Rabbit chronic snuffles - anything new?

Re: Rabbit chronic snuffles - anything new?

Gerbil — Fri, 29 Nov 2013 21:22:45 GMT

[quote user="Robin Grimmer"]

I had a case just like this that Mark Rowland helped me with. He recommended injectable penicillin, 20mg/kg sid for 1 month minimum. Use penstrep as it's much easier to inject - the streptomycin doesn't do any harm. Obvious precautions to ensure the rabbit doesn't ingest any penicillin, but he's a doctor, so should be fine.

[/quote]

Ha Ha I've also had one that I treated on Marks advice just the same, fixed it a treat!

Re: Rabbit chronic snuffles - anything new?

Marie Kubiak — Fri, 29 Nov 2013 18:58:23 GMT

[quote user="Sarah Mark"]

Thanks everyone - just spoken to the owner and he's not so keen on more spending so will probably be trying the injectable penicillin. I've used Depocillin in the past to treat Treponema, I presume this would be OK to use?

[/quote]

Depocillin specifically states on the data sheet not to be used in rabbits - duphapen carries only a warning for smaller rodents, this is likely only a theoretical benefit but worth considering when using off label antibiotics in this litigious society.

marie

Re: Rabbit chronic snuffles - anything new?

Marie Kubiak — Fri, 29 Nov 2013 18:52:17 GMT

Martin - you'd be surprised how keen a lot of owners are to investigate problems further. I get a lot of second opinions who sought further treatment since their vet 'only wanted to put it on penicillin and not try and solve the problem'. Also insert 'baytril' for penicillin. Fair enough, a lot aren't enthusiastic but in all honesty how much does a swab for culture cost compared to long term antibitiotics? Particularly for something like pasteurella where resistance to multiple antibiotics is common and you can go through a few different antibiotics before seeing a clinical response. Also worth considering that one of the hot topics in vet medicine and a focus of the governing bodies currently is non-targeted antibiotic usage and resistance encouragement, and Pasteurella is a potentially zoonotic organism with variable resistance patterns.

Admittedly I probably see a slightly skewed population of owners but much of my caseload is still first opinion so not as if I deal with insured, super-motivated owners constantly - though this would be lovely for my stress levels. I genuinely think if you can have the time to go through the case - discuss why the anatomy hampers medical treatment, (I use skulls and draw pretty pictures...), difficulties of the specific bacteria potentially involved, be realistic about the range options and costs a lot of owners will appreciate that a bit more investigation will help. Still get flat refusal from some but sadly that's the downside of owner-funded vet medicine and I feel I've at least given them all the available options and have at least an informed refusal!

Not a big fan of penicillin injections personally where safer first-line antibiotics are likely to be equally effective, but where used I prefer Duphapen LA for the longer interval between dosing. I always avoid streptomycin because of the increased potential for side effects.

Marie

Re: Rabbit chronic snuffles - anything new?

Sarah Mark — Fri, 29 Nov 2013 17:29:56 GMT

Re: Rabbit chronic snuffles - anything new?

Martin Atkinson — Fri, 29 Nov 2013 17:24:45 GMT

[quote user="Robin Grimmer"]I had a case just like this that Mark Rowland helped me with. He recommended injectable penicillin, 20mg/kg sid for 1 month minimum. Use penstrep as it's much easier to inject - the streptomycin doesn't do any harm.[/quote] +1.

Marie's approach is of course gold standard but most people are not going to want to pay out what it would cost for a bunny. Another thing I've tried, and I will of course she be shot down in flames for this because it is contra-indicated, is an injection of Convenia, but it worked. Another thing I did by accident and this is confession of the month, I gave an injection of Cartrophen by mistake (I meant to give it Convenia so from bad to worse!) that worked as well. I figured it was because of some immuno-modulatory action and I wouldn't knowingly repeat it, but there's food for thought.

Re: Rabbit chronic snuffles - anything new?

Marie Kubiak — Fri, 29 Nov 2013 14:33:01 GMT

I usually do rhinoscopy on these where possible - usually just find drainage of pus from sinus but you can target where you take culture sample from much better and I have found a grass seed on one which was satisfying to remove.

One of the main propagating issues is the failure of natural drainage from the sinuses due to the position of the exit hole. This leads to sequestration of a protected focus of mucus, pus, bacteria and necrotic debris that persists. New fashionable technique is sinus surgical exploration and debridement via a dorsal trephination. This however requires CT to target where you need to get in and remove pus and necrotic bone which often makes cost prohibitive.

I don't tend to use septrin as it is deactivated by pus so doesn't really get into the site of ongoing infection even if the bacteria themselves are susceptible- I most commonly use a combination of a fluoroquinolone and metronidazole, or azithromycin based on sensitivity results.

Other possible treatments include nebulisation therapy which can help reduce symptoms if the rabbit tolerates it. Stress reduction is crucial in maintaining a stable symptom-free state.

Marie

Re: Rabbit chronic snuffles - anything new?

Robin Grimmer — Fri, 29 Nov 2013 14:29:42 GMT