# Is this the best antibiotic and dosage for ear infection from pasturella?



## cmh9023 (Oct 22, 2011)

I have a little 1.5 lb Netherland Dwarf named Button who has a really bad ear infection, so much so that he's off balance and unsteady when he hops. He had a big glob of hardened discharge and gross pusin his ear that the vet removed so that helped somewhat. He also has an eye infection. His culture came back positive for pasturella.

He is currently getting injections of Pen G Procaine every other day at .08 cc. The trouble is I feel like a lot of that tiny dose isn't getting in him but rather stuck in the end of the syringe and the end of the needle that connects to it. He's had 3 doses so far and is still tippy. He is also getting eye ointment called Terramycin 3x per day and 4 drops of Baytril/saline in his ear twice per day.

He goes back to the vet on Tuesday. She's very open to making changes to medication and trying new things...a lot of the things we've tried for my other buns is because of good advice I've received here  So I'm just wondering what people's thoughts are on his current treatment and dosages. Button's partner, Jessie, had a bad case of head tilt and had good luck with Pen G as well as Azithromycin.

Thanks!
Cara


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## Maureen Las (Oct 22, 2011)

Hi Cara

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

I think that when you say Procaine Pen G that you mean bicillin ...right? 

Bicillin is usually in a bottle that combines penicillin G procaine with benzathine penicillin . The total amount of units per cc should be 300,000. that means that 0.125 cc/ml of bicillin would have 37,500 u . 

Check this against the medirabbit dosage for bicillin. I think thather dosage is in the correct range 

Are you diluting the bicillin with lactated ringers solution or sterile water. If you are not I would ask the vet to give you a bottle of lactated ringers ; it will help get the medication into her
I agree though that if she is not showing any improvement that this may not be the correct drug or the vet may want to add another one. 

Did Button's partner get azithromycin and bicillin simultaneously?

Some other possibilities may be oral chlorampenical or even Convenia ?
Randy has not been on RO for awhile but I will give you his email. There may be newer meds/ or med combos that he could suggest so I would go ahead and send him an email. Would your vet be willing to talk to him? 

Randy 
[email protected]

let us know howlittle Button is doing 

Maureen


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## cmh9023 (Oct 22, 2011)

Hi Maureen,

Asking if it can be diluted is a great idea! The tech was talking about how thick it is and with the tiny size needle he needs to use it makes it hard to get it through. I'll have to check the bottle that came from the vet for the cc's, etc. that you mentioned. I actually still have a huge bottle that I got at the Tractor Supply store that Jessie used for months. I'll check the numbers on that too (assuming its not expired). I'm pretty sure Jessie got both those medications simultaneously. I'll ask the vet to check her records. 

He's got a huge appetite and has been drinking his water and also he's very alert and interested in everything. Jessie's head is still quite crooked and it took her a while to get comfortable moving around. But now she races around perfectly well.So I'm thinking maybe he's just not used to the feelingof being off balance yet.

I felt terrible that I waited so long to take him to the vet. He had beenh sneezing for a long time, but it seemed to be only when he ate hay so I thought it was just because of the dusty hay. 

P.S. Vivienne (Saphire) is healthy as can be. She still wants nothing to do with me and has a fit if I try to touch her, but she loves to sleep on my bed as if it were her own. I think she secretly likes me, she just doesn't want to show it 

I'll write on Tuesday after Button's appt. Thanks for the reply!!

Cara


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## Maureen Las (Oct 23, 2011)

Ha Ha I am sure that Vivienne Violet loves you; you are the best thing that could have ever happened to her..

"The Ice Princess" LOL

Igave Beau bicillin for years and always diluted it with sterile water (ordered online) ; I never had any issues at all getting it in butI do know what you mean about seeing the amount that seems to sit in the barrel of the needle. Diluting the drug will also prevent sterile abscesses from forming .
If the infection has gone on a long time it probably really has a hold on him; It may take longer to resolve, also you may need more than 1 drug. 

Keep updating


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## cmh9023 (Oct 23, 2011)

How much bicillin and how much sterile water did you mix together and then how did you know how much to adjust the dose?

Do you also get your bicillin online or from the vet?


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## Maureen Las (Oct 23, 2011)

I used the bicillin from Farm and Fleet; it was Duo-Pen or Twin-pen... one of those .

I used a larger gauge needle to draw up the bicillin and then took off that needle and screwed on a smaller gauge needle ; I had small vials of sterile water and would draw upabout 0.25 cc of sterile water and then sort of roll the syringe to mix it and then inject. The amount of dilutent is not "set in stone" ; you just need to make the penicillin less viscous so it goes in easier .
I really had no vet to help me but Randy taught through a series of emails ( although Randy would use lactated ringers solution rather than sterile water ; I had no access to that. )

So you would initally just draw up the .08 cc of penicillin like you always do.
I think I used 21 gauge needle to draw up the pencillin and 23 gauge needle draw up the sterile water and then give the injection ( butI also was using 3 cc syringes )

If you have insulin syringes with the needles already attached to the syringe then you couldn't use that .


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## Maureen Las (Oct 23, 2011)

Cara, 

Just suggest to the vet that if you diluted the bicillin it may go in easier and I am sure that she will give you all the equpment that you need. I had to sort of "wing it'


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## tonyshuman (Oct 25, 2011)

I think what angieluv said about different gauge needles for drawing up the penicillin and injecting it is a very good point. It is common to pull up bicillin with a large gauge needle, draw up the sterile diluent, roll the syringe to mix it, and then replace the needle with one that is smaller gauge for the injection.

Insulin syringes with attached needles have needles of around 25-26ga, which is very small. I don't think they would be very good for bicillin injections, even diluted ones. You can also draw up air into the syringe before you draw up the drug and keep that air bubble in there to push stuff through the needle, since it is a sub-q injection.


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## cmh9023 (Oct 25, 2011)

Thanks for the info tonyshuman! I was hoping you'd see this thread  I'm going to the Tractor Supply store tomorrow night to pick up bicillin (I currently have Pen G Procaine), but I think I'll have to get the needles from the vet. What gauge should I ask her for?And what size syringe would it be mixed in? His dose is only .08 cc and I'm using a 1 cc syringe. I think I will have to order some sterile water online. I'm not sure I completely understand so I may have to ask some more questions on how to do it once I get the supplies.

Button's follow up appointment was today. At the first appt he weighed 1 lb. 5 oz. and today he was down to 1 lb. 1 oz., which isn't good. Especially considering he was eating a lot during the week. In fact, I was giving him an extra serving of pellets each day. So not sure what the weight loss is about.

He got some Azithromycin. I had it filled at Walgreens and got the sugary pink stuff. Later I read an old thread saying it was better to have powder from a tablet. After he took it he was totally druggy and stopped eating and pooping almost immediately, which I also read on that older thread. But, it's now about 2 hrs later and he's eating quite a lot again and pooping. The dose is .75 cc once per day. Does that sound right with him being just over 1 lb? 

She said to continue the Baytril solution in his ear twice/day and the eye ointment 3 times/day. On my own I gave him some Benebac Plus in unsweetened applesauce last night. I also picked up some alfalfa pellets to mix in with the Bunny Basics T thinking that might be helpful in weight gain. He is also due for his Pen G injection tonight.

He's still pretty off balance when he tries to hop, but he's alert and interested in things. Do either of you know what Randy typically uses for Pasturella?

Thanks!!!

Cara


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## Maureen Las (Oct 25, 2011)

Randy really doesn't believe in the word "pasturella" because the word really encompasses a group of different bacteria that can cause infections in rabbits. You could have the bacteria cultured in order to determine the medications that the specific bacteria are most sensitive to but inYour bunny's case it sounds like you need something right now 

I can give you our collection of Randy'sposts to go over. I do believe that he has used zithromax and bicillin together many times. 

http://www.rabbitsonline.net/view_topic.php?id=57554&forum_id=100


In order for us to know what the correct dose would be we would need to know how many mg of zithromax are in a cc (it would say on the bottle...I think ) 

if you could get supplies from your vet it would be a lot easier than ordering stuff on-line. 

I used the 21 gauge needles to draw up the bicillin and 23 gauge to give the SQ injection but I could only attach those size needles to a 3 cc syringe so it was a little harder to measure the dose in a larger syringe but possible ...

You may also want to ask the vet for some meclizine for the dizziiness


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## cmh9023 (Oct 25, 2011)

Is this the info for dosage:

Azithromycin 100mg/5ML Susp 15 ml

Cara


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## Maureen Las (Oct 25, 2011)

According to medirabbit a rabbit weight a kg (2.2) lbs should get between 30-50 mg per day 

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

Since your bun weighs only 1/2 kgs he should get between (1.1lbs) 15-30 mg a day 

he is getting 0.75 cc=15 mg which is the low range but OK


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## cmh9023 (Oct 26, 2011)

Thanks, I am clueless at math!


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## tonyshuman (Oct 26, 2011)

I would go with the syringe sizes mentioned by angieluv, 21ga to draw it up and 23 to inject it. The 23ga is still pretty small so it shouldn't be too painful.

You could also use meclizine, to make him feel more balanced. It's a human seasickness med that helps for bunnies with tilt. Jadeicing has used it with her permanently tilted bunnies.

Keep an eye on him with the zithromax--the reaction you described sounds like a rare adverse event BUT since it went away quickly he may just have had his balance more upset because of the stress of getting the med. Also, because he ate again so soon it should be ok, but still.


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## ra7751 (Oct 28, 2011)

Just happened to stop in and saw this thread. I have done a lot of vestibular infections. I would suggest getting some x-rays of the upper arcade teeth on the side of the infection to take a peek at those roots. If you are using PenG Procaine, that drug should be used every day. Procaine is fast in and fast out of the body. It is better to use the Pen G version that combines Procaine with Benzathine. The Benzathine takes longer to get to working levels but stays in the body longer.In this form, you should administer every day for 3 days and then every other day.Since pastueurella was grown in a culture (which is somewhat rare)....I would suggest starting Azithromycin in addition to the PCN. This drug is dosed in rabbits at a much higher dosage than with dogs. As far as needle gauge....21g is a good all around size. The PCN will easily flow when buffered with fluids. I use a 19g to pull the fluids and PCN. With the Azithromycin, as with all oral abx, there may be some loss of appetite and a little upset GI but the benefit of this drug is worth it. There is a great probiotic that I use, offered by Platinum Performance (horse company), known as Gastric Support. I use it in all mammals including deer and it is a wonder product. I don't give dosing amounts on the forum but if your vet is willing, I will be more than happy to discuss formularies with her.

Randy


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## Sweetie (Oct 28, 2011)

Randy's email is [email protected]

Randy is a very good vet tech and has helped me with my rabbits and still does. He is very knowledgeable about rabbits. He has saved my rabbits when they were sick and I couldn't get to the vet right away.


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## Maureen Las (Oct 29, 2011)

GAH so happy to see Randy on here .....
Thanks Randy


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## cmh9023 (Oct 29, 2011)

Thanks, Randy!! I was actually re-reading some ofthe responses you gave me in 2009 about issues with one of my other rabbits (Jessie)when Button first got sick. That was the first time I used Azithromycin, per your suggestion, and it was very helpful. Jessie's head is still pretty crooked, but she's healthy as can be and gets around like a champion 

Thanks for the clarification on the Pen G Procaine. I will start giving that every day until I am able to get to the Tractor Supply Store to get the bicillin (which is what I used for my rabbit in 2009).

His appetite is very good, but he lost weight from his first visit to his follow up (1.5 lb down to 1.1 lb). He has another follow up on Monday. I've added afalfa pellets to his Bunny Basic T and am giving him as many pellets as he wants, unlimited hay and extra servings of veggies. Hopefully his weight increases some. 

Is that probiotic sold by vets or online? He is currently taking Benebac, but I'd be glad to try the kind you suggested. 

He seems more steady on his feet, moves around more and is more alert. A big remaining problem is what looks like a corneal ulcer (from the pictures I've looked at in the library section). He's been getting Terramycin ointment for over a week and no improvement. It looks so sore. I've read on here that could be related to e.c.

I'll be printing out this thread and bringing it to his appt on Monday. Thanks!


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## Maureen Las (Oct 29, 2011)

Beau had a corneal ulcer that would not respond to anything we tried at all; The only thing that really worked well was chloramphenical opthalmic salve . Beau did not have Ec but the corneal ulcer may have been an injury from Willow ( I was trying to bond him at the time ) or possibly because his teeth were so infected. 

The infection in his eye was so bad that I was contemplating euthanasia .. took him to Verona and Dr. Barney Smith pulled out a tube of chloramphenical salve as a last resort; his eye began to clear up afer the first dose.


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## cmh9023 (Oct 31, 2011)

Update:

Button went in for his follow up today. He gained 3 oz which was great. His ear has cleared up, but the vet said to continue with the Baytril/saline ear drops. The pet pharmacy is making up some chloramphenical ointment for his eye, which hasn't improved, that I will pick up later today. She also said to continue on the Azithromycin. BUT, she said to stop the Pen G Procaine injections. I'm skeptical about that. I think I should continue it. Any thoughts?


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