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Question
Around Thanksgiving of last year (2012), my bunny (9 months old then) was attacked by my wiener dog in the face. Her mandilla was almost fractured and the vet had to wire her mouth for 6 wks. She also had a fractured lower incisor which became infected and was surgically removed two weeks ago. The vet said because of the pus he was not able to get a few fragments, but thinks he got enough "root to bone". We had her pus cultured and it came back yesterday as anaerobic and the vet has her on two oral medicines - Metronidazle Susp 100mg/ml;  SMZ-TMP 48mg/ml per 30ml-A&E, twice a day for 30 days. My question is are the "tooth fragments" he left behind going to keep causing infection and does she have a good chance of kicking this infection completely?  She still has a mass under her chin which the vet said will probably have to be drained one more time, but the infection should be gone.  We've spent thousands of dollars trying to save this bun's life and if the infection comes back AGAIN, do we keep trying.  The vet said there is one more antibiotic that we can try, but toxic to humans and we cannot get on our skin, but okay for rabit to ingest.  He said that we can always go back in and try to get tooth fragments, but I am not sure I want to put her through that again.  When do we say enough, she has been through sooooo very much and this is not about the money, but for her.  We love dearly and want to save her, but don't want her to keep suffering.  Thanks for your help!

Answer
Dear Kate,

If you have not yet tried dual-acting Penicillin-G Procaine/Benzathine, then I would give that a shot.  If there is still infection in the jaw, then the bones will not heal properly.  Even if they heal, they will probably no be straight, and your bun will have a lifelong problem with malocclusion (this can be dealt with, but it will be chronic).

In my experience, SMZ-TMP is pretty much useless against the organisms in a typical jaw abscess.  Please see:

http://www.bio.miami.edu/hare/jawabscess.html

As far as "how much is too much"?  Only you can decide that.  I am not there to see her condition, her outlook on life, her will to live.  Provide her with plenty of pain management:  metacam plus tramadol can be very good for bone pain.

I suspect the vet wants to try chloramphenicol.  It might work, and it might not.  And the other thing to consider is that a culture from a jaw abscess might not give very accurate results, since there's a very good chance to get contaminants from the mouth.  I would not be surprised if there were multiple, opportunistic pathogens in there.  

If this were my bun, I would seriously consider the dual-acting penicillin.  We have seen practically miraculous results with this, if the bacteria are sensitive to penicillins.  And if the culture indicates they are not, then consider the possibility of misidentification of the real pathogens.  At this point, if it's life or death for the bunny, it certainly can't hurt to try the dual-acting Pen.

Our vets use 50,000IU/kg once every 48 hours, subcutaneous injection only.  Draw back on the plunger once the needle is under the skin, to be sure you have not hit a blood vessel (which can be disastrous).

I hope this helps.

Dana

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Dana Krempels, Ph.D.

Expertise

I've lived with companion rabbits for more than 35 years, and consider them members of my family. I can answer any questions about the biology and health of rabbits, from the commonplace to the unusual. But please note:

RULE #1:
THE INTERNET IS NOT THE PLACE TO SEEK HELP IN AN EMERGENCY.

...it is an EMERGENCY.

Find a rabbit vet at www.rabbit.org/vet for immediate help, and don't risk your bunny's life by spending time asking questions online! If you can't get in touch with your vet, read these Emergency Sick Bunny Instructions.

If you have found a wild baby rabbit, please read these EMERGENCY INSTRUCTIONS FOR WILD BABY RABBITS and then use this link to FIND A LOCAL WILDLIFE REHABILITATOR who can give you the right advice.


RULE #2:
Help me help you! Please make your subject line informative if you have an urgent question. then LET ME KNOW IN THE SUBJECT LINE so I can give your question highest priority over non-urgent questions. If you don't do this, then I can't guarantee timely assistance!

For all the best, most accurate rabbit health, care and behavior information, visit The House Rabbit Society.

Experience

I have been rescuing and rehabilitating domestic and wild rabbits for about 30 years. I have written articles for many rabbit rescue publications, as well as for the veterinary journal, Exotic DVM. I own EtherBun, the internet's largest listserve dedicated to health, care, and behavior of domestic rabbits.

Organizations
Houserabbit Adoption, Rescue, and Education, Inc. (H.A.R.E., Inc.) president National House Rabbit Society (Board member)

Publications
Exotic DVM
Warren Peace (Journal of the House Rabbit Society of Miami)
Various newsletters of the House Rabbit Society, nationwide

Education/Credentials
Ph.D - Biology
B.S. - Biology
B.A. - English

Awards and Honors
Lightspan Academic Excellence Award for web site on rabbit health and biology
(http://www.bio.miami.edu/hare)

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