but all sources say BID.

ETA Ive just calculated out his dose and believe its not split, its the max twice a day

ETA 2 just found this and emailed it to my vet http://animalhealth.bayer.com/ah/5192.0.html#c14567
 
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Giving Baytril once a day is faily new. My vet told me this year that the studies show once a day Batril provides a more therapeutic dose than a split dose.
I am not sure what strengh your Batril is. I have 50mg/ml oral liquid for my 1 kg bunny. My vet dosed him at 10mg, so he gets .2 ml of the Batril once a day.
 
Yes, Baytril once a day here too. I use SQ injections

I hope that your Bun will respond to this course Julia. You really have had an awful few months :cry:
 
Jane has a good point about using SQ injections.
When I was given a choice, I felt that SQ injections were more effective than oral for certain conditions. I used injectible for years before oral was available and am thinking of asking for it again. Plus it has a better shelf life than the oral. You may need to dilute injectible Baytril used for SQ injections since using regular strength MAY cause a scab to form at injection site. (The skin/fur will lift off later leaving a permanent bald patch.) It can also be given IM which requires some instruction/practice.

Sending more vibes to you and your bun.
 
Thanks for the responses, my vet has tried both single and twice daily doses and finds that twice a day works better. I don't want to risk sterile abscesses by using SC, he's a good boy and takes it well... so long as its followed by yummy metacam lol!! He did throw the syringe back at me today though :shock:

Anyhow, I am almost hesitant to write this without running down and checking on him again, but, he's doing really well! Yesterday and today he's managed to hop in a straight line :D still the odd circle but a definite improvement. He has topped scanning, no nystagmus and the twisting has greatly reduced. I watched him eat his forage at 5pm without moving his head to the side at all!! The fact he's blind and arthritic means he will always be a bit wobbly and clumsy, but his disorientation is most definitely improving!

So fingers crossed we are on the right path!! :D
 
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