# Antibiotic and GI Inflamation Questions



## NickZac (Mar 27, 2011)

Hello...please forgive me for the length as this will be my first post. I am Zac and I own Lilly, a Netherlands short haired dwarf. She is about 2 years old and 5.5 to 6 pounds and overall body structure is a classic dwarf, with not all that fat nor skinny, but well filled out as house rabbits are opposed to wild rabbits. She lives in my house, and while she has a cage, the only time she is in it is to eat or excrete, and otherwise is usually sleeping in my bed or with my Maltese, Beau, who is her BFF. My room in which she is left alone to free roam is rabbit proofed, and the rabbit has also been house proofed. Her diet is a combo of Timothy Hay (certified natural/pesticide free when I can find it), locally grown and/or organic Romaine Lettuce, Spinach, Carrots, (very little) Celery (for the hi-de fiber and its help on the GI tract), and Sunaturals Natural Rabbit Food (in the purple/gray bag). Her water comes from a ceramic bowl, after I noted how much bacteria would multiply in a bottle, which I stopped using 6 months ago+/-. The bedding used for her cage and litterbox is Carefresh Ultra, and her litterbox is serviced a few times through the day and outright changed as needed, usually every day or so. She gets brushed daily with a light wire comb, and her hair is neither short nor long, and is easy to work with and groom. I cut her nails myself with a specialized trimmer, as she will lay on the floor and let me cut them, which seems to beat the stress of having someone else do it. Her teeth have never needed filing or trimming, as they wear evenly from a variety of things to chew on. Intelligence wise, Lilly is smarter than my dog, Beau, and has shown an extensive problem solving IQ that includes adjustment to artificially introduced 'stimulants'...which is almost scary. Friend wise, she plays with my dog daily, and is also good friends with our next door hunting dog (which is in itself amusing as the dog LOOOOVES her). Behavior wise, she is like a small horse, and has lost most of the 'stereotypical rabbit behavior', as she is unphased by new people, animals, and loves being picked up. When she sees another living animal, she hops towards it thinking that it is playtime.

So her sheds, like some other rabbits, are weird as she loses clumps exposing skin in bizzare patterns. This year for the Spring shed she lost a lot of hair on her bottom exposing pink skin. Given she loves to binky and play with the dog, this patch got irritated quickly, to the point of it becoming an open wound, much like run burn. Because their skin is so sensitive, I tried to wait it out and see if it would heal on its own for a few days, but it only got worse. At that point, I made an appointment with my vet and started cleaning it with Provon soap (best stuff ever for anyone with sensitivites), and topically treating it with a Benzethonium Chloride topical in an aloe vera base, in addition to a light amount of hydrocortisone. In the 2 days of doing this, it got a lot better than it was. At the vet, they did a swab for a few common skin parasites and did a biopsy and bacterial swab and I presume a stain. They indicated a small amount of bacteria was present, which as you probably know does not mean an infection as we always have bacteria on our skin and all wounds will have some bacteria in them. He said to do 10 days of Baytril and a probiotic.

Over the next 2 days I continued the topical treatment and began the antibiotic and the sores continued to heal, even the much more extensive ones used for the biopsy at the vet. She decreased the amount she was eating over the past 12 hours (but is still eating decently well). Today I noticed her fecal pellets are drastically fewer, drastically smaller, and much dryer than they normally are, and this has me extremely alarmed. This is NOT from hair as I brush this rabbit religiously and use the 'wet hand' method, and she does not overgroom. Also, as it was the weekend, bunny has been with me for most of the day and night.

I am very familiar with human antibiotics but not animal ones. I checked up on Baytril, and was alarmed to find that it is enrofloxacin, which is chemically similar to Cipro (ciprofloxacin, but everyone calls it by the actual brand name), as it is a Fluoroquinolone, which is without a doubt the most dangerous class of antibiotics that humans use today. I am also upset, and almost irate, that I was not told that this medication type was being administered to my rabbit, who is in all respects a member of my family. Cipro is a potentially dangerous (and blackboxed) antibiotic, and alternatives that have fewer side effects exists. It's advantages to another wide-spec antibiotics, called doxycycline are few. The big side effects of the Fluoroquinolone for humans include: (common) tendon rupture, long term health decline, and even death. While this can occur with any medication, Fluoroquinolones are much more likelier to produce severe to life-threatening adverse reactions. Doxycycline has a much lesser side effect profile, wide-spectrum activity, and costs far less to produce than Cipro. Doxy is well tested in dogs, birds, and fish, and has been used on rabbits in clinical studies without issue and has shown effectiveness and safety...with that said I do not know how doxy works with 'pets' as these studies were animal-based research for human relevance.* My question is, can enrofloxacin cause GI slowdowns in rabbits to a dangerous level?* It has not been unheard of for Fluoroquinolones to greatly slow gastric emptying in people; can this occur in rabbits? Dehydration is also another potential issue, although I would have to assume less so in rabbits as they cannot vomit in the sense that other animals can.

*Furthermore, if her GI tract is continuing to be slow at this level, what should be done? For a person, one of the first-line treatments is Reglan (metoclopramide)*, and I am aware that it has had extensive use in smaller mammals, including rabbits, for the purpose of gut stimulation. Even people have more GI problems when exposed to stress, and at this point, I am weary about taking her anywhere, including the vet, as it could make things worse than better. At this point, I want to do something before her GI tract stops fully, which is a whole nightmare of its own.

*Finally, would the correct dosing of Reglan be about 1-1.5 mg for a 5.5-6lb rabbit? What are other potential antibiotics and their dosings that could be switched to? Would you just discontinue the antibiotic outright since the wounds it was prescribed to treat are healing well? Thank you so much in advance!*


----------



## tonyshuman (Mar 27, 2011)

Enrofloxacin is used extensively in rabbits and other pets. It is rare for us to see adverse side effects. I have been on this forum for years and not seen any of those bad effects you mentioned. Occasionally a bunny will have a slight GI slowdown with enrofloxacin, but adding a probiotic usually relieves the problem.

Doxycycline is usually not used because it is a member of the tetracycline class of antibiotics, and many bacteria have become resistant to these antibiotics because they have been around for a very long time. Tetracyclines have been added in large quantities to animal feed over the years and are present in a lot of antibacterial products (soap etc) so bacteria are exposed to them more often thus leading to greater resistance. Tetracyclines usually also lead to greater GI upset.

If you are concerned about her fecal output, call the vet. They may put her on a different antibiotic. They also can prescribe gut motility drugs like reglan. I would not give gut motility drugs in rabbits unless under direct supervision of a vet and then only in certain cases, where I'm sure there's no chance of intestinal blockage causing the slowdown. A bunny that goes under anesthesia or has a traumatic illness might have a GI slowdown that's totally unrelated to GI obstruction, for instance, and that's an ok situation for gut motility drugs.

Are you giving the probiotic? What is it?

Do you think she might have urine scald? Often if there is a urinary tract problem the urine pH will change and this can cause the skin to be irritated. An antibiotic would clear up a UTI, but it would be good to have the vet test for one.

Here is a list of safe antibiotics for rabbits:
http://www.medirabbit.com/Safe_medication/Antibiotics/Safe_antibiotics.htm


----------



## Maureen Las (Mar 28, 2011)

*tonyshuman wrote: *


> Enrofloxacin is used extensively in rabbits and other pets. It is rare for us to see adverse side effects. I have been on this forum for years and not seen any of those bad effects you mentioned. Occasionally a bunny will have a slight GI slowdown with enrofloxacin, but adding a probiotic usually relieves the problem.
> 
> Doxycycline is usually not used because it is a member of the tetracycline class of antibiotics, and many bacteria have become resistant to these antibiotics because they have been around for a very long time. Tetracyclines have been added in large quantities to animal feed over the years and are present in a lot of antibacterial products (soap etc) so bacteria are exposed to them more often thus leading to greater resistance. Tetracyclines usually also lead to greater GI upset.
> 
> ...




I agree with Claire on the use of baytril. Most vets "play it safe' by using baytril because it is considered so safe for rabbits ..to the point where it has been over used. 
You do not want to use a probiotic at the same time that you give the antibiotic. 

I have used bayril many times over the years without my rabbits having any changes in their GI tracts but many vets prescribe a probiotic "just in case." 
Something is definitely affecting your girl as she sounds extremely well cared for and loved and I am sure that you know her well. 
I am wondering if she is ingesting any of the skin treatments that you are applying to her skin while grooming herself; that could cause Gi disturbance. 

best to talk with your vet ....


----------



## NickZac (Mar 29, 2011)

You have both made me feel a lot better as I was really worried. Given issues seem to be small with rabbits, I will continue the antibiotic! Thanks!

The probiotic is Probiocin, which has a few different strands of bacteria in it. Is this good?

Urine burn may be possible, but it would be hard given a lot of the fur clumps are on her upper back, and the Carefresh in her litter box seems to absorb liquid very well.

I got in touch with my vet who told me to go ahead with the Reglan, as her fecal production had not stopped fully. I am happy to say her waste seems to be improving. Furthermore, most of the bald areas have stopped being open wounds are are starting to grow hair around them and new skin to cover the cuts.

How the topical impacts her when she licks it has had me worried from the start, but the healing agents also reduce pain and protect it from infection. I've tried to hold for at least an hour after applying, but who knows how well that works. Hopefully by tomorrow I will be able to stop using the topical on the last small spot which is still inflamed slightly.





...on kind of a side note as I love discussing (mainly human) medications...Fluoroquinolones are the most widely used antibiotic class, and they are used against FDA recommendations and abused by consumers, which has made their capability to kill more resistant bacteria markedly less. As of now, there are substantial types of bacteria which are resistant to most fluoroquinolones, including Cipro and Enroflaxicin, and some bacteria has shown cross resistance to virtually all of the drugs in that class. Complete and full resistance is observed (via susceptibility testing) in a few different (and most common) types of staph, certain waterbourne bacteria, and numerous others. Because of this, anyone told that their rabbit has a bacterial infection should either request or personally do both a stain susceptibility testing, as it saves lives of both people and animals.

Doxy is far different from the 'classic' tetracyclines, and it is the only drug in that class which can be used for children, given certain circumstances. It has a much wider spectrum of action as well. GI issues with most tetracycline antibiotics are a nightmare and a half. The GI issues seen in doxy are significantly less than tetracycline, minocycline, or oxytet, and the last time I saw blinded studies, fewer patients stopped taking doxy than most other antibiotics, where as almost all of the fluoroquinolones had the highest discontinuation rates due to side effects. Doxycycline still kills numerous types of resistant bacteria, and like Cipro, it is a first line and very effective treatment in the event of anthrax exposure. There are a few types of (gram negative) bacteria in which doxy is the only antibiotic that kills it. Clinical research is also starting to show that doxycycline will kill some of the staph bacteria involved in 'VRSA', in which the V is for vancomycin. VRSA is far more serious than MRSA because for years, vanc was the last line of treatment for staph, and in many areas, it still is. Resistance exists, but it kills most of the bacteria that is resistant to tet and oxytet, where as clinical use of other tetracycline antibiotics are currently topical creams due to substantial resistance.

With all of the above said, both Cirpo and Vabramycin (doxy) are still very effective drugs and have among the highest wide-spectrum activities of all antibiotics used. Cipro, and other 2nd gens, seems to have a significant inflammatory effect, which can be very beneficial. Now the real odd thing I have observed is that with Cipro, you seem to have one of two outcomes: 1) it has no side effects whatsoever and is the best tolerated antibiotic you ever take, or 2) it is hell on earth. Because people with major GI issues can often use Cipro with fewer issues (myself included), it indeed has its own clinical use. Unfortunately, both doxy and Cipro were very potent medications that we, humans, are slowly turning into a worthless chemical.


----------



## Maureen Las (Mar 30, 2011)

We have a moderator named Randy ( ra7751) who owns his own rabbit rescue and is also a wildlife rehabber. Because he and his rescueare closely allied with the University of North Carolina Veterinary School he has brought much knowledge to this forum that challenges many "old school" ideas on the treatment of rabbits 
He has strongly advised us on the overuse of baytril in rabbits ( all fluorquinolones except Zeniquin /Marbofloxiicn). 

At his rescue heoften mentionsthese particular drugsforrabbits 

Zithromax /azithromycin oral

Bicillin sub q ( 150,000u procaine G penicillin and 150,000 u benzathine penicillin per ml) 


Convenia injections - which needsto be dosed more frequently in rabbits 

Chloramphenical oral

Zeniquin /Marbofloxixin oral


And possibly I have missed a few :expressionless

he has much disdain for the repeated prescribing of baytril 

I have used baytril in my own rabbits but frequently ( not always ) the infection will return after a few months
I have given you a link to some of Randy's posts that are in our library ; you may find them interesting 

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


We have another moderator, Claire (Tonyshuman) who works with and has an extensive knowledge of pharmeceuticals; when she comes backI am sure that you will have some great discussions with her.!!!

I hope that Lilly continues to improve.


----------



## tonyshuman (Mar 30, 2011)

I am a grad student in pharmaceutical sciences and I agree that fluoroquinolones are overused in pets and people. However, usually when we take our rabbits to the vet, the vets are so scared of GI side effects that they use the oldest type of antibiotics around--sulfa drugs. These are actually worse for the GI and because they have been around longer, there is a great deal of resistance to them. Baytril is better than those drugs.

You have to think a bit in terms of how the vet wants to stock their pharmacy. Baytril is effective in animals with GIs that won't tolerate -cillins, is cheap, and in liquid form is easy to make dosages for anything ranging from a 15lb rabbit to a 30g hamster. It is effective against a lot of different bacteria and is cheap.

A wider spectrum of activity does not mean a better antibiotic. Often the ones with broad-spectrum activity are not as strong at eliminating a single particular bacterium.

Zithromax often has GI issues in rabbits and is expensive. Injectibles aren't easy for a pet owner to do. Convenia is the exception because it is only dosed every 5 days--but it is extremely expensive. Chloramphenicol can cause bone marrow suppression which is scary for the owner (and the pet). Zeniquin (marbofloxacin) is of the same class as Baytril and is very expensive as well.

It is expensive and not easy to do strain resistance testing on every animal that comes in. I had it done for a hamster with a persistent ear infection--it was $50, which is far more than most people will pay for a diagnostic on their hamster. We had started the ham on a sulfa drug and didn't see a lot of improvement, and the strain testing revealed it was sensitive to baytril, which we are using now. It also takes several days to do the resistance testing and most people want to come home from the vet or doctor with a prescription in hand to start right away.

There are a number of reasons that vets use Baytril a lot, and to be honest I think it's better than using tetracycline and related antibiotics or sulfa-related antibiotics. Cost is a big concern because most people don't have health insurance for their pets, and we're used to not paying a ton for prescriptions for ourselves because we have human health insurance. With $5 and $15 co-pays on our own medications, paying $20 for 2 weeks of something for your rabbit doesn't sound right--and that's about the cost of Baytril. All the other ones go up in price from there. 

The shelf life of the drug is also a concern. For instance, the shelter doesn't treat a ton of small animals with infections, so they don't keep the small animal formulation of baytril on hand--just the dog/cat one (because they see more of those). For that reason, small animals first get a sulfa drug if they have an infection, and if that doesn't work they try the dog baytril (which tastes like liver). My own vet sees a lot of small animals for infections so she keeps the small animal form on hand--it will not expire before she can use it all. A vet can't buy just enough drug for a single patient--they have to buy it in large quantities. For that reason a less specific antibiotic that works in many species on many different bacteria is needed--and that's what Baytril is. The other ones are good too, but price, side effects, and species specificity make it unreasonable to buy them in vet-practice-quantities.


----------



## NickZac (Mar 30, 2011)

*This site is awesome! I have a lot to read...

Marbofloxicin is a great antibiotic, especially for more resistant staph bacteria!!!...I assume most animal vets do not use it as a first line antibiotic though given its higher toxicity. We use azithromycin a lot as a first line antibiotic as it is well tolerated, cost effective, works well, and has a much easier treatment plan than traditional antibiotics (literally 6 pills over 5 days for the standard dosing commonly called a 'Z-Pack' [diff types exist though]).

It's good to hear about the others as well, as I know little about how antibiotics fit into rabbit treatment safety v. effectiveness wise. Obviously, some people are limited by costs, but this is not a factor in any treatment plan for my rabbit, so the safest and most effective is my top choice. From what I am gathering, Baytril is neither of those, although it is indeed cheap, easy to find, and a 'gold standard' of treatment...this does NOT mean it is a effective, safe, or the best standard...just that it is popular.

Do you know if the primary administration of penicillin drugs is an IV/IM push? Despite its age and known resistance, it (for people) is still an important and (surprisingly) effective antibiotic, especially since so many people prescribe it for anything but bacterial related diseases.

So a sample swab, stain and (planned susceptibility) test was done. Lilly does not seem to have a 'bacterial' infection...she has bacteria on the wounds, on her skin and inside of her, but the bacteria seen did not indicate an acute infection. If she did have a bacterial infection, the statistical odds of enroflaxicin working is about 70-86 percent, depending on the source.

This article discusses resistance of bacteria to enro...you will not like the results, as depending on the strand of bacteria you are faced with, enro is more or less worthless...other studies I have examined aren't much better.
http://www.google.com/url?sa=t&sour...sg=AFQjCNFfuvK87uL-sd8HgSNjbAkPzaBT0g&cad=rja 

As far as Lilly goes, I am happy to say all but a dime sized area of skin is back to its normal pink/gray color, all wounds have healed, and hair is growing on the bare areas. She also is back to jumping on my head and 'chillin' their, which she stopped presumably because it hurt. Bowels are still not as good as I would like pellet size wise, but her GI tract is moving, and she is eating greens, hay, pellets and drinking water with a minor supplement in it, so we'll see how it goes!

Thank you all so much...I was going crazy over all of this!!!

angieluv wrote: *


> We have a moderator named Randy ( ra7751) who owns his own rabbit rescue and is also a wildlife rehabber. Because he and his rescueare closely allied with the University of North Carolina Veterinary School he has brought much knowledge to this forum that challenges many "old school" ideas on the treatment of rabbits
> He has strongly advised us on the overuse of baytril in rabbits ( all fluorquinolones except Zeniquin /Marbofloxiicn).
> 
> At his rescue heoften mentionsthese particular drugsforrabbits
> ...


----------



## NickZac (Mar 30, 2011)

*I agree that Sulfa drugs are the WORST GI wise...especially for the elderly. TMP SMX is damned near torture for older persons with certain risk factors. If you are faced with using a fluoroquinolone or sulfa drugs, indeed the fluoroquinolones are a far better choice...with that said, the low cost of TMP-SMX is a driving force for its continued use in older persons despite well documented risks. Narrow spectrum antibiotics assume that you know the particular bacteria strand, which does not seem to be common practice and I would imagine why side spectrum antibiotics are preferred.

*How bad is the bone marrow impacts of chloramphenicol on animals like rabbits? Bad enough to avoid it outright?

Correct me if I am wrong but cycline antibiotics, especially doxy hyclate, become dangerously toxic after their expiration date? Also, would the pH difference of rabbit's GI systems render many of the PH-specific cyclines outright useless?

Finally, why does the formulation I have of Baytril say to refrigerate as opposed to a 'cool, dry place'? Is that the actual substance needing this or simply a precaution to preserve it as long as possible and maximize its effectiveness?
*
tonyshuman wrote: *


> I am a grad student in pharmaceutical sciences and I agree that fluoroquinolones are overused in pets and people. However, usually when we take our rabbits to the vet, the vets are so scared of GI side effects that they use the oldest type of antibiotics around--sulfa drugs. These are actually worse for the GI and because they have been around longer, there is a great deal of resistance to them. Baytril is better than those drugs.
> 
> You have to think a bit in terms of how the vet wants to stock their pharmacy. Baytril is effective in animals with GIs that won't tolerate -cillins, is cheap, and in liquid form is easy to make dosages for anything ranging from a 15lb rabbit to a 30g hamster. It is effective against a lot of different bacteria and is cheap.
> 
> ...


----------



## Maureen Las (Mar 31, 2011)

NickZac ..I am curious ? 

Would you share your educational background and profession? (but only if comfortable ) 


Chloramphenical can cause white blood cell suppresion in some humans who have physical contact with it. I would guess that veterinarians do not want to use it out of fear of clients mishandling it . I have usedchloramphenical salve on a rabbit and it saved my rabbit's eye which was infected and would not respond to any other antibiotic. I used plastic gloves when administering it without issue . Others on this forum have used it successfully orally on their rabbits ex: (Pipp the administrator of this forum) and also an Infirmary Mod.

Bill Gengler, Animal dentist and also aVeterinary professor at the University of Wi. Madison Wi ( who treated one of my rabbit's dental issues) told me that when he was a resident many years ago that a dog bit his arm quite severely and that he packedhis own wound with chloramphenical salve because at at that time no one knew of the possible side effects of the drug ; luckily he had no reaction to it andhis arm healed well. 
it was his associate who prescribed the eye salve for my rabbit's eye. After weeks of an infection the eye began to resolve after the firstapplication (I thought I was imagining it) 



I have never heard of an animal having a suppression of white blood cells from it ; Why ?I do not know? 

Chloramphenical is especially effective in absesses and other deep infections because it crosses the blood brain barrier (learned this from Randy) 


I cannot answer your questions re doxyhyclate expiration 

I would guess that your baytril has been compounded meaning that the vet or pharmacist has mixed it with a flavoring. if this is the case it most likely is the reasonwhy it needs to be refrigerated. 
Pure baytril solution is usually kept at room temp.



Safe antibiotic and doses from medirabbit (reliable source)

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

Unsafe antibiotics

http://www.medirabbit.com/Unsafe_medication/dangerous_antibiotics.htm

Almost forgot about bicillin. The bicillin obtained for use in rabbits is the type sold at farm stores for cattle and farm animals it can be found under brand names like Dura Pen . Duo-pen , Twin pen etc. the important thing is that each ml contains 150,000 u of procaine G penicillin and 150,000u benzathine g penicillin. 

The drug is given subqutaneously QOD for several weeks minimum. Marcy Moore wrote the a ground breaking article on bicillin for absesses 

http://www-unix.oit.umass.edu/~jwmoore/bicillin/bicillin.htm


It is best to dilute the thick penicillin with lactated ringers solution prior to injection as it is not only easier to inject but also prevents sterile abscess formation. 


I have used bicillin on my own rabbits ndI feel that it is a miracle drug and easy for me to get..

Most vets are afraid of it because they have learned that it cannot be given orally; they do not trust that a client can give a sub q injection. 

I have given a lot of sub q bicillin injections and never had a rabbit with any GI disturbance at all. 

Glad that you like this website


----------



## NickZac (Apr 3, 2011)

I think I may get some bicillan for my bunny after reading that. The more I read on Baytril, the more I find about near complete resistance to many common bacterial infections it is supposed to treat. With that said, I think in my case my rabbit would have recovered without any medication, but I love my bunny so I was not going to risk it. I like to have ICSH stashes for her, as you never know when you may need something as such given how quickly some bacterial infections can regress.

I am currently working for the Federal Government in regards to public policy and program design and implementation for people who are disabled and/or old. Much of what I currently do relates to accessibility of accessing these services. I am also doing a large study (as volunteer work) in which I am working with about 3,000 older persons and examining their lives and trying to find out what increases and/or decreases it, with great results and I am about to publish my findings!  I guess you could say I am a nerd, as I love what I do and I enjoy learning.

My professional field is gerontology and while my degrees are more on the public health and socio-cultural aspect, I've had some formal drug education and attend continual education seminars frequently. The reason for my doing of this is (other than I like to learn) I hear about and see doctors give older persons medications that are great first line treatments for most people, but god awful for elderly persons. This has fatal consequences more often than most can imagine, and so careful monitoring of this is one of my core values when administrating services to older persons, and holding doctors (and pharmacists but this is rare as many pharmacists are the ones that pick up on the doctor's mistakes) accountable for the medication that they administer to older persons. I feel strongly that everyone in this field should have at least a basic understanding of medication and the elderly, because most drugs effect older persons in a completely different way, and a failure to understand this could result in the accidental death of someone. Many doctors do not utilize elderly medicine management continuing education, and I have observed them treat elderly persons with protocols that were changed decades prior and administer drugs which I personally find to be inferior effectiveness wise and statistically speaking are far more dangerous than alternatives (some doctors still use DEMEROL and compezine as first line treatments for pain and nausea, respectively).

Obviously, any medication has a higher probability of killing you as you age, but some medications are 'unproportionately' high relative to alternatives. Using drugs such as ciproflaxicin in older persons (55-65+, and esp. the old, old of 85+) has a ridiculously high probability of causing tendon rupture compared to younger people. Indeed some people benefit from it and it is one of the few stronger antibiotics that they can tolerate; I hear it is a strong antibiotic of choice for many people with GI issues such as IBD, but I do not know this first hand as it is a drug I advocate as one of the last resorts given how its side effect profile affects elderly persons. Generally speaking, the drugs with the highest risk are ones with higher renal toxicity and major GI upset resulting in severe dehydration and eventually death.

Another issue is the widespread assumption that something is not safe where as it is both safe and its use well warranted, such as vancomycin, which does not have a high renal toxicity despite popular belief. Historically, other chemicals used in the IV solution were, but vanc in itself is not as high as many people think it is. The newer antibiotic called linezeloid (Zyvox) seems to be even safer and it can be taken orally unlike vanc (which may not work in certain older people with gastric emptying issues making IV admin ideal), but Zyvox costs even more than vanc (IV vs. IV admin), and most insurances seem to push for IV vanc over IV Zyvox. If you have a patient with an infection at this level, despite age, you have to use these medications. MRSA, and even VRSA (which is of tremendous concern) are becoming more common, and recent studies report LRSA, which is of the greatest concern if that spreads in the clinical setting. Resistence to daptomycin now exists as well. In all respects, people of older ages are the ones to get some of the worst bacterial infections, and their body recovers slowly, can handle less medication quantity wise, wait longer to seek treatment for serious skin infections which are often MDR.

And honestly, as you already know, this is our fault as a society. If we weren't pumping vanc into birds for years, VRE/VRSA may not exist. On a good note, the newer drugs such as Zyvox are more carefully managed than schedule 2 narcotics as we are learning the consequences of abuse of antibacterials. On an even happier note, glocopeptides (sp) derived from vanc are showing exceptional capability in clinical trials, some with no known resistance at all such as oritivancin. That and a few other vanc derived antibacterials show the ability to kill most or all of the 'superbugs' (or should I say man-made diseases), with less side effects, quicker recovery times, and easier administration systems. Unfortunately, the FD and EU have been slow to examine the application and while I agree testing is limited, the fact that they kill bacteria that current antibiotics do not makes it worthwhile to speed the process. Even if the antibiotic turns to have more side effects than thought, I do not know of any person with VRSA/VSE that has survived without treatment, and so the options are limited.

My biggest problem, however, is the use of NSAIDs and poor knowledge on pain control. These drugs, both cox1 and cox2s, have been shown to kill a lot of people. Vioxx was a cox 2 that is the most notorious, and likely killed thousands of people before being removed from the market. An even less safe drug, ketorolac (Toridol) is still commonly used on older persons despite a ridiculously high risk of life threatening side effects. 

Some doctors still use codeine and Demerol; both are far less safe than their alternatives, and both have limited effectiveness. For moderate and severe (and terminal) long term and post-op pain control, the drug tapentadol, which is derived from tramadol, has been found to be 'not inferior' to an 'equivilent' dose of morphine, the gold standard of pain control. Tapentadol has advantages to other narcotics as it has minimal cognitive impairments, a low abuse liability (not much higher than tramadol, which is OTC many places), a low side effect profile, has a lesser impact on seizure threshold, has a higher patient rating of overall pain control and tolerability, and does not seem to cause the changes in mood/mental health seen with some other medications. Some clinical trials have suggested that it is a better drug for numerous types of pain to CR oxycodone (Oxy Contin) due to level of pain control, lower discontinuation rates from side effects, and far less abuse. So why does no one ever hear of this drug? The DEA made is a Schedule 2, despite the fact that research has shown it to have far less abuse liability than any S2 drug. I feel this is because they equated such effective pain relief with a 'potent narcotic' which is misleading as tapentadol is a synthetic opiate, but it is debated as to if it (and tramadol) are actual narcotics. Many medical professionals don't even know of the drug's existence, and I feel blinded studies have established tapentadol to be a powerful tool for managing both acute and chronic pain, that is not being utilized despite the possibility that is may better control pain that other options. We use a lot of depression meds to manage pain too, and some of the effects these medications have on the overall mental well-being of older persons causes me concern, as the exact mechanisms of most antidepressants are still completely and totally unknown, hence why all the commercials say "drug X is thought to work by: ___"

oh wow you got me on a rant...I am sorry to write to much but I could talk about this stuff all day long.


----------



## tonyshuman (Apr 3, 2011)

A lot of what you have to say is true, but I want to add that we do know what the molecular targets of antidepressants are--we just don't know how altering these molecules with drugs leads to improvement of depression. We don't understand what is going on in a depressed brain; we just know that for some people in some cases, drugs that effect certain neurotransmitters seem to help.


----------



## NickZac (Apr 3, 2011)

I've heard a few different theories on why people who are depressed see remission upon using certain drugs in the family of antidepressants. It seems the mainstream understanding of it now is that they 'correct' a 'chemical imbalance'. People also seem to directly associate serotonin with it and too much emphasis is added to the serotonin due to a variety of factors at play. They even give animals SSRIs and benzodiazephenes (sp), which I really don't know how I feel about that.


----------



## Maureen Las (Apr 5, 2011)

I have something to add on this as I was a psychiatric nurse (impatient) and saw old folks who were feisty and resistant to Nursing home placement be "drugged up" with phenoziathines like haldol in order for the staff to manage them. 

this of course impairs brain function and the decline spirals downward. quickly
Iam glad that I have this knowledge as my parents are healthy 91 and 92 yr olds and if/when they are ever in a Nursing homeI will be watching their charts and meds like a hawk. :nasty:

this thread is absolutely wonderful but we have really gotten off the subject of Lilly. 

The contents of this thread really belong in the "Let My Hare Down" Forum so hopefully we can pick this topic up in there and focus on lilly in this forum

NickZac you are quite impressive and this is a fantastic conversation 

Why not start a thread about medications ( human) and animal in the Let MY Hare Down section and we can pick it up there


----------



## NickZac (Apr 22, 2011)

This is so, so, so true. I cannot tell you how many older persons that I have worked with whom have been given medication, sometimes through force and/or coercion, that has known, and sometimes permanent, negative impacts on cognitive functioning. Generally, these medications are known to affect short term memory, but I've seen sufficient evidence to also say that it affects long term memory and speeds cognitive impairment. Some of these medications also seem to begin a chain reaction that takes a mentally-capable and independent older person and speeds cognitive impairment to the point of being unable to function in any independent fashion.

As you know, medications affect older persons in different ways than they affect younger persons due to differing chemistry and physical characteristics...I just wish most general practice doctors would realize this 

And it sucks that you have to do this these days, but your monitoring of the medication that is prescribed to your parents can save their lives, as the accountability of medication prescribed to older persons is very, very low, and CODs are commonly indicated as natural causes such as 'heart failure', and what caused the heart to fail is grossly overlooked and disregarded

And thank you for the compliments! It is great talking to you and everyone here, and it has given me peace of mind while Lilly is recovering.* 

Ultimately, the people who know the most about the care and well-being of rabbits are those who own rabbits themselves, and view them as a part of their family; and this site proves it.

*Where/how would you start up a thread in the "let my hare down" section?*

*I am really happy to say that Lilly is back to normal with a full coat of brown and blonde highlights and is eating ridiculous amounts of food again, and is producing waste as she should be. By mid May, her blonde highlights will slowly change to red, as this rabbit literally changes colors as the seasons change as if she were a chameleon. I am trying to slowly change her food with mixed results, but we will see how that goes over the next few weeks or so. 

*THANK YOU all so much for the help; you are WONDERFUL!!! :biggrin2:



angieluv wrote: *


> I have something to add on this as I was a psychiatric nurse (impatient) and saw old folks who were feisty and resistant to Nursing home placement be "drugged up" with phenoziathines like haldol in order for the staff to manage them.
> 
> this of course impairs brain function and the decline spirals downward. quickly
> Iam glad that I have this knowledge as my parents are healthy 91 and 92 yr olds and if/when they are ever in a Nursing homeI will be watching their charts and meds like a hawk. :nasty:
> ...


----------

