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Forum HOUSE RABBIT Q & A Metronidazole for URI (Also laser treatment on nose?)

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    • Celamentum
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        Hello!

        My bunny boy Milky is still being treated for snuffles and after 3 months my vet finally decided to change the antibiotic that he was on. Milky is doing well, just minor, occasional sniffles and discharge from the nose and eye on his left side of his face.

        Anyway, the vet prescribed metronidazole (flagyl)? I did some research and it seems it is usually used for liver/GI issues as it fights anaerobic (no air) bacteria… which seems a bit strange to use to treat a respiratory infection. I’ve only found one source listing metronidazole as a URI treatment (source).

        Just wondering if anyone else has had metronidazole prescribed to treat a URI in their buns. 

        The vet also asked if i was interested in a laser treatment for his nose? He has a very thick accent when he talks and he tends to mumble so when I asked why he would suggest the treatment he didn’t give me a proper explanation except for “help clear the nasal passage”. But I can’t find any information on laser treatments on the nose for rabbits… I’ve mostly just found information on it being used to help with pain. Has anyone else heard of laser treatments being used to treating a rabbit’s nose?

        Thanks!


      • jerseygirl
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          Ive not heard of laser treatment for the nose before. Im assuming it’s cold laser? That seems to be becoming more common for treating all sorts of things. It may be that the clinic has new equipment and is trying it to see if it helps with various conditions.
          One of the main things cold laser does is bring down inflammation. So, that may be beneficial as that would reduce swelling in the nasal passage. Anti inflammatory meds will do this also.

          Reading back over an older thread you wrote about Milky, it sounds as though you’re not overly confident with this vet. Is that fair to say? If you are considering the laser therapy, I think it would help if you discussed it more with someone from the practice. Perhaps one of the senior nurses? They might have some pamphlets about it also.

          I also read in the other thread that you had an x-ray done for Milky. Was this only of the chest or have they done a head xray also? A head xray would show if there is any bone thickening or tooth root involvement with his issues.

          I couldn’t say why the vet has chosen metronidazole this time – other then it’s deemed a safe, lower risk antibiotic then some others. Rabbits also usually really like it!!! I used to give it to my rabbit that had a jaw abscess.

          With chronic infections, sometimes injectable antibiotics are needed to really make a difference. Or dual antibiotics that are delivered in a different way. For exapmle, one oral, one nebulised. Or one oral, or drops and one injected.

          Has it only been baytril that Milky has had so far? It sounded like he did respond to it. Could a longer course of baytil be beneficial??
          Another antibiotic I didnt see listed in that article you linked is azithromycin (Azithromax). I think that is one that is quite effective for URI’s. It depends on what bacteria is causing the infection and if there are other contributing factors (ie. like the nasal passage being physically narrower).


        • Celamentum
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            Haha you’re right on the money about me not being confident in this vet. The way he handles Milky doesn’t really put me at ease as he tends to stress my bun out unnecessarily like by grabbing him out of his carrier really fast. He also flips Milky onto his back to check his nose and holds him in the position for a long period even when he’s done looking. Milky really doesn’t like being on his back, he doesn’t fall under that “bunny trance” thing people say rabbits do when they are on their back. When the vet did that today, the weird, bubbly breathing sound that had been away for a month came back. The sound is gone now, but it was still upsetting. He has even started sneezing more than he was before he went.

            I’ve been to other vets (an emergency vet and another rabbit vet that’s too far away for me to reach on a regular basis) who instructed me on how to handle Milky so that he would feel safe while they could look at him. They only seemed to handle him when it was necessary, like when they checked his teeth or to use the stethoscope on his chest. But they seemed to make an effort to reduce the amount of stress Milky had to endure from the visit… while my current vet doesn’t.

            There are literally two animal hospitals in my city who see rabbits, the one I currently take him to is the closest… the other is across the city and the only way to reach it is by car, which I don’t have. It’s too expensive to take a taxi on a regular basis and I’m unable to call an uber because my phone is too old to run the app. I also don’t have anyone I can ask for a ride from either.

            I’ve insisted to have a culture and sensitivity test done by my current vet and he keeps telling me I don’t need to have it done or it is a “last resort”… and that just seems really strange to me that he would deny that request.

            I really wish I could take him to the other vet instead, I feel like this whole ordeal would have been done sooner.

            Ohhh is that so? That’s interesting. Maybe next time I go, I will see if they have pamphlets. The nurses at his office don’t seem to know a lot on rabbits, whenever I ask them questions, they always have to ask the doctor for an answer.

            The x-ray was done only on his chest. A doctor did check his teeth back in Feb when I had to take him to the farther animal hospital because the closer/current one was unavailable at the time and said they were very good, but to be honest, I wouldn’t be surprised if he did have something on his nose. When Milky was a baby, I let one of my friend babysit him when I went away on a trip. She had her own rabbit at the time and tried to let our buns play together and her rabbit nipped Milky on the nose. He now has a bit of a bump there. Another vet, who has since moved to a different hospital, saw him for that injury and told me it was just scar tissue and wouldn’t be an issue… but Milky has had off and on teary eye ever since. Other than that, it’s never been an issue and he hasn’t had a runny nose until he got sick in February.

            In Feb when I took him to the first vet, they put Milky just on baytril. But when the URI came back in March, I had to go to the emergency vet who put him on Sulfamethox + Trimethoprim for about one week, which didn’t seem very effective. After that I went to my current vet who stuck him back on baytril and added doxycycline on top of that and has been on it until now. About a month ago, I kind of made my own decision to try adding echinacea (in tincture, non-alcoholic form) to his treatment and I did get a huge improvement from that (his breathing sounds cleared up after I stuck him on it and his weeping eye/runny nose got a lot better. He even became more energetic and playful like his old self). I did inform the vet of this choice, he didn’t know anything about echinacea but thought there was no harm in it since it was natural.

            I actually asked him about azithromycin, since I did read about it being really successful in treating URI and he told me it wasn’t necessary since Milky was “much better than before and didn’t need it”. And when I asked “isn’t it better to be more aggressive with treating this sort of infection” he kinda smiled and mumbled something while shrugging but then ensured me that “I’d definitely see a difference” with metronidazole.

            I’ve also asked him about nebulizing treatments in the past and I didn’t get a straight answer either.

            I think you can understand why I’m kind of hesitant to trust my vet and how this is starting to get frustrating.


          • Muchelle
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              As for the bun on the back situation, my vet handles the bun in that same way but he angles him in a way that doesn’t cause him to go into trance. It’s quicker and less stressing than to have him on the table when we need to check his mouth/face area. Just putting it out to say that it is a legit technique (but then again, it can be your vet is too rough anyways).

              About azithromycin, it can cause allergic reactions because it’s very strong. It’s not common to have such reactions in my vet’s opinion, but it’s surely not a medicine given often to buns in his clinic. It can be it’s a last resort kind of med?

              In the meanwhile, I’d insist to have an x-ray done to his head to make sure the wet eye is related to the URI and not to underlying molar teeth issues.
              Aren’t there smaller clinics in your area that have vets specialized in rabbits to have a second opinion?


            • Celamentum
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                My vet held Milky on his back while continuing to talking to me, after having checked his nose/mouth/face area, not paying Milky any mind while the rabbit was was clearly stressed out. Milky was struggling and the vet just firmly hold him in place. You can see the white of his eyes and bunny-mommy sense just screamed he was scared and I just feel awful seeing him like that. Especially after a previous visit when the vet tried to hold him down and Milky got hurt/broke a nail and started bleeding everywhere.

                But Milky doesn’t go into a trance regardless of how you hold him on his back, it’s just the way he has always been.

                That may be about azithromycin, but I also don’t see the reason for the vet denying my request for a culture and sensitivity, to find an the most effective medicine for the job instead of playing the guessing game and drawing out the whole treatment period for so long. I know URI can be difficult to treat and it’s frustrating when the vet seems so half-hearted about finding the most efficient way to treat it.

                If I don’t see an improvement with this course of medication, I will ask him to do an x-ray on Milky’s head.

                I’ve literally called every vet practice all over the city. It seems a lot of smaller practices that have previously treated small animals/pocket pets have stopped seeing them for whatever reason. About 5 years ago, there was a small practice 15 minutes form my house that did see rabbits. The doctor that worked at that clinic moved to the hospital that I’ve talked about that is on the other side of the city and too difficult for me to reach without me spending well over $100 on a taxi ride there and back. Believe me, I’d LOVE to get a second opinion

                I’ve considered calling but I imagine there’s only so much they can do over the phone. They are able to make house visits but I don’t think I’d be able to afford that.

                I gave him his first dose of metronidazole a couple of hours ago and have been monitoring his condition. I know this is probably not because of the new medicine but I’m surprised I haven’t seen any white discharge from his nose today, even after having such a stressful day so at least I’m taking that as a good sign.


              • Bam
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                  My guess is the vet wants to target the anaerobic bacteria that dwell deep within the sinuses and nasal cavity. For several reasons it’s difficult to sample those bacteria. There are also bacteria that can grow in both in aerobic and anaerobic conditions (facultative anaerobic bact). It’s a hot area of research and by now well known that bacteria can hide successfully in tight, moist, warm hard-to-get-at spaces and form biofilms there. The biofilms “spit out” bacteria that divide, those get killed by “normal” antibiotics, rabbit (or human) gets better, antibiotics are stopped and the biofilm, unharmed, keeps spitting out bacteria that start to multiply again. This is why you see improvement with abx and then there’s a relapse.

                  Biofilm infections are notoriously hard to get at. They often needs prolonged treatment with more than one abx. They can also become chronic and need to be managed rather than eradicated.

                  Cold laser is good for reducing inflammation. A human you’d give aerosol (cortico)steroids (nasal spray) to reduce swelling in sinuses and nose. Rabbits are very, very sensitive to steroids though and should only be given steroids as a very last resort, more or less.

                  You need to check if they’d done cold laser on rabbits’ noses before. Black animals are more sensitive to laser treatment than lighter animals. Same goes for humans, dosage must be adjusted with regards to color of skin. (My mother does cold laser therapy on humans. She’s a physiotherapist.) 

                  Sources of info in this post: Bacteria and Chronic Infections, MOOC by University of Copenhagen. Acute and Chronic Rhinosinusitis, A Comprenehsive Review, MOOC by the Icahn Scool of Medicine at Mount Sinai. These MOOCs are on human medicine, but much the same applies to other mammals. (Although rabbits don’t have frontal sinuses.)  


                • Celamentum
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                    Ahhh that makes a lot of sense! Thank you, I wouldn’t get that sort of possible explanation if I asked my vet… I spend a lot of time researching as much as I can to better Milky’s health so I want to understand that’s happening with my bun. I feel much more comfortable and confident when I can understand how a treatment benefit him… I’m sure that goes for most other people too.

                    Yeah :S I read about steroids not being very good for rabbits.

                    I have a feeling that they just got the laser technology recently and have not used it on rabbit’s noses before because when the doctor suggested to do the treatment, he turned one of his nurses to ask and confirm with her if they could use it on rabbit’s noses… it wasn’t very encouraging.

                    I’m having trouble understanding how reducing inflammation in his nose would help though… does it effect the bacteria in his respiratory system? Or does it help elevate his sneezing/weeping eye symptoms? He doesn’t show any signs of being in pain or discomfort either…

                    But I’ll keep that in mind about dark colours. Milky is a grey colour with a little patch of white around his mouth (when he was a baby it looked like he had a little milk moustache, that’s why his name is Milky!)


                  • Bam
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                      I asked my mother about laser treatment on a rabbit’s nose, she thought it sounded like a good idea, but expensive. She estimates he’d need 1-2 treatments/week. His eyes must be protected so a pen laser should not be used (but they’re probably not using pen laser).

                      The reason why you want to suppress inflammation is to give the body a chance to clear the sinuses/nasal cavities itself, and to allow antibiotics a better chance at reaching the bacteria. Anaerobic bacteria can’t divide in the presence of oxygen, so if you get air in to them, they can’t thrive. In humans chronic rhinosinusitis is often treated with steroids alone, sometimes with a milder antibiotic.


                    • jerseygirl
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                        You need to check if they’d done cold laser on rabbits’ noses before. Black animals are more sensitive to laser treatment than lighter animals. Same goes for humans, dosage must be adjusted with regards to color of skin. (My mother does cold laser therapy on humans. She’s a physiotherapist.)

                        Wow! That’s so interesting. Learn something new every day.

                        I’m having trouble understanding how reducing inflammation in his nose would help though… does it effect the bacteria in his respiratory system? Or does it help elevate his sneezing/weeping eye symptoms? He doesn’t show any signs of being in pain or discomfort either…

                        Usually inflamed areas swell. So reducing inflammation reduces the swelling. In the nose, this should allow easier breathing, cooler air to pass through the passages and hopfully any gunk to flow out.
                        Steam and nebulising with saline can help get gunk moving also. Some people give OTC mucolytic meds (like bisolvon) to help get things flowing. Then the antibiotics have a better chance of working on any population left in nooks and crannies.

                        Keeping his environment free as dust (as much as possible) will help also. I know, not exactly easy when we feed them hay!
                        Some types are dustier the others though. Bagged hay often breaks down and becomes dusty quickly.

                        It’s great you saw such an improvement with echinacea! That is something I would definitely continue to help boost his immune system even after antibiotics start working.
                        I bought some in capsules that I sprinkle on the rabbits food sometimes but Im forgetful about doing it consistently! Same with probiotics.


                      • jerseygirl
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                          Oops. Bams post and answer to your Qu went up while I was still writing mine.

                          Im assuming the vet did mean cold laser therapy. He wouldn’t have meant some kind of surgery would he??


                        • Celamentum
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                            Thank you so much for the information on laser treatment and explanation about inflammation! I always thought that reducing inflammation was more of a concern with pain than actually helping fight the infection itself.

                            I regularly try and do a little steam treatment as long as Milky will tolerate it and I’ve been debating on purchasing a small handheld nebulizer off amazon. I’ve been keeping his environment as clean as possible, cleaning his cage every day. I try shaking as much dust off his hay before I give it to him too… I didn’t realize the dust from hay could effect him until recently!

                            I hope he didn’t mean surgery… Milky did have the snuffles a few years ago and he had suggested surgery back then, but I’m also pretty certain that he didn’t offer any sort of laser treatment at his clinic. They’ve renovated and upgraded a lot of their equipment since then. I thought surgery was a bit extreme to just clear out his nose… but he made it sound like it was a quick procedure so i assume he meant cold laser.

                            Good news is that the discharge from his nose has seemed to clear up a lot. He’s still sneezing and shakes his head a little bit but it’s usually just super soft snorting noises. His left eye is still pretty weepy, but it’s always been like that, so I don’t think I should be too concerned. I hope I’m actually seeing progress though!

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                        Forum HOUSE RABBIT Q & A Metronidazole for URI (Also laser treatment on nose?)