# HELP! Eye infection after treatment for pasteurella



## michelle86 (Feb 20, 2010)

I have two bunnies. They are both dwarf size. One is 9 months old (Bella) and the other is 6 years old (Ben). They were both recently treated for white nasal discharge. They were prescribed azithromycin oral suspension for 10 days. Treatment was over Feb 8th. It cost me $84 for the vet visit and another $130+ for medicine for both rabbits.

They have both stopped sneezing, and from what I've noticed haven't had any obvious nasal discharge.

I was caring for Ben today. He has longer hair than my other rabbit and the thick syrupy medicine had matted the hair around the corners of his mouth and the skin is scabbed and split between the scabs. It looks sore. this is a hard area to see because of his hair so I only noticed it today :/ So I was clipping the hair around his mouth and dampening the scabs and trying soften them before removing them and applied antibiotic ointment on the corners of his mouth. 

After I did this he went to bathe himself because I got him all wet and he bent his head down to lick his chest, and I watched a drop of white discharge form at the corner of his eye! I looked at the other eye and he had some there too.

My other rabbit's eyes are fine.

So my question is... what do I do? Do you think it is a plugged tear duct? I read about having rabbit's tear ducts flushed out and being treated with eye drops and antibiotics. Do they have to be under anesthesia to have their tear ducts flushed? I want to be educated a bit more on what effective medications there are for buns for this problem and also have an idea of how much it will cost me for these treatments.

My rabbit was treated with baytril in the past, but this medication made him lose his appetite, and his droppings were much lighter and smaller in size. It made him a lot worse. He did not feel good at all when he was on it. And so at the recommendation of someone here, I asked the vet to put him on azithromycin. This was a little over a year ago. The medication worked awesome and he had no negative effects.

The vet knew he had been treated with azithromycin in the past and that it worked, so he prescribed it again. But I wonder if it didn't work because the bacteria had become resistant to it. My younger rabbit though seems fine and it worked perfect for her, even though she caught the bacteria from Ben.

I'm really confused because he has stopped sneezing but he seems to have the same pasteurella infection in his eyes.

I know that tear duct infections often result from overgrown molars, but the vet checked his mouth when he went in and he didn't notice anything wrong with his mouth, so I assume that his eye got infected when he'd clean his nose with his paws and then rubbing his paws over his eyes.

I already felt so bad for noticing his mouth sores this late, and now this!  I'm very concerned for him.


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## ra7751 (Feb 20, 2010)

Couple of things here. First, if there was not a culture performed, do not assume Pasteurella. At one time we could assume but no longer. I have never actually seen a blocked tear duct but a skilled vet can flush tear ducts without sedation in most cases. Azithromycin is the current drug of choice against Pasteurella. But many vets underdose this drug quite a bit....dosing for a rabbit is much higher than for a dog. If you can provide your rabbit's weight and the concentration of the drug....I can calculate the dosing for you. Looking at the teeth doesn't cut it. If there is a root issue, that has to be seen on radiology.

A few things about drugs.....Azithromycin is the best available currently to treat Pasteurella (as well as several other pathogens). I also use Zeniquin sometimes as well as penicillin and Convenia. The latter two drugs are safe only as injectables. Zeniquin is a newer Floroquinolone that is in the same family of drugs as Baytril and Cipro. The newer version is not yet showing signs of resistance. I understand it is a very expensive drug. I do not generally use Baytril and never use Sulfa as they are ineffective in most cases and sulfa can severely damage the beneficial bacteria in the GI. Dosing protocols for these drugs are many times not available to vets. And Convenia is specifically labeled "not for use in rabbits" but when dosed properly is highly effective. I have used it in wild and domestic rabbits and squirrels....one of my vets has even used it in guinea pigs. 

When using oral antibiotics, it is always beneficial to support the GI with an appropriate probiotic such as Bene Bac. The appetite can be stimulated with a B Comp (a vitamin) injection.

Randy


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## michelle86 (Feb 20, 2010)

I am pretty sure his weight is something like 5 lb 11oz. His dosing was 3.125 ml daily (200mg/5ml azithromycin suspension) x 10 days.


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## ra7751 (Feb 20, 2010)

The dosing is correct (in fact it's almost the high end dosing....props to your doctor)....I normally go 14 days or 5 days past the presentations of the infection. I would talk with your vet about either continuing the Zithromax or doing a culture to identify the bacteria and treat accordingly.

Randy


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## michelle86 (Feb 21, 2010)

I am going to give the vet a call tomorrow (couldn't do it this weekend) and see what he wants me to do.

I found somewhere online about using boiled salt water (cooled) to clean the area around the eyes. Does anyone know the rationale behind this? Is it just soothing? I figured I'd do it because I couldn't take him to the vet this weekend and there was nothing else I could do for him.


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## tonyshuman (Feb 22, 2010)

The salt water should be the same concentration as the eye fluid--it's less painful to get slightly salty water in your eye than to get pure water. I use sterile saline made for storing contact lenses--not contact lens solution, just sterile saline. If you've ever done a sinus rinse they also use boiled water with a low concentration salt solution. 

The main reason is that the cells of the body prefer to be in a solution that has some salt there. It's based on osmosis. The eyes are particularly sensitive to the salt concentration because they're delicate and don't have a protecive barrier like skin. I think the best thing to do for him is rinse the eyes with sterile saline for contacts, artificial tears drops, or one of those sinus rinse products--they have sachets of salt you're supposed to add to a certain volume of pre-boiled and cooled water.


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## michelle86 (Feb 24, 2010)

I am taking Ben to the vet next week.

I've been watching him more closely. I haven't noticed as much eye drainage, but what I am noticing is that he still feels stuffy. He doesn't sneeze anymore, but he forces air out his nose to try and clear it. Also when he cleans his ears (you know tilting his head to the side) he makes a sound. like a *humphhh* as if it is harder for him to breath in that position.

Anyone recognize these as classic symptoms of anything?

He's already been treated 10 days with azithromycin. When I had taken him to the vet, he said his lungs were clear and that his infection was only in the upper respiratory tract.


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## Pipp (Feb 24, 2010)

It can take a long time on antibiotics to completely clear an infection. My Vet can keep my guys on them for a month, (sometimes three months).

Does he sleep sitting up or rest with his nose slightly upwards? 

I've had healthy bunnies make noise when they clean their ears. Is this a new behaviour? 

I think he just needs more time.

How are the corners of his mouth? 


sas :clover:


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## Pipp (Feb 24, 2010)

PS: Can you put your location in your profile? Thanks!


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## michelle86 (Feb 24, 2010)

Well after he cleans himself he forcibly blows air out his nose to try and clear it. If he ever did this in the past, then he's doing it a lot more now, because I never noticed it.

The corners of his mouth healed up really nice. I was able to take a small pair of scissors and remove the scabby mats. I put some antibiotic ointment on the raw skin, and now he looks great, not 100% back to normal but tons better than he was.


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## michelle86 (Feb 24, 2010)

Oh and he has been sleeping as he always does. On his side.


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## tonyshuman (Feb 24, 2010)

It sounds like he's doing better, but Pipp is right that he probably needs to be on the antibiotics for just a little longer. The absolute minimum course, from what I've read on bunny health, is 14 days, with 20 preferred.


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## michelle86 (Feb 24, 2010)

I called the vet, and asked to just speak with him, and he said that he would prescribe Ben for another round of antibiotics. So 10 more days.


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## tonyshuman (Feb 24, 2010)

That sounds good!


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## jamesedwardwaller (Feb 25, 2010)

*michelle86 wrote: *


> I have two bunnies. They are both dwarf size. One is 9 months old (Bella) and the other is 6 years old (Ben). They were both recently treated for white nasal discharge. They were prescribed azithromycin oral suspension for 10 days. Treatment was over Feb 8th. It cost me $84 for the vet visit and another $130+ for medicine for both rabbits.
> 
> They have both stopped sneezing, and from what I've noticed haven't had any obvious nasal discharge.
> 
> ...


awesome..!.>lots of support,,people who care>!!.now,my take on this is as follows,,,a proper exam w/facial radiogragh would rule out teeth and tear ducts.//.pasturella is contagious,,one rabbit close enough,drinking,,eating,,pooping-will get it...the key here is a strong immune sytem/proper diet-70% hay/water,,some quality lowfat pellets,,and a couple treats-(never free hand pellets)-big mistake,,teeth are constantly growing requiring proper maintenance-chewing on-(hay)- fruit tree branches/twigs are great for trhe gi-tract too..//.if the culture comes back positive for pasturella--once it is treated--the rabbit will have to be monitored for signs of a flareup.//.need to eliminate alot of stress,,build the immune system up,,and when giving oral antibiotics,,always give a probiotic-(benebac)-found at farm supply stores,,32grams for $8.00-one gram a day for up to 10 # rabbit..,,please let me know if this helps.??..sincerely james waller -god speed:wave::rose:ink iris:inkbouce::bunnydance::biggrin2:


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## Al_Koenig (Apr 20, 2010)

Dear Guys,

You guys won't believe how happy I am to stumble upon this post. We live in Indonesia right now, and unfortunately there are no rabbit savvy vets in the whole country.

Our 6 year old Lionhead, Luna, has had an outbreak of Pasteurella. We used Zithromax on her and after a (rather lengthy) 20 days, her snuffling and nose discharge stopped.

However, we have now the same problem as with Michelle's bunny. Her eyes seem swollen and the eye-lids are a bit reddish. From time to time you can see whitish discharge coming out of her tear duct.

Michelle, I was wondering how it went with your bunnies. I understand the vet gave them ten more days on zithromax? But what about the white discharge? Did it go away after the second regimen of zithromax? Or did the vet do something else?

We'd really appreciate if anybody could give us hints on how we can finally help our little baby. As I mentioned before, there are no rabbit savvy vets at all in Indonesia (you can check it out on house rabbit society, it's amazing - there are simply NONE), and we are left on our own with medicating our bunny. But having no expertise as a vet myself, we just can't do stuff like flushing tear-ducts etc.

Kind Regards,

Al


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## michelle86 (Apr 20, 2010)

I just replied to your PM


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## tonyshuman (Apr 20, 2010)

Al: I think it would be worth it to continue with the zithromax for 10 more days. It did work on her earlier, so the bacteria are at least susceptible to it (not resistant). I have heard of needing a 30 day course, or even more, of zithromax (or other drugs) to completely clear up a persistent URI. There are other antibiotics that can be used, but they're a bit trickier and might not be available. I am thinking in particular of Convenia, which is a dog and cat antibiotic that's administered by injection every 5 days in rabbits, and a penicillin G formulation that can be hard to find outside of the US--it's typically used for livestock. But since the infection first did respond to zithromax, it's best to try that for a bit longer. If it doesn't work this time, you may have to switch antibiotics.


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## Al_Koenig (Apr 21, 2010)

Dear Michelle and Randy, many thanks for your input. I'll do just that. I'll continue to give her Zithromax for 10 more days. If her condition IS getting better after 10 days, but not perfectly goes away, should I simply continue with the drug? Are there any long-term side-effects?


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## Al_Koenig (Apr 21, 2010)

@tonyshuman: With the bacteria being susceptible to zithromax, do you think it has a good chance that in time, it will kill off / suppress a major part of the bacteria when the antibiotic is sustained for a longer period of time?

If yes, are there any known side-effects of long-term zithromax use (beyond 30 days)?

I'm really sorry, I really seem to give my bunny a trial-and-error approach to medication. But for us down here, there are simply no vets nor to speak labs that can perform a proper C&S test. So, u gotta do, what u gotta do 

Thanks in advance for your help,

Al


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## tonyshuman (Apr 21, 2010)

First, make sure the dosing is correct:
"Azythromycin, a modified erythromycin, that does not show the side effects of the later in rabbits, is very efficacious in the treatment of Bordetella sp. (and so is enrofloxacin). The azythromycin dosage used for rabbits (50mg/kg PO QD (SID), is much higher than that used for other small animals like cats and dogs (5-8mg/kg). Treatment lasts generally 7 days, after which an evaluation is done and eventual prolongation decided."

http://www.medirabbit.com/EN/Respiratory/Bacterial/URI.htm

I can't remember now, but I have heard of bunnies being on it for I think 2 months. I will look and see if I can find that.


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## Al_Koenig (Apr 21, 2010)

We've tried a dosing of 40mg/kg a day. Twice. But she went into a terrible GI stasis, which was really hard to remedy with sub-q, benebac and force-feeding. Maybe it has to do with her age (6 years). and so therefore we lowered it to 30mg/kg a day.

Would it work on a lower dose but with a longer duration of the treatment? 

And, please, it would be great if u could find more info on this. Thanks a lot!


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## tonyshuman (Apr 21, 2010)

I can't find it. The reason to keep going after all the symptoms have gone is that even if there aren't outward signs of infection, a few bacteria can still be left, the stronger ones, and by taking away the antibiotic they can come back stronger.


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## tonyshuman (Apr 21, 2010)

I'll try to get our expert on this.


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## Al_Koenig (Apr 21, 2010)

That would be awesome! I have posted this on many forums, but couldn't get the answer to it: 


 If our rabbit can't endure a regimen of azithromycin for 7 days on 50mg/kg, would we get similar results with a lower dose (let's say 30mg/kg) with a treatment duration of 30 days or more?

Also, as was the case of Michelle's bunnies, our bunny also has swollen tear ducts after her acute sneezing subsided. Is that conjunctivitis? The Medirabbit document page says that conjunctivitis must be treated locally in addition to the main antibiotic. I think it was not the case with Michelle's bunnies. (Right Michelle?)
However, if that is a mandatory, I could look around for Gentamycin or Enrofloxacin. Could you give me some pointers on the right dosage. Does it have to be drops? Would nebulizing the bunny with a mixture of Saline Water + Gentamycin or Enrofloxacin help her tearducts too, or does it have to be drops directly applied to her eyes/tear-ducts?​


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## michelle86 (Apr 21, 2010)

My rabbit's eyes had discharge, but his eyes were not swollen or red. It was essentially just a buildup of the nasal discharge coming up through his tear ducts. His eyes and tear ducts were not infected. (if I had not treated it promptly, it could have turned into an eye/tear duct infection).

When I researched eye discharge in bunnies, I read about vets flushing the tear ducts to clear them because in those cases, the rabbits had eye discharge because their tear ducts were blocked - which may be the case in your rabbit.


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## Al_Koenig (Apr 21, 2010)

Thank u again, Michelle! Bad thing is no vet in town will do a tear duct flush here. So, I'm looking for topical alternatives (if there are any).


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## michelle86 (Apr 21, 2010)

Does anyone more knowledgeable know what antibiotic eye drops are effective against pasteurella?


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## ra7751 (Apr 21, 2010)

Al....Zithromax does cause some GI upset initially in most rabbits but I just ride it out. I have dosed Zithromax both alone and with Penicillin for months. Didn't seem to have any long term effects. If you can find some injectable Penicillin to go with the Zithromax, I can probably work up a dosing protocol if I know precisely what it is. You can certainly dose the Zithromax at a lower dose. In my early days of using that drug, dosing was by "SWAG" method and I did have success at lower dosing...but I use the higher dose now.

As far as eye drops, Gentamicin is what I call a "big gun".....it is the best (in my non-professional opinion). As far as tear duct flushes....totally overdone. While I am sure it can happen, I have never actually had a rabbit with that condition. I did flush the ducts of a rabbit born with bilateral micorphthalmia just to make sure his damaged eyes were lubricated properly. In most cases a tear duct flush is not necessary and only leads to stress on the rabbit for no real benefit.

There is adrug you might find quite helpful.....it's rarely found in the US but is still commonly used in third world countries. That drug is Chloramphenicol. It is a very effective drug....especially against "walled off" infections such as abscesses or lower respiratory infections. It is very safe for the rabbit. One down side is that some humans are very sensitive to this drug and it can lead to a condition known as Aplastic Anemia.


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## Al_Koenig (Apr 21, 2010)

Wow, that's a relief. I was worried that a tear duct flush would be a mandatory.

So, today I will be looking for Chloramphenicol or Gentamicin. If I can find both, with which one would u go? And could u advice me with the proper dosage on each of the two drops?

I'll also be on the lookout for injectable penicillin.

One last question on Zithromax: Does it harm the rabbit in any way if the dosage is not consistent? (i.e. higher dosage now, and then lowering it or vice versa?)


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## ra7751 (Apr 21, 2010)

Only use Gentamicin as an eye drop. You can get Chloramphenicol drops but you want the oral version. It is very gentle on the beneficial bacteria in the GI. If you find a vet that will use this drug, follow instructions for properly handling the drug. Just drops will usually not do much good unless it's for a corneal abrasion.

Drugs are always more effective if kept at a constant level.....I never vary dosing and try to administer drugs at the same time each day.

Randy


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## Maureen Las (Apr 21, 2010)

I once had a rabbit who required tear duct flushes/

The presenting symptom was always a runny eye with clear fluid but when flushed the vet would get pus discharge from the duct

The vet did the procedure without anesthesia and I too had trouble finding someone who would do it. The treatment was an antibiotic eyedrop ( some neosporin drop combo??) and an oral antibiotic At thattimeI was prescribed baytril. 
Looking back (this was awhile ago)I would think that if the oral antibiotic had been a more effective drug and the drug had been given long enough that the eye problem would not have kept reoccuring. 

I had a rabbit (lost him today ) who had a horrendous eye infection and corneal abrasion several years ago;. it was unresponsive to everything I tried . it was so bad thatI was going to have the bun PTS if he did not get some help. A new vet pulled out a tube of Chloramphenical 1% opthalmic salve and it noticeably worked within the 1st 24 hrs of treatment and saved my little guys life. 

In terms of the Zithromax dose why don't you try it at 40 mg/kg; right in the mid range???
I also had been looking into getting oral Chlorampenical;I was looking on-line and it is apparent that it is easier to get in foreign pharmacies than here, however the problem would be getting it compounded so that you wouldn't have to handle it yourself. 

You might find that your vet would order it.


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## Al_Koenig (Apr 23, 2010)

@Randy: I could only find Gentamycin eye-drops and Chloramphenicol - but in eye-drops form, too. So I guess, that means, we're going to give Gentamycin a try. I've heard of a dose of 2 times a day? Is that right? How long should I continue giving her the drops?

Also, should we expect any GI complications or any other side-effects during the treatment. Will it be painful for her, should we prepare some painkillers? If yes, what kind of painkillers are rabbit-safe?

Her sneezing and nasal discharge have completely gone away. But she'll be still on zithro for 7 more days. 

many thanks,
Al


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## Al_Koenig (Apr 23, 2010)

@Angieluv: I'm sorry to hear about your loss. I'm sure she had a happy with with such a caring and knowledgeable rabbit-mum.

We've tried 40mg/kg on our rabbit. Maybe it was her condition that was already far from top-notch or her age (6 years), anyhow, she stooped to eat and poop for almost 2 days. We had to give her sub-q (also ONLY available at a vet down here) and also probiotics, which are quite rare here. However, the lower-dose zithro seemed to work, albeit slower than people reported with higher dosages. She's stopped sneezing and no nasal discharge for 3 days already. However we'll keep the zithro for 7 more days.

I'd really wish someone knowledgeable about rabbits would open shop down here in Indonesia. He/she could save so many lives. From my experience the few "exotics"-vets who are here, are only good for surgeries and spays.

Now, let's just hope Gentamycin can fix her eye-infection.


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## Al_Koenig (Apr 24, 2010)

Gentamycin just arrived. It says:

GARAMYCIN - Gentamycin Sulfate - Drops for eyes and ears. 5mL 0.3%
Produced by Schering-Plough Labo N.V., Belgium.

That is the right drug is it? Please could someone give me the right dosage? 2 times or 3 times a day for how long?

Our bunny is still on Zithromax; Gentamicin won't interact strangely with Zithromax, will it? Should we brace for GI trouble ahead? Please advice...


Thanks a bunch people,
Al


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## tonyshuman (Apr 24, 2010)

It shouldn't be used in the ears for rabbits, although I guess that's not an issue here. Anyway, Medirabbit says the dose is 1-2 drops per eye, 3 times a day (that's what tid means in prescription-speak).

http://www.medirabbit.com/Safe_medication/Antibiotics/Safe_antibiotics.htm

I looked at the interactions for azithromycin, and gentamycin is not on that list. I am having a hard time finding what concentration of gentamycin sulfate is used on rabbit eyes.

I would not worry about interactions anyway because the gentamycin will only be on the eye, and thus won't go to the GI tract which is where most issues are for antibiotics in rabbits.


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## tonyshuman (Apr 24, 2010)

I did find a study where 0.3% gentamycin sulfate was applied hourly for 24 hours, and that didn't hurt the eye.

Here it was given 4 times daily but the dose wasn't specified.
http://www.mohrs.org/hrswebpg24.html


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## Al_Koenig (May 1, 2010)

Dear Guys,
Just wanted to update you on Luna's condition. We've stopped her Zithromax after 30 days. She has stopped her sneezing completely, however her eyes-lids are still a bit reddish. The Gentamycin we planned to give her was a year beyond its expiry date. good thing we noticed it beforehand. 

Today we found an eye-doc that was kind enough to give us "fresh" Gentamycin. So, we're starting to try to treat her eye-infection today. 

Thank you all very much for your kind help so far! We will keep you posted on how it goes!


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## tonyshuman (May 1, 2010)

That's good to hear! I hope the gentamycin takes care of the remaining redness.


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## Al_Koenig (Jun 4, 2010)

Dear Guys,

Many thanks for your kind a replies. It helped us a lot in helping our bunny make her recovery. The Gentamycin finally cleared up her reddish eyes. 

However, after last week or so, we could see our bunny sometimes sneezing randomly (mostly in the morning) two to three times consecutively. But it is really random, not the semi-continuous sneezing that we had before her treatment. I reckon, there is still something left of the bacteria in her body, and it has not been suppressed completely.

What would u guys do? Should we put her on another course of antibiotics (zithromax) to prevent it getting worse (having in mind that she already had a long term course behind her not so long ago), or should we wait and see first?

Kind Regards,
Al


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## tonyshuman (Jun 4, 2010)

What was the dosage that you had zithromax at for 30 days, mentioned above? I noticed that you did give her 40mg/kg but that led to GI issues-what dose ended up being ok to give her?

I would tend to think that since the infection initially responded to zithromax, a longer course or greater dose might finish it off completely. However, 30 days is a pretty long time and if you can't increase the dose w/o having GI issues, that may not be the best. If the dose you were giving was a lot less than the recommended 40mg/kg, you might be able to increase it without having GI problems, and that might take care of it for good. If you were already giving something like 30mg/kg, going on it longer-term may not improve things...


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## Al_Koenig (Jun 9, 2010)

Hi, we gave her 30mg/kg... we were never quite able to get her drink all of it. Effectively, maybe only three-quarters of the dose. 

Oh, and another question. From your POV, how long should a 'normal' long-term regimen last?


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## tonyshuman (Jun 9, 2010)

I would say a normal long-term regimen would be one month, with 6 months being a bit excessive. I know angieluv had her Beau (RIP) on long-term maintenance therapy with bicillin (a combination penicillin injectible), that was a constant thing, with no end in sight, just to keep his tooth root abscesses under control. If it took more than 6 months to treat, then I would worry, but you are at the lower end of the dose so longer may be better. One other drug you might look into is chloramphenicol. It's also an antibiotic that has to be handled carefully by people but has some good success in URIs and is available in many areas of the world.


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## Al_Koenig (Jun 10, 2010)

We have looked into chloremphenicol. It seems no vet wants to touch it here, and it's hard for us to get it without prescription. If her sneezing acts up again, we will I give a proper 30mg/kg zithromax another try. Many thanks for your help. All of you! This forum rocks!

Cheers,
Al


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## tonyshuman (Jun 10, 2010)

I see. sounds good!


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