URI/Upper Respiratory Infection Difficulty Treating URI

[mecole]

I recently adopted my 5 month old guinea pig, Luna, from a rescue that saved her from a pet store that was closing down. I quickly noticed that she was sneezing and wiping her nose frequently. I also found some crust in her eye. I took her to my exotics vet who prescribed a 10-day course of Bactrim along with .5g of benebac two hours after administering the antibiotic. The vet did say that Luna's lungs sounded fine. I finished the course of Bactrim, but Luna was STILL sneezing.

So, I took her back to the vet, where she was prescribed azithromycin, again along with benebac. The vet said she thought Luna must have bordatella, which is why the Bactrim was ineffective. She reacted TERRIBLY to the azithromycin--extremely soft poop and diarrhea. She also became extremely lethargic and would sit in the corner of her cage fluffed up in a tiny ball. Normally she is extremely active and likes to run, popcorn, etc. I took her off the azithromycin immediately.

I took her to the vet AGAIN, and while there, we saw that her rectum was bleeding. I hadn't noticed since Luna's bedding is hot pink fleece. The vet figured this was a result of the gastric distress and irritation Luna was experiencing. So, the vet prescribed Baytril despite the possibility of the bone abnormalities, and I continued to pair it with the benebac. The vet said we had been backed into a corner regarding the available antibiotics to treat Luna's URI, which was why she chose Baytril despite it's potentially negative side effects. She also gave me sucralfate to give every 8 hours to coat any ulcers in Luna's GI tract and critical care 3x daily to keep her weight stable.

Luna is on her second day of Baytril now. Yesterday she was very bloated and was not pooping at all, so I gently massaged her tummy which seemed to help--she pooped some, but it was very soft.

Today she is pooping much more, but it is still very soft and very long. I know it has only been two days on the most recent antibiotic (maybe too soon to expect results), but Luna is still sneezing. She does seem more active and has run some laps around her cage and popcorned.

To be honest, I am just a very overwhelmed piggy mommy, and am hoping that someone can provide some insight into this issue and advise me if there is anything else I can be doing to help Luna get better.

 

[bpatters]

I'm not a vet, but I'd prefer to see her on doxycycline than Baytril, particularly if it's giving her problems with her digestive tract. The other thing that can be done, and which has been very successful with some pigs with stubborn URIs, is nebulized medicine. Gentamycin, which can't be given orally, can be given that way, and it's a strong antibiotic. As far as I know, the azithromycin could be given the same way.

You can rent a nebulizer, and can make a chamber to put the pig in from a plastic box.

If she's not eating, hand-feed her aggressively. If she's eating nothing else, she needs 50-60 cc of Critical Care or pellet slurry per kilogram of body weight daily, split into 5-6 feedings. Reduce that amount proportionately for however much she weighs, and also reduce some more if she's still eating.

Pigs MUST eat, or they'll die. See https://www.guinealynx.info/handfeeding.html for directions on how to do it, and post back here if you have questions.

 

[mecole]

I suggested doxycycline to my vet as an alternative to Baytril, but she said it is very small spectrum and has been ineffective in her experience treating cavy URIs. I will definitely call tomorrow to ask about the nebulized antibiotics. As long as she is still eating, drinking, pooping, and not losing weight do you think I should see her through the Baytril treatment? I'm also wary of switching a fourth time to another antibiotic, since I don't want to create a super resistant strain.

 

[bpatters]

I really don't know. I just lost a pig that I didn't take off Baytril soon enough, so I'm a little gun-shy here. But, if she's eating/pooping somewhat normally/peeing/maintaining her weight/not acting like she's in pain, then you could consider keeping her on it. But if she loses weight, gets really gassy or stops pooping, then stop the med.

I wouldn't worry about the antibiotic resistance. "Pulsing" antibiotics -- giving one, then another, is a common technique, although usually the patient is on them longer than a day or so.

 

[mecole]

Hey all! I've got an update on little Luna, and wanted to hear your thoughts. Luna stayed on the Baytril for a week until things went wrong. Interestingly, she seemed to be improving on the Baytril, her poop was finally starting to look normal (after the azithromycin incident), until one day everything flipped. She was back to wet sneezing pretty frequently, became lethargic, stayed puffed up in her hidey, and was back to soft/clumpy poos and diarrhea. I got her to the vet the next day. The vet suggested that since she has been through three partial rounds of antibiotics and her GI tract is clearly wrecked, that we actually give her a week without antibiotics to "detox" and get her back to normal before we try another treatment.

I discussed the possibility of nebulized antibiotics which my exotic vet said would be an option, though he seemed more confident in injectable antibiotics which would bypass her seemingly delicate digestive system. Are injectable antibiotics a good alternative?

Interestingly, after just one day off the Baytril, Luna's sneezing has been reduced, and she's back to popcorning and stuffing her face. Her poops are still very soft, runny, and clumpy, but she looks and acts a lot happier. Is it possible that she could overcome the remaining URI on her own? I say remaining because the antibiotics have wiped out the crusty eyes and runny nose, just leaving the sneezing behind.

Final details: The vet said her lungs were clear, and Luna is continuing to gain weight steadily.

I'd love to hear your thoughts. Thanks!

 

[bpatters]

Stopping the antibiotics seems like a reasonable thing to for her.

Some antibiotics can be injected, but may cause sterile abscesses -- Baytril is one of those. So most vets tend to avoid injectables, although there are occasions when they're necessary. There's no downside to nebulized meds as far as I know, other than getting your hands on a nebulizer and making a box to put the pig in.

Keep up the good work, Luna!

 

[mecole]

Update again: Luna has been off of antibiotics for one week exactly. Her follow up vet appointment is tomorrow. The vet and I made this appointment on the assumption that if she worsened in the week off antibiotics, that we would take a culture, and treat her accordingly with nebulized or injectable antibiotics. The vet was hopeful that she would be able to improve on her own, though.

Weirdly enough Luna hasn't gotten worse at all, but her sneeze is still around. It does seem fainter to me (more of a "ts" sound rather than a full/strong sneeze), but that could just be wishful thinking on my part. She has no crusty eyes, good sounding lungs, no visible nasal discharge (though I guess she could be wiping it away), and has a GREAT appetite and is steadily gaining weight as she should be. She still has soft, mushy poop as a consequence of the Baytril and azithromycin issues, but I assumed it would take awhile for her GI tract to right itself and am not too worried about that. What do you all think is the best course of action?

I will still gladly take her to the vet tomorrow for treatment and a checkup, but I am also worried that if this is somehow not a URI (maybe environmental?) or if she is overcoming it on her own, that amping up the antibiotics will make everything worse again. Also, she has no nasal discharge so the vet would have nothing to sample for a culture.

Thoughts?

 

[bpatters]

If she's getting better/acting normal/gaining weight/eating & pooping ok (soft poops excepted), I'd probably not put her back on antibiotics. But I'd watch her like a hawk for any signs of illness, and get her back to the vet ASAP if any occur.

 

[mecole]

Thank you! I just got my vet on the phone and he agreed. So it is possible then for guinea pigs to overcome these illnesses on their own, especially if antibiotics maybe weakened the infection?

 

[bpatters]

Well, technically we don't usually know that they have a URI, because a culture isn't done. We go by the symptoms, and if they seem severe enough, we usually give antibiotics. That's mainly because pigs go downhill so quickly that you don't want to risk them being overwhelmed by infection. But on the other hand, antibiotics are really harsh on their symptoms, so you're trying to balance the possible need for treatment against the probable side effects.

But yes, it is possible for them to overcome an infection with a little help. But you do have to watch very carefully for any recurrence, and get them in immediately so they can start the antibiotics again. The theory there is that if they still have continuing infection, and you've stopped the antibiotics for a while, they're not quite as robust as they were before they got sick, so you have to be proactive about treatment.

 

[mecole]

Update again: I had a culture done for Luna so that we could determine once and for all what her specific problem was. The vet said her culture showed both Streptococcus and Staphylococcus species, which she said were resistant to almost every type of drug they use in guinea pigs. She prescribed nebulized gentamicin twice a day until she improves, after which I would downgrade to once a day, until her symptoms are gone. I did my first nebulized treatment with Luna today and she seemed to handle it well. Do you have any advice for me? Does this seem like an appropriate treatment? When should I expect to see results? Thanks!

 

[bpatters]

Yes, it seems appropriate to me. It may take a while until it clears up, but that's the only way to get those strong antibiotics into the lungs. The good news is that nebulized antibiotics don't generally make pigs lose their appetites like oral ones do. You do need to watch to see whether he's eating normally, and weigh him daily while he's on it, but I wouldn't expect him to have much difficulty with it.

 

[mecole]

Great! I'm really hoping this does it, otherwise the vet said ciprofloxacin is our only other option, and even then one of the bacteria is only "intermediately susceptible" to it. I also worry about trying oral antibiotics again because Luna still has very soft poops almost two weeks after her last oral antibiotics (even with daily benebac). What would you say is the crossover point at which it would be clear the nebulized gentamicin isn't working? It's just so hard to tell whether or not she's improving when her only symptom is the sneezing.

 

[mecole]

Sorry to post again but it's been almost two weeks of of the 3 cc nebulized gentamicin twice a day and Luna is still sneezing. But, she has gained 60 grams (now up to 570) and her pooping has returned to normal, which is good, though that is probably just a result of finally being off oral antibiotics. Should I be worried that her symptoms haven't improved yet? Or could it take awhile to improve? It just seems to me that they must be working, albeit slowly, or she would be getting worse and be losing weight, getting lethargic, etc. Is that a safe assumption? I'm just wary of adding in the oral ciprofloxacin since she responded badly to oral ABs in the past, and it's potential to cause lesions in young guinea pigs.

 

[bpatters]

Is sneezing the only symptom she has at this point?

 

[mecole]

Yes--as far as I can tell! Her nose does seem damp sometimes, but even early on in the URI saga she was really good about wiping her nose, so she could be doing that when I'm not looking. It's just frustrating to try and keep tabs on her sneezing since sometimes she's not sneezy, other times she does it a lot, and I'm not always home to monitor it. Thanks for the quick reply, by the way!

 

[bpatters]

What does the vet say? Have they done another culture to see if the infection is gone?

I'm wondering if maybe the current sneezing is prompted by the nebulization. It does get moisture into the nose and lungs, and maybe she's just sneezing it out. I don't know if that's even possible -- just sort of grasping at straws here.

 

[mecole]

That's an interesting point, I hadn't thought of that. Now that you mention it I do notice her sneeze right after I get her out of the nebulization chamber. I will get a culture done as soon as I get paid (I'm out $1,000 from her vet bills and have $75 to my name until July 15th). Is it worth stopping the gentamicin, do you think? I'll call the vet tomorrow and run that possibility by them.

 

[bpatters]

I don't know that I'd stop it without talking to them about it.

Sometimes doctors (human and animal) will alternate antibiotics when treating a stubborn infection. They give one for several weeks, then another, then back to the first, etc. They also sometimes combine them -- Baytril and doxycycline are often given that way. Possibly there's another that they could also nebulize. Like you, I'd be pretty reluctant to put her on a strong oral antibiotic.

 

[mecole]

I spoke to them about that option, but they said according to her culture the only effective antibiotics for treating both the bacteria she has are gentamicin and possibly oral ciprofloxacin but that one of the bacteria is only "intermediately susceptible" to the ciprofloxacin. The vet framed the cipro as a sort of last result. I guess there is a possibility of effective treatment via injections, but again I'm wary of all of the problems those can cause, as well as the high price.