Panacur rabbit as prevention for E. cuniculi

Re: Panacur rabbit as prevention for E. cuniculi

Virginia Campbell — Fri, 12 Oct 2012 19:11:00 GMT

Thanks, I may be overthinking this! I think I'll just tell them to do what the panacur sheet recommends.

Re: Panacur rabbit as prevention for E. cuniculi

HMC — Fri, 12 Oct 2012 13:33:36 GMT

My head hurts! I though fenbendazole was the treatment for E. cuniculi and now I hear it's not all that great, or worse, harmful.

I dutifully gave my own rabbit 28 days of lapizole a few years ago as I thought that would reduce/rid the burden of EC. At least no ill effect were noted.

Re: Panacur rabbit as prevention for E. cuniculi

Virginia Campbell — Thu, 11 Oct 2012 19:38:48 GMT

[quote user="Beverley Panto"]I just wanted to canvass opinion from some more experienced colleagues - particularly those of you with a special interest/specialism in exotics, as to the importance of E. cuniculi prophylaxis in rabbits[/quote]

Resurrecting this thread as we euth'd a rabbit for presumed E.cuniculi this week. (rolling rabbit with some uveitis, did not respond to tx over a few days and Os thought quite rightly was unfair to continue.

They have several other rabbits and want to know if they should be using Panacur metaphylactically now and in future. All other rabbits well at present. Os had read (online I think) 1 week course pancur every 6 weeks. Leaflet in panacur rabbit box says 2-4 times /year for 9 days as a "preventative regime" (though whether for E.cuniculi or "intestinal worms", it doesn't say). Under "uses" it says "as an aid in the control and tratment of E.cuniculi". I'm a bit suspicious of the word "aid" (in the same way that a big Mac "can only aid weight loss as part of a calorie controlled diet")

I'd tell them to go right ahead, if there was no such thing as the potential for bone marrow suppression etc. Does anyone know the duration and frequency of treatment likely to put them at risk?

Thanks as always

Ginny

Re: Panacur rabbit as prevention for E. cuniculi

James Laidlaw — Tue, 03 Jul 2012 12:07:24 GMT

[quote user="David Mills"]This shows that at 1cm 25% were incompletely excised. 2cm margins were associated with 100% removal both in this study and another prospective one: [/quote]

This says 100% with 2cm margins. So why 3cm? Or am I missing something.

My real point is that the "3cm rule" is arbitrary and not based on scientific evidence. As with the 28 day rule for fenbendazole in bunnies. There's a lot of stuff we are taught and that we accept as the way to do things that aren't necessarily based on any scientific evidence. Some days I get more worried about this than others.

Generally I approach them with wide margins and deep FP, probably more than 2cm most times to be safe. I don't think anything is wrong with 3cm margins, just that the "rule" has no scientific basis historically, it just appeared.

Re: Panacur rabbit as prevention for E. cuniculi

David Mills — Tue, 03 Jul 2012 11:38:58 GMT

[quote user="Rajat"]

I think James was referring to this paper: http://avmajournals.avma.org/doi/abs/10.2460/javma.238.11.1464?journalCode=javma

I dont take 3cms in grade 1-2 MCTs, and most people I work with don't either- many renowned oncs would agree. Many times 1.5- 2cm + a deep FP will suffice. Vast majority do not recur.

[/quote]

Yes, likely. However this is a retrospective study which comprised a histopath laboraoiry/correspondence-based various-centre study where actual margins were assessed on formalin-fixed samples fixed for varying periods upon which the authors rest the conclusion ('it probably was...') - largely actually expert opinion - about tumour margin at removal. The methodology for clinical removal is completely flawed.

For myself, I far prefer the prospective study wherein the tumour margins were marked on the skin pre-removal and then submitted:

http://www.ncbi.nlm.nih.gov/pubmed/14736068

This shows that at 1cm 25% were incompletely excised. 2cm margins were associated with 100% removal both in this study and another prospective one:

http://www.ncbi.nlm.nih.gov/pubmed/16426187

Incomplete excision (25% on 1cm scheme) is associated with a high rate of recurrence (another prospective study):

http://www.ncbi.nlm.nih.gov/pubmed/22559107

However many of these tumours are grade II or similar and the numbers aren't that high so precautionary principle applies in that 3cm would be my preference - I think total non recurrence should be the aim not 'vast majority', where appropriate of course.

Re: Panacur rabbit as prevention for E. cuniculi

Rajat — Tue, 03 Jul 2012 09:36:38 GMT

I think James was referring to this paper: http://avmajournals.avma.org/doi/abs/10.2460/javma.238.11.1464?journalCode=javma

I dont take 3cms in grade 1-2 MCTs, and most people I work with don't either- many renowned oncs would agree. Many times 1.5- 2cm + a deep FP will suffice. Vast majority do not recur.

Re: Panacur rabbit as prevention for E. cuniculi

An On MRCVS — Tue, 03 Jul 2012 09:32:08 GMT

[quote user="James Laidlaw"]In the words of Stewart Lee - "you can prove anything with facts"... Long day, can't be bothered with this argument and it's not pertaining to the OP.

[/quote]

Oh, I dunno: the thread's largely about arbitrariness in clinical protocols. FWIW, you're both right on this one - when the way forwards is unclear, there is often a consensus view on where to draw the line. Subsequent reviews and weight of clinical evidence then either corroborate or squash the initial premise, and we all take a leap forwards. Sometimes, of course, only to take a leap back - witness the whole hokey-cokey nature of limits on egg consumption a few years back.

The Over Thirty Month scheme was a case in point. There was, mainly, political pressure to start drawing boundaries to at least give the appearance of safeguarding public health - and out of this necessity somebody just made up 30 months as an upper limit for beef. There wasn't any real evidence, but it caught on and pretty soon if you tried to palm off thirty month-and-one-day-old beef, you were an enemy of the state and liable for millions of cases of nvCJD. All nonsense, really, but probably necessary in the great scheme of things.

In relation to MCT, I don't find pre-removal LOCAL staging / typing / whatever you wish to call it all that useful unless there's an absolutely zero margin or surgery is out of the question - at which point, stuff like masivet gets dusted off. I simply take the biggest margin that I can, and send the whole thing off. I'd be delighted with 3cm, but on some distal limb lesions, half a cm is frankly miraculous. In these cases, I think the attention to preventing seeding of cells in tissue layers is absolutely critical.

(Sorry for the anon - on another computer)

Re: Panacur rabbit as prevention for E. cuniculi

James Laidlaw — Mon, 02 Jul 2012 19:08:44 GMT

In the words of Stewart Lee - "you can prove anything with facts"... Long day, can't be bothered with this argument and it's not pertaining to the OP.

Re: Panacur rabbit as prevention for E. cuniculi

David Mills — Mon, 02 Jul 2012 18:35:05 GMT

[quote user="James Laidlaw"]Sorry, I meant biopsy. Nice avoidance of the main point though. 3cm margin is not based on science.

[/quote]

Possibly not originally, but subsequently proven - by studies looking at actual flesh margins not those assessed retrosepctively on tissue samples - to be the safest margin for ensuring complete removal and minimising regrowth. If you want to take smaller that's your prerogative but it should really be based on critical analysis of the papers - so far unquoted by yourself (see previous discussion for mine) - on which you're basing your practice.

Re: Panacur rabbit as prevention for E. cuniculi

James Laidlaw — Mon, 02 Jul 2012 06:53:20 GMT

Sorry, I meant biopsy. Nice avoidance of the main point though. 3cm margin is not based on science.

Re: Panacur rabbit as prevention for E. cuniculi

David Mills — Sun, 01 Jul 2012 23:36:08 GMT

[quote user="James Laidlaw"]Actually, the 3cm margin came in arbitrarily. I THINK that a 2cm margin will take 100% of grade 1 and 2 MCT's. Read the more recent literature - still good reason to FNA and identify a grade first if possible - may mean significantly reduced margins required.

[/quote]

Hold on sec, you're suggesting MCTs can be graded from FNA?? Which pathologist do you use and where does he have his crystal ball made?

Re: Panacur rabbit as prevention for E. cuniculi

James Laidlaw — Sun, 01 Jul 2012 15:43:54 GMT

Actually, the 3cm margin came in arbitrarily. I THINK that a 2cm margin will take 100% of grade 1 and 2 MCT's. Read the more recent literature - still good reason to FNA and identify a grade first if possible - may mean significantly reduced margins required.

Re: Panacur rabbit as prevention for E. cuniculi

David Mills — Sun, 01 Jul 2012 12:22:14 GMT

[quote user="James Laidlaw"]Kind of like the 3 cm rule for mast cell tumors, it's just "accepted" generally without proof?

[/quote]

Hold on a moment, there is plenty of evidence available on a short search of the literature showing that 3cm is a sensible margin certainly when compared to 1cm or lower. There was a thread on this recently. Tar same brush etc.

With panacur I sincerely believe that owners never fiishs the course anyway.

Re: Panacur rabbit as prevention for E. cuniculi

Mark Rowland — Sun, 01 Jul 2012 11:52:20 GMT

Ha ha numbers just plucked out of thin air!

Re: Panacur rabbit as prevention for E. cuniculi

James Laidlaw — Sun, 01 Jul 2012 10:08:31 GMT

Mark am I correct in thinking the "28 day" treatment plan isn't based on any scientific evidence either? Kind of like the 3 cm rule for mast cell tumors, it's just "accepted" generally without proof?

Re: Panacur rabbit as prevention for E. cuniculi

Nicola Lawlor — Sat, 30 Jun 2012 22:27:12 GMT

Thank you Mark. Good luck with the alternative protocol...look forward to hearing about it, if it is positive!

Re: Panacur rabbit as prevention for E. cuniculi

Mark Rowland — Sat, 30 Jun 2012 21:53:29 GMT

1) From the 2009 AEMV proceedings bu Michael Garner of Northwest ZooPath (an American specialist exotic pathology service)

Toxicoses

There are several isolated reports of lead toxicosis in house rabbits that chew on lead paint or have access to lead-based materials in the home. At Northwest ZooPath, the most common form of known toxicosis is fenbendazole toxicosis. Affected rabbits have bone marrow suppression, intestinal crypt necrosis, and bacterial sepsis. This drug is indicated for encephalitozoonosis, but perhaps should be used conservatively.

2) Matt Johnston, Assistant Professor of Exotic Animal Medicine, James L. Voss Veterinary Teaching Hospital, Colorado State University is documenting cases of pancytopaenia in rabbits following a 28d fenbendazole coures. When I last emailed him I think he was almost at 20.

3) Panacur, despite what many may think isn't licensed to treat E cuniculi, It is marked under the small animal exemptions scheme. This is because there is no documented proof it is efficacious.

I still use panacur but with caution and monitor haematological parameters. I dont believe it has no effect. They get supportive care also obviously. I am working on an alternative protocol with less potential side effects but its too early to say how well it is going to work. If it doesnt, I will try to think of something else.

I think there are still more questions than answers with this condition. Ive many more thoughts on this issue but hopefully what is above should act as a start.

Hope this helps

Mark

Re: Panacur rabbit as prevention for E. cuniculi

Nicola Lawlor — Sat, 30 Jun 2012 20:31:39 GMT

That's interesting Mark - What risks are there with fenbendazole for rabbits? How often would you potentially expect issues using it?

From your post I assume you don't use fenbendazole in suspected clinical cases? Dex and supportive care or other medications alongside too?

Thanks

Re: Panacur rabbit as prevention for E. cuniculi

Mark Rowland — Sat, 30 Jun 2012 10:50:28 GMT

I don't use the prevention protocol. Fenbendazole therapy is not without risk in rabbits. In the original paper by Suter that everyone quotes, for affected animals, fenbendazole had the same cure rate as dexamethasone. The idea that fenbendazole cures E cuniculi is likely a myth IMO.

Re: Panacur rabbit as prevention for E. cuniculi

Michael Woodhouse — Thu, 22 Dec 2011 23:53:15 GMT

Lapizole is a much cheaper (and easier IMO) method of medicating bunnies. The 100ml bottle is ideal for a full 28 day course for the average sized bunny!

I have not succeeded in ever encouraging anyone to routinely worm their bunny. We have a very low vaccine uptake. Most of the bunnies I see have myxi, are wild and brought to us by well meaning holidaymakers.

Re: Panacur rabbit as prevention for E. cuniculi

Rob Loxley — Thu, 22 Dec 2011 15:37:43 GMT

I'd rather see longer treatment for at risk/newly acquired/ill animals and am less concerned about quarterly 7day treatment for all rabbits in a stable healthy group.

Re: Panacur rabbit as prevention for E. cuniculi

Mark Holmes — Thu, 22 Dec 2011 10:18:42 GMT

We spend our lives vaccinating against things we never see. VHD being one, most of the dog diseases as well. It seems to be illogical to promote these and not taking steps to prevent E. cunic which is implicated in a wide range of common bunny ailments and seen regularly. Even if not 100% protective, neither are vaccines particularly kennel cough a much better promoted vaccination yet minor condition.

Not that I get much take up, but hey ho!