Two Antibiotics At Once?

Pokeymeg

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[Short Version] Dante has a recurring infection and a culture just determined he has two bacteria - Pseudomonas aeuriginosa and aeromonas hydrophila. He's currently on Amikacin (again), and the vet wants to add Enrofloxacin (Baytril?). Does anyone have any experience with giving 2 antibiotics at once?? I know Enrofloxation is a heavy-hitter, so I'm hesitant...

[Long Version] Dante showed signs of a respiratory infection and swollen leg in October. We treated with Amikacin. He seemed to perk up for a week and then declined. Then both legs were swollen, so assuming there was a secondary infection that took over after the RI cleared up, we treated with Ceftiofur in November. Dante was off antibiotics for December, but got bumps in his legs from the ceftiofur. He was slowly getting better, but last week had bubbles out of his nose. We started Amikacin again Jan 02 and started a lab culture. Dante was holding steady (eating and alert) until Jan 08, when he started some mouth breathing and seemed uncomfortable (not eating and tucked in his shell).

His discomfort and lack of appetite continued today, and we just got the lab results. The vet advised Amikacin, Ceftiofur and Enrofloxacin should be effective against these bacteria, but obviously we don't want to use Ceftiofur again...and I'm not convinced Amikacin is working.

I'm tempted stop the Amikacin and just go with the Enrofloxacin because I'm nervous about using both at once, but I'm wondering if maybe Dante really does need two antibiotics to knock this s%$ out of his poor little body once and for all...Would love thoughts or experiences!
 

Yvonne G

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You're right in that Baytril (enrofloxacin) is a heavy hitter. I don't want to second guess your vet, but if it were my tortoise, I would give the Baytril dosage injected into a bite of food and not give the other antibiotic. You can also mix Baytril 9 parts sterile saline to 1 part Baytril and squirt it sharply into each nostril. This is the same thing as giving it in food because the other end of the nostrils is in the roof of the mouth.

A Baytril injection is quite painful and sometimes causes problems at the injection site.
 

Pokeymeg

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You're right in that Baytril (enrofloxacin) is a heavy hitter. I don't want to second guess your vet, but if it were my tortoise, I would give the Baytril dosage injected into a bite of food and not give the other antibiotic. You can also mix Baytril 9 parts sterile saline to 1 part Baytril and squirt it sharply into each nostril. This is the same thing as giving it in food because the other end of the nostrils is in the roof of the mouth.

A Baytril injection is quite painful and sometimes causes problems at the injection site.

Thanks for the advice, Yvonne! I'm very interested in this idea of squirting it into his nostrils. Since he's not eating ATM, this could be a great solution. He's been poked so much lately, I'm sure it'll cause problems with his legs if we inject it...
 

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I had a Russian rescue several years ago who had a bad pneumonia case and the vet prescribed 2 antibiotics to use @ the same time one syringe in the mouth and one nostril
 

DutchieAmanda

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Please ask your vet why he wants to combine those two antibiotics and whether you can indeed apply via the nose.

Some antibiotics strengthen each other and work even better given together. I'm not sure if this is also the case here.

If you inject an antibiotic it gets right into his system. If you apply it with food or via his nose, it gets into his stomach first. This could influence how well it works and also what side effects you could expect.

I'm no reptile vet, so cannot advise you on this, except to follow expert advice. Maybe a forum vet (@deadheadvet?) could help you.

Something else: did you know what made Dante sick? Were you able to remove the cause?

Good luck with all this, hope he gets well soon!
 

Pokeymeg

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Please ask your vet why he wants to combine those two antibiotics and whether you can indeed apply via the nose.

Some antibiotics strengthen each other and work even better given together. I'm not sure if this is also the case here.

If you inject an antibiotic it gets right into his system. If you apply it with food or via his nose, it gets into his stomach first. This could influence how well it works and also what side effects you could expect.

I'm no reptile vet, so cannot advise you on this, except to follow expert advice. Maybe a forum vet (@deadheadvet?) could help you.

Something else: did you know what made Dante sick? Were you able to remove the cause?

Good luck with all this, hope he gets well soon!

Yeah, I realized changing the application method on my own might not be wise....I'm going to talk to my vet today about it when I pick up the meds.

I'm not sure what made him sick, but I've been trying to brainstorm. Everything will be getting boiled and sanitized.
 

Pokeymeg

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I had a Russian rescue several years ago who had a bad pneumonia case and the vet prescribed 2 antibiotics to use @ the same time one syringe in the mouth and one nostril
Good to know, thank you!
 

deadheadvet

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Ask for the culture results. There should be sensitivity associated with the culture. It may be that the 2 organisms grown will not respond to just one antibiotic. Just so you know, Amikacin is a big gun antibiotic already and likely would be effective against both organisms, however the report is very important. Enrofloxacin given orally is a good alternative but will affect the appetite. Tough situation, They may not check on the culture for Ceftazidine which is a good alternative if you can get it, Hard to come by right now, We don't even have it unfortunately.
 

Pokeymeg

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Ask for the culture results. There should be sensitivity associated with the culture. It may be that the 2 organisms grown will not respond to just one antibiotic. Just so you know, Amikacin is a big gun antibiotic already and likely would be effective against both organisms, however the report is very important. Enrofloxacin given orally is a good alternative but will affect the appetite. Tough situation, They may not check on the culture for Ceftazidine which is a good alternative if you can get it, Hard to come by right now, We don't even have it unfortunately.

Thank you for your input!! I'll ask my vet about it.
 

Pokeymeg

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So we opted to go with both antibiotics via injection as originally prescribed. Dante was doing very poorly and needed something asap. We got Baytril into him on Sunday. Monday and Tuesday were really rough, as he was mouth breathing and seemed to be very uncomfortable. His breathing is improved now, his nostrils are not visibly clogged anymore. Currently his eyes are a bit swollen and mostly closed (I think that's our fault for leaving him too close to the UVB light when he obviously wasn't going to move himself away if it bothered him). Since he's been scratching at his eyes, I've put terramycin on them to protect them a bit, and they seem to slowly be improving.

It's been a week now since he's eaten, but he's getting a soak 2x a day, one with carrot purée... Hopefully the Baytril continues to work with the Amikacin and knocks these nasty bacteria out of him :-/ Not sure what else we can do but wait...I think he drank a bit during his soak yesterday, which is encouraging.

It's unfortunate that the Amikacin had seemed to work throughout the week last week (he still ate and was alert) until Friday when he suddenly declined... I think maybe the Amikacin just wasn't enough on its own.
 

Pokeymeg

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Alright, now I'm just posting so I have a record of Dante's treatment and recovery (and for anyone who may search on this topic in the future)...He only has one more dose of Amikacin, but 3 more weeks with the Baytril. The two antibiotics won't be overlapping for the entire length of treatment.

Since his breathing is better, the vet told us Friday to go ahead and try force feeding some baby food. So for the last three days Dante has received 0.4cc of carrot puree. Within 24 hours we started to see improvement to Dante's eyes. Today he opened his eyes fully. He's putting up much more of a fight now when syringe feeding him, which is great to see! He has zero interest in eating on his own as of yet, so we'll continue with syringe feeding as he'll 'let' us.
 

Pokeymeg

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So I took Dante back to the vet today. The vet was concerned that Dante is still not eating (we're closing in on 3 weeks since he's eaten without being force fed) and wanted to make sure there wasn't anything else going on that we missed. (I got a pic of his lab results from earlier this month, for anyone who is interested in seeing them. ) 1453948086009.jpg

We took an X-ray and blood sample today. The X-ray showed a little gunk still in one of his lungs and the blood sample showed antibodies still present in his blood. So basically, he's still sick. But getting better. Sloooowly. Ugh.

The vet was also concerned about Dante developing fatty liver disease from lack of eating for so long. The best thing to do is what we've been doing and continue to force feed until he starts to eat on his own.

I'm reassured that there was nothing new and surprising found during today's tests, but Dante's still not out of the woods...We still have a couple more weeks of antibiotics to go. Go Dante go!
 

Pokeymeg

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So we finished the Baytril on Tuesday Feb 9th (finally!!!!) and Dante is still hanging in there.

Since finishing his treatment, we've seen a couple half-hearted attempts at tail-wiggling, which we haven't seen in weeks. Hopefully he's cooking up some sort of bowel movement so we know his parts are all in working order!

He also showed interest in chewing the formula we made him, so we made some Mazuri into a thick paste to syringe feed and he has successfully been chewing and swallowing, which is the most beautiful thing I've seen in 6 weeks! Progress is painfully slow, and Dante is not out of the woods by far. We don't even know if we've successfully knocked the infection out for good this time (praying that we have!), but we need to get his strength up before another vet visit.
 

Pearly

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So we finished the Baytril on Tuesday Feb 9th (finally!!!!) and Dante is still hanging in there.

Since finishing his treatment, we've seen a couple half-hearted attempts at tail-wiggling, which we haven't seen in weeks. Hopefully he's cooking up some sort of bowel movement so we know his parts are all in working order!

He also showed interest in chewing the formula we made him, so we made some Mazuri into a thick paste to syringe feed and he has successfully been chewing and swallowing, which is the most beautiful thing I've seen in 6 weeks! Progress is painfully slow, and Dante is not out of the woods by far. We don't even know if we've successfully knocked the infection out for good this time (praying that we have!), but we need to get his strength up before another vet visit.
Good joojoo going your way to strengthen you in your efforts of caring for your tort and healing thoughts going to Dante❤️
 

Lyn W

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Small steps but all in the right direction! Hoping Dante goes from strength to strength and continues to improve.
Best wishes to you both.
 

Pokeymeg

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How's Dante doing? How are you-his caregiver?
Thanks for asking!

It's been a rough day, actually. We're just on our way back from the vet now. I noticed his back leg was swollen this morning, and I automatically assumed the worst -liver or kidney failure...I kind of thought we were making our final trip to the vet :-(

But the vet was still optimistic. The swelling could be unrelated to organ failure... The fact that he hasn't moved at all in 1 1/2 months could be reason enough, I guess. So he got some fluids and we're to just keep doing what we're doing... Hopefully he continues with little steps forward because today nearly have me a heart attack!
 
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