Persistent Ear Infection

tms8

Post   » Fri May 17, 2019 11:20 pm


Hello,

I have a 2.5 year male guinea pig with a persistent ear infection. I first noticed it due to the smell, then noticed the ear discharge. The first vet I took him to prescribed Ofloxacin opthalmic solution one drop 2X day for 2 weeks. Within a day of using it a huge abscess formed on the side of his face near his eye and started leaking pus. I brought him to the emergency vet who drained it, put him on a week of Metacam, and a two week course of Baytril. The abscess has healed well, but his ear is still full of discharge despite the treatment. I stopped the Baytril a couple days early because he began to lose weight rapidly (3lbs to 2lbs 13oz). He was only eating hay and treats, no pellets. He has just started to get his appetite back, but I still have to syringe feed him critical care (30mL) a day to at least keep his weight consistent (although he hasn't gained any back). I am not sure what to do at this point because I really don't want to start another oral antibiotic with his current appetite and the drops don't seem to be doing anything. He does not have any head tilt/rolling, the only signs are the discharge, smell, and crying in pain. I also don't want to leave it unattended as it may spread to his inner ear. I was wondering if anyone has experienced anything similar and had a better treatment option. Also looking for any vet recommendations in New England (CT or surrounding states), I don't care too much about the drive as I have honestly yet to find a vet who will do a culture and actually identify the proper antibiotic.

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sef1268
Supporter in 2019

Post   » Fri May 17, 2019 11:49 pm


Have xrays ever been done on his head/jaw?

I haven't had a whole lot of experience with stubborn ear infections, as most of ours have cleared up on either oral Baytril or Baytril Otic -- or a combo of both. I've heard that Chloramphenicol can be very effective, but again...hard on the gut.

Hopefully someone with more ear experience will weigh-in on this.

tms8

Post   » Fri May 17, 2019 11:59 pm


He has not had an x-ray done. Both vets did check his teeth/inner mouth and found no problems. Is the Baytril Otic solution for dogs safe to use? I could try to get a prescription for it as it's also an antifungal. The vet did do a swab of his ear though and said she saw "a lot of bacteria."

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Lynx
RESIST

Post   » Sat May 18, 2019 7:23 am


Ditto on the xray. It may help show the extent of the infection.

tms8

Post   » Sat May 18, 2019 11:35 pm


Update:

I brought him back to the vet tonight and they prescribed a different antibiotic eye drop to try and said I could put him back on the Metacam. I suggested we do a culture and sensitivity test on the ear discharge, so the results from that should come in sometime next week. Hopefully that will help identify the proper antibiotic to use topically (she said if we treat topically we have more options). She said if that doesn't work I will have to be referred to a facility to do a CT-Scan under anesthesia as she doesn't think the x-ray will be helpful if the infection is deeper.

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sef1268
Supporter in 2019

Post   » Sun May 19, 2019 5:52 am


Sounds very reasonable. What is the new med?

Good luck and keep us posted.

tms8

Post   » Mon May 20, 2019 11:30 am


The eye drops are 0.3% Gepotidacin I believe. His appetite seems to be returning at least for critical care. I am concerned he’s still not eating pellets even though it’s been a week since stopping the Baytril. We usually feed Oxbow adult pellets, I was wondering if it would be worth trying a different brand? Any recommendations?

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ItsaZoo

Post   » Mon May 20, 2019 3:11 pm


Oxbow has a Garden Select pellet with herbs that is very fragrant. The pellets are a little larger than the standard adult pellet. My GP thought they were pretty good. I think the fragrance attracted her - they smell fresh.

tms8

Post   » Tue May 21, 2019 4:46 pm


Sorry I meant Gentamicin. I ordered those pellets they come in on Thursday. In the meantime I bought a bag of "EXTREME guinea pig food" (I cringe even quoting that) and tried picking out the treats and just giving the pellets. He seemed to start eating it so maybe he's just being a picky pig.

tms8

Post   » Thu May 23, 2019 5:40 pm


Update:

Took Golgi to Tufts today and finally received some definitive treatment options (although highly expensive). He's going back Tuesday for a CT-Scan and possible irrigation of his ear. Apparently he's moderately overweight despite the weight loss (my other pig must be obese then lol). Without the irrigation there is zero chance of the antibiotics curing the infection as the whole canal is clogged. If this does not work there is a surgery to open and clear the ear permanently, but he would also be rendered deaf in one ear. Also, this surgery has only been performed in rabbits not pigs so he would literally be a "guinea pig." He's been switched to Baytril Otic in the meantime. He also has been prescribed Tramadol in addition to the Meloxicam, but I am hesitant to give him the full doses as it causes sedation. Oh also, they don't have an endoscope that can fit in his ear, so they would be flushing blindly.

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sef1268
Supporter in 2019

Post   » Thu May 23, 2019 9:15 pm


They consider 2 lbs. 13 oz. to be overweight?

I'd wait and see what the CT-scan reveals, and then decide how to proceed. I'm not familiar with a surgical procedure to "open and clear the ear permanently" in guinea pigs, but I've heard of something like that being done in rabbits. Did they explain what would be involved?

How much Metacam are you giving him?

tms8

Post   » Thu May 23, 2019 10:36 pm


They didn’t explain the future surgery much as that would be scheduled at a later date after the scan. Yes, it would be the same as the surgery done in rabbits. All I know is it would cost $2.5-3.5k.

Yes the discharge notes say he is “moderately overweight,” I was surprised. He’s receiving 0.2mL Metacam once daily at 1.5mg/mL.

I’m more concerned now about putting him under anesthesia as I know that’s a risk in and of itself. She said the alternative was to keep him on long courses of antibiotics, but that with his appetite issues he may die before the infection is even fully cleared.

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Lynx
RESIST

Post   » Fri May 24, 2019 12:11 am


I hope you get some answers from the CTscan.

There is some good pain management advice linked to and added on these pages:
www.guinealynx.info/pain.html
www.guinealynx.info/postop.html

You might want to look at the guidelines a veterinarian provided us for evaluating weight in an individual guinea pigs:
www.guinealynx.info/weigh.html

tms8

Post   » Fri May 24, 2019 1:30 pm


Sorry guys, I just had a quick question regarding Tramadol dosing. Thank you so much for the advice by the way, having an ill pig is very stressful.

It was prescribed as a 10mg/mL suspension given at 3mg/kg twice daily. Does this seem high?

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sef1268
Supporter in 2019

Post   » Fri May 24, 2019 1:39 pm


Suspension is 10mg/ml, and you're saying that they have prescribed it at .3cc twice a day? Or 3mg per kg of weight? What is his weight?

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sef1268
Supporter in 2019

Post   » Fri May 24, 2019 1:45 pm


ETA: I don't have the Formulary in front of me, but I think the standard dose on Tramadol for rodents is somewhere around 5mg/kg, but with a range (if memory serves) of 4mg/kg-10mg/kg.

tms8

Post   » Wed May 29, 2019 2:44 pm


Update:

Golgi had his CT-scan and ear flushing yesterday. He's recovered well from anesthesia albeit lost some weight. The scan wasn't that useful, basically the infection completely obstructs his outer and middle ear on the left side. She couldn't make out the tympanic membrane, so the flushing may have only been effective in the outer ear. I still found discharge this morning. He's on the Baytril otic and oral Bactrim now. The culture results came back with Xanthomonas maltophila as the culprit. I would prefer them to do a myringotomy (incision into eardrum) with flushing, but they're missing a properly sized scope. The surgeon thinks the antibiotics won't be effective and wants to pursue surgery, but it's invasive and risky with possible facial paralysis. It has also never been done in a guinea pig. Also, he apparently has a reactive lymph node on the right side and slight malocclusion of his back teeth. The vet said unless he starts drooling or not eating to just let it be.

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Lynx
RESIST

Post   » Wed May 29, 2019 9:44 pm


Were any of the oral antibiotics you were giving him effective on Xanthomonas maltophila?

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sef1268
Supporter in 2019

Post   » Wed May 29, 2019 11:05 pm


Interesting! Google search of Xanthomonas maltophila didn't yield anything too helpful from a veterinary standpoint. I did see trimethoprim-sulfamethoxazole (Bactrim) mentioned several times as possibly having some degree of effectiveness in treating human patients.

Where is the inflamed lymph node? Did the vet think it was in response to the ear infection?

tms8

Post   » Wed Jun 05, 2019 6:33 pm


The inflamed lymph node is on the opposite side of the ear infection surprisingly.

I am still struggling to get Golgi to eat any pellets. The only ones he will touch are alfalfa based which is less than ideal for an adult pig. I've had a pig with a bladder stone before and would not like to go down that road again. I'm wondering if it would be safe to feed him the alfalfa pellets for a few months considering he's not eating much anyways? I ordered the KMS Hayloft pellets to try. I could also try to switch him to a timothy hay and veggie only diet and supplement with the Oxbow multi-vitamin tablets.

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