Rabbits/Upper respiratory infection
I have a Holland lop who will be turning 3 in September, who has recently been having a very difficult URI. It normally starts with his left nostril but eventually both eventually get wet. He cultured bordetella and Staph.
He has been on a host of meds. most recently Zenquin which both were sensitive too. They were also both sensitive to doxycycline. However, it Zenquin is not longer effective and even on Doxycyline his nose was congested.
He has recently been nebulizeed with Amikacin and Acetylcysteine which really helped. However, a couple day after he is congested and sneezes up white snot.
At the same time as he was being nebulized I had a CT scan done on head and chest the scan showed a incidental hyperostosis of the right incisive bone. His nasal passages look fine.
However his right cranial and right middle lung lobes show ground glass increase in soft tissue density with air bronchogram. However he show no signs of pneumonia or being ill other than the nasal discharge. Super bright and excited, he eats plenty.
My vet said they were definitely going to ask for a third opinion, he seemed very skeptical before doing a aspirate.
Thanks in advance
Sorry for the delay. I didn't get a notice of your message from AllExperts, and just now found it.
I agree with your vet about the aspirate. That might well do more harm than good.
Holland Lops have a predisposition for dental disease, and this is often the cause of chronic URI, even if you can't see the problem clearly on radiograph. Please see:
Antibiotics might knock the problem back for a while, but a partially (or fully) occluded maxillary sinus just sets up such a nice environment for opportunistic pathogens that they'll eventually be back when the meds are stopped (or the population is selected for resistance). It's a very tough situation.
If your little guy is really miserable with the congestion, you might ask the vet about a very gentle, shallow nasal flush procedure to see if the sinuses can be cleared. You might also consider the possibility of a foreign body that's radio-translucent, and not showing up on x-ray.
I have noted that rabbits with pneumonia often do not show obvious signs of distress unless the condition has become so advanced that they are having trouble breathing. I think the nebulization is a good idea, and amikacin is a good choice to hit stubborn, resistant bacteria.
Since the zeniquin worked, it might be time to switch to a different fluoroquinolone, such as Orbax. We've had very good success with this one, and I hope it will help your little guy. Sometimes infections like this are like the Red Queen: you have to keep running (switching tactics/antibiotics) just to keep up. It doesn't help that he's a purebred Holland Lop, which means that his immune system and anatomy are not priming him for success in a case like this. :(
I hope this helps with a few ideas.