Penicillin Induced Enteritis- A Treatment Regime That *SEEMS* To Have Worked

I thought I would post this here incase anyone else's Bun becomes as poorly as Bobbie has been due to a Penicillin Induced Enteritis.

http://forums.rabbitrehome.org.uk/showthread.php?t=95847

In Buns this condition is usually fatal What happens is the 'bad' gut bacteria multiply out of control, particularly Clostridium Spiriform, which releases lots of toxins that are subsequently absorbed into the bloodstream causing septicaemia and death

This is the treatment Bobbie was given (with permission from Christobel, our Vet) when she developed acute diarrhoea having been on Depocillin Injections for 5 days :

1-Aggressive fluid therapy- every time diarrhoea was passed I administered 20-30ml subcutaneous warmed Hartmanns Solution to Bobbie. She had a total of almost 400ml subcut' over 24 hours.

2- Analgesia-Torbugesic every 6 hours + Metacam once a day-both VIA INJECTION

3 - Cholestyramine (QUESTRAN) given orally at a dose of 0.5mg/kg once a day. This is a medication used for humans with high cholesterol. For Buns at risk of enterotoxaemia it is used to 'mop up' the toxins in the gut before they are absorbed.

4- Fibreplex- orally 3 times a day

5- Vitamin C- 100mg/kg given orally once a day (Vitamin C can REDUCE the rate at which the 'bad bacteria' multiply)

6- Syringe feeds of Critical Care mixed with Bio-Lapis

7- Avipro-C in drinking water

Eight- Bobbie was permanently on a heat pad to prevent hypothermia and shock

9- COMPANY AND AFFECTION- If she turned herself away from the front of her pet carrier I'd turn her to face forward again, I basically hassled her not to 'give up'

The treatment was intensive and improvement in Bobbie's condition did not occur for about 36 hours. Since then she has gone from strength to strength. She is eating and her poos are nearly back to normal. I will continue with the probiotics for at least a week.

Bobbie may relapse, but so far so good and I hope this info' might help any other Bun unlucky enough to be adversely effected by antibiotic therapy

Janex

:wave: I have printed that out 'just incase' - thankyou and WELL DONE!

I think it is amazing what you have done for Bobbie!

Kathryn

That's a great advance in vetinary science Jane - and you did it all by yourself I think you should maybe convey this info to a well-known vet, like FHB, or Anna Meredith - I'm sure they'd be very interested.

Of course nursing care as devoted as you have been is harder to come by - I'm sure that's the reason Bobbie survived

Two of my Beatles had bad snuffles and Lenny went to see Theo's vet and was given a course of Depocillin, once every other day for 20 days and has subsequently cleared up. Harry was given a variety of medications all without sucess and my vet has finally given in to my nagging and allowed me to give him Depocillin too. She would only give me a 10day course due to her concern for what you have mentioned Jane.

What I would like to know is how safe is this Depocillin? I know people on here swear by it but my vet was really not happy about giving it and made a note on Harry's file that she was reluctant. This seems to be another big :?: where vet opinions vary so much. Theo's vet was more than happy to administer it for a fairly long period of time whereas mine was reluctant to at all. :?

Why does there seem to be so few proven drugs for rabbits that vets can agree on?

I think Depocillin can be a lifesaver but it is a VERY high risk drug for causing gut dysbiosis. Thats why the cascade prescribing system should be used whereby the first abx given should be the 'safer' ones (Baytril/Septrin) and only if they fail should the higher risk abx (Penicillins-HIGH RISK, Cephalosporins like Cephalexin-MODERATE RISK) be used. I have had many Rabbits on long courses of Depocillin with no ill effect. I have lost one Bun, Orlaith, to Penicillin induced enterotoxaemia and I nearly lost Bobbie. With Depocillin I see it as a 'last chance' that comes with significant risks. I would agree to using it again as a last resort, but NOT for Bobbie

Janex

Totally agree Jane, I think it's a 'last chance' when all others fail, both Mack and Mabel would not be here if it weren't for depocillan and I continue to use it on them (when prescribed by my vet) because nothing else works, it's a horrible situation to be in when a bunny is so poorly that you have to give then a drug with could further damage their health in the future but whilst so little research and developement is done for bunnies and illnesses and cure, I beleive we must try everything.

Chloe, I am going to see Paula this week and will ask her the question, I have 100% faith and trust in her, she is an amazing vet as you found out, but I wold be interested in her response, will let you know. As a point of interest, has the 10 day course worked?

Heya Theo Thanks for that, would appreciate Paula's thoughts. Harry is only half way through his course so far, gave him the third injection yesterday and he is still wet around the nose but no white snot and he's still sneezing. My vet asked me to call her towards the end of the course and let her know how he's doing with the possibility of extending the course or trying something else if he's no better.

Thank you Jane, I also have saved this to my bunny health file, just in case.
I hope Bobbie continues to improve, she is so beautiful.

carasblanco said:

Thank you Jane, I also have saved this to my bunny health file, just in case.
I hope Bobbie continues to improve, she is so beautiful.

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I really hope you never have the need to use the info'. It was absolutely horrific to see such a sick Bunny

I am not trying to claim that I came up with this treatment regime. I just pooled the resources of various Veterinary expert advice and used them all!!
Maybe me and Bobbie were just lucky :?

Janex

I hope I'll never have to use this protocol, but thanks Jane for posting it, it could help save bunnies's lives.

Well, when I saw this topic I thought, hope I never have to use that and then Willow goes down with awful diorrhea!!:shock: :shock: , we put most of this into practise and she is making a slight improvement.....so again, it seems to work, however I printed this thread off today and took to my vet and this is her response:

Every injection / drug has potential for ill effect but the cost / benefit ratio must always be weighed up what any antibiotic may cause. Rabbit medicine is developing all the time and the regimes I use today I may not use in a few months. Vets, even specialists frequently don't agree, we all have different experiences.

I refer to FHB text book of vet medicines "Penicillan is an example of conficting information about safety of a particular antibiotic in rabbits, clinically it seems penicillan is a safe antibiotic to use parenterally but not orally"

Depocillan......I weigh all rabbits to be accurate, 0.2ml per kg every other day is the maximum dose I use (this given to me by a specialist vet at Edinburgh University) and yes, I have been lucky and never had any adverse effects, which isn't to say I won't however!, I personally don't agree with 'save it for a last resort' simply because by then you are treating a debilitated rabbit, therefore more likely to have an adverse effect. Like most vets, I use the antibiotic in my experience for that condition appears to work. For instance Baytril, in my hands, has never been very effective for bad respiatory infection or abscesses, therefore I wouldn't bother with it.

Jane I really think you should be a vet. Your knowledge and experience is far better than most I thik I've ever come across! I will keep this thread and print it once i've unpacked the printer...!

Thanks for that Theo - Harry is looking loads better despite me wearing his last dose rather than it going in him!! :roll: He no longer has white snot and the sneezing has all but stopped, he is still a little damp around his nose and having spoken to Rebecca she has prescribed another three doese and fingers crossed that will knock it on the head.

snowy said:

Depocillan...... I personally don't agree with 'save it for a last resort' simply because by then you are treating a debilitated rabbit, therefore more likely to have an adverse effect.

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A very good point and should I have to deal with another snotty bun I will raise this with my vet. :thumb:

So glad you can do what you are doing, I wasn't so lucky with Mr Thumps last year. He was doing well but he ended up crashing while in the vets and died. When we got the pm results it showed poisoning in his colon which was through the penicillin.

Please don't let it put any of you using penicillin if your vets reccommend it as I myself would use it again and have done with excellent results

Duplicillin, with Questran as a supportive measure could likely have prevented this sitruation. I fell that ytou were were poor;y advised in the the treatment of this animal.
Certain types of penicillin are PERFECTLY safe in the treatent of rabbits. I suggest you google Marcy Moore and Bicillin as a starting point in youtr quest for further enlightentenment on this subject.

Oscars said:

Duplicillin, with Questran as a supportive measure could likely have prevented this sitruation. I fell that ytou were were poor;y advised in the the treatment of this animal.
Certain types of penicillin are PERFECTLY safe in the treatent of rabbits. I suggest you google Marcy Moore and Bicillin as a starting point in youtr quest for further enlightentenment on this subject.

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Bicillin is ILLEGAL in the UK

Janex

Oscars said:

Jack-Jane/whatever... I can confidently state that your comments appear entirely motivated by your apparent reliance on other peoples admiration of your alledged extensive and specialist knowledge, albeitly misplaced, which seems to be dependant on the Google facility.
Your ignorance regarding the use of penicillins in rabbit medicine is evidential, without the need for for me to add any supportive scientific substantiatng evidence (which I shall leave you to google) can only lead me to the comclusion that the apparent reverence with which you are held on this forum is entirely undeserved and misplaced and potentially dangerous.

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Thank you 'Oscars' I have forwarded your 'interesting' PMs to Admin

Jane

Oscars said:

Duplicillin, with Questran as a supportive measure could likely have prevented this sitruation. I fell that ytou were were poor;y advised in the the treatment of this animal.
Certain types of penicillin are PERFECTLY safe in the treatent of rabbits. I suggest you google Marcy Moore and Bicillin as a starting point in youtr quest for further enlightentenment on this subject.

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Unfortunately for those people living in the UK 'Bicillin' which comprises of penicillin G benzathine mixed with penicillin G procaine is unavailable in the UK. UK vet's requiring to treat a rabbit with this have to obtain a 'named patient' licence and import the drug from abroad which will inevitably take time which is not ideal if you have a very sick rabbit.

Bicillin: the UK position

Basic facts about bicillin

Many rabbit owners seeking background information about the treatment of serious bony infections in rabbits have read about bicillin treatment, mainly on websites based in the USA. This is one topic where the situation between the US and the UK differs!

Your vet's prescribing and the law

Veterinary surgeons in the UK cannot give any drug they fancy to an animal - they're obliged by law to follow the "cascade" system.

The first choice would be to use a drug licensed to treat that problem in that species. The second choice would be to use either a drug licensed to treat the same problem in another species or, a different problem in the same species. Only if these options are not available is a British vet free to choose any drug available in the UK (either for animals or humans) for use in any species. If the desired drug isn't available in the UK, then the vet must obtain permission from the Veterinary Medicines Directorate to import and use the substance.

Bicillin falls into this category - it isn't licensed in the UK at all. It can only be imported and used legally in the UK if the vet treating a particular rabbit has obtained a Special Treatment Authorisation (STA) from the Veterinary Medicines Directorate (VMD). Obtaining an STA is usually relatively straightforward - so long as the treating vet can convince the VMD that there is no safe alternative available in the UK, and that the proposed treatment is both safe and effective. And this is where the bicillin story starts to unravel.

There's no firm scientific evidence that bicillin is an effective treatment for rabbits with abscesses and osteomyelitis. Although rabbit owners and vets have reported successes in individual rabbits - including some "near miracles" - no formal studies or trials have been conducted. And these anecdotal reports are not enough to convince the VMD.

At the end of 2002, the RWA/RWF wrote to the VMD enquiring about their position on bicillin and were informed that every application for an STA to use bicillin in rabbits had (so far) been refused - because nobody had presented them "with data or any convincing evidence that this combination is the only effective treatment for conditions in rabbits....". The VMD went on to add that, "If unequivocal evidence was presented to the VMD then we would reconsider our position."

Realistically, it is unlikely that any such evidence will emerge. Bicillin is an old-fashioned combination of two penicillins that came off patent years ago, so there's no commercial incentive for manufacturers of the drug to run a complex and costly trial to formally study the effectiveness of bicillin in rabbit. Also, many British vets maintain that there is nothing unique about bicillin, and that other penicillin preparations have just as much chance of working just as well.

DO NOT BE TEMPTED TO USE SMUGGLED BICILLIN

Obtaining and using bicillin (or any other drug not available in the UK) without an STA is a very serious criminal offence, and yet some rabbit owners have been so desperate to help their seriously ill rabbits that they have risked a hefty fine and a criminal record by using bicillin smuggled into the UK from abroad.

Some rabbit owners who obtained bicillin for their bunnies via internet contacts were not aware they were breaking the law. Others knew, but didn't realise the scale of the fine they were risking if caught, which can run to thousands of pounds.

One rabbit vet told the RWA in autumn 2002,
"One of my clients turned up with an un-labelled bottle of what he said was bicillin, and asked me to inject his rabbit with it. I refused. Not only would it be grossly negligent of me to inject an unknown substance of unknown quality into an animal, but by doing so I would be committing a criminal offence as well as the client."

Clients turning up with illegal supplies of bicillin in this way are putting their vet in an impossible situation, as Christine Shield (a Council member of the Royal College of Veterinary Surgeons) explains:

"The Medicines Regulations 1994 states that it is an offence to administer; cause; or permit to be administered an unauthorised veterinary medicinal product. So, vets who co-operate in treating rabbits with illegally obtained bicillin - such as by injecting the rabbits, or supplying needles - could be risking their career. On the other hand, vets have a duty to ensure that the welfare of animals in their care is not compromised. They then have to decide between throwing the client off their books, which might place the rabbit at greater risk, or agreeing to monitor the animal's condition."



Bicillin Facts
What's bicillin?

A combination of penicillin G benzathine plus penicillin G procaine. Bicillin is not available in the UK but rabbit vets in other countries (particularly the United States) have gained considerable experience with it.

What's it used for?

Bicillin has been used to treat abscesses and bone infections(osteomyelitis), especially if surgery has failed or is not an option.

Does it work?

The different treatment options for abscesses & osteomyelitis in rabbits have never been compared in a proper trial. So the only "evidence" for bicillin is in the form of case reports.... but the same applies to surgical alternatives.

Devotees of bicillin (usually rabbit owners) claim near-miraculous results. Many vets aren't quite so convinced, but increasingly regard bicillin as a useful addition to their armoury.

Aren't penicillins dangerous to rabbits?

Penicillins can cause serious or fatal diarrhoea in rabbits. But, given by injection, rather than by mouth, bicillin is remarkably well tolerated. Nevertheless, the risks/benefits have to be carefully weighed up by the prescribing vet

The original version of this article was written by Dr Linda Dykes MBBS (Hons) MRCSEd A&E and Owen Davies BVSc MRCVS. It appeared in "Rabbit Health Matters", Rabbiting On, Summer 2001.

This completely revised version was prepared by Dr Linda Dykes, Owen Davies, and Judith Brown MRCVS in April 2003.


Copyright © BHRA 1999

the trouble is with penicillin that its more a family of drugs than a single drug, it comes in various forms and preparations. here is the wiki info on it http://en.wikipedia.org/wiki/Penicillin

that info is very interesting Jane, thanks for posting