Inner Ear Infection?

[Potatofriend]

I have a young Guinea pig, Theo, who I adopted recently (age 8 weeks, adopted on day 1). He presented with signs of respiratory disorder, which were treated with baytril (days 2-7); it didn’t improve and the vet discontinued the treatment, saying the symptoms were environmental. The symptoms worsened (days 8-10), and he was taken to a second vet, where he was prescribed baytril again (day 11). He then presented with drool and a head tilt, and was prescribed metacam (day 14) and, as symptoms worsened, sulfatrim (day 17). He improved, and received these medicines and a probiotic (fibreplex) since, and an antibiotic eyedrop (since day 27) for a squint he developed on the eye tilting downward. His weight dropped initially then increased, and his weight gain is going well.

Euthanasia was suggested on day 11, however due to improvements the vet decided discontinuing the medication on day 35, pm, was the right choice.

He went without 3 doses, 1.5 days, and symptoms resumed - he started drooling again (lightly), sniffling, dried mucus around the nose, and the tilt and balance seemed worse- he also had a red lump at the bottom of his ear, around where the auditory meatus meets the tympanic bulla. Sulfatrim, baytril, metacam, and fibreplex were resumed on day 37, am. The lump is smaller and no longer red in the centre. His tilt and balance are worse, but respiratory symptoms have ceased. It is now day 38. I have an appointment in two days with the vet.

I was wondering if anyone could advise:

What medicines/treatments should I ask for? The vet said previously that blood tests won’t tell us what the infection is, ear drops will not be helpful as there’s no pus/ discharge from the ear and so it’s too deep in to reach. Is there a stronger antibiotic I could ask for? Something better designed for this type of infection?

Thank you for your time

 

[Wiebke]

Hi

I am extremely sorry for your little boy. Unfortunately, this is a new problem that I have never come across in my own piggies or in my years on this forum so I can't advise you on what works.

I am however keeping my fingers very firmly crossed for your little boy.

 

[weepweeps]

Hello. I’m sorry your piggy has been so unwell. I don’t have any experience of these symptoms but someone will be along soon with more advice. I hope you can get to the bottom of the problem.

 

[Merab]

I have no experience to share, but just want to offer support.

 

[Potatofriend]

Thank you for the support - it has been very difficult, he’s so cheerful, inquisitive, friendly and full of life- trust his tilt was around 45 degrees before his meds, he took them ever so well, and now he’s running around with his friends

 

[Potatofriend]

Just to keep a record, in case it helps anyone in future
The vet suspects the lump is an inflamed lymph node- so the infection started as URI, moved to the inner ear, and then the lymph node.
The bacteria responsible respond to baytril and sulfatrim but have some resistance as it’s not gone after 6 weeks on medication.
The vet doesn’t think the prognosis is good, so we’ve got another week of antibiotics- 0.18ml of baytril (2.5%) and metacam (0.5mg/ml), 0.09 ml doxycycline (25mg/ml), and 0.13ml of sulfatrim (16+80mg/ml), at x2 per day except metacam x1. I give fibreplex an hour after the antibiotics, usually wrapped in salad leaves.
The lump has gone down in size but not gone, we are on day 3 of this medicine regime. Theo is eating, energetic, and has put on weight at a rate of 2.2g/day (line of best fit calculation from weight graph) - he is now 14 weeks (around- I’d need to check my excel for him to be certain, so maybe 13, possible 12) and at 500g. Poos are healthy in size and quantity.
He has been very good with the medicines- at first I could just offer the syringe and he’d take it, no need to even pick him up! But as time has gone on he’s got increasingly fed up and he also really hates the doxycycline (it is quite smelly), but we are getting them down him.
His head tilt has gone from ~50 to ~25 degrees, based on photos measured with a protractor, one straight line across the top eye, then one line angled up from the bottom of his jaw. The squint on the downward tilted eye comes and goes.
Apart from having to take medicines he seems happy, he runs around and plays with his friends (at first I didn’t separate because he was so young and because I thought they’d already have it anyway, then I haven’t separated because they don’t seem to be getting it, though I watch them like a Hawk for symptoms- maybe he’s just susceptible? None of the other pigs at the rescue he’s from have had symptoms either)
Anyway that’s my update on my boy Theo, hope it helps someone.

 

[Potatofriend]

Here are some photos of him, enjoying some food, and tilt monitoring photos (Least tilt taken just now)

 

[eileen]

What a cute piggie,ive had piggies with head tilts,due to not getting treatment at a rescue.he went on to live a full life.my vet used zithromycin antibiotic to stop the infection spreading.also nebuliser to help the nasal discharge.ct scan was suggested as treatment for the head tilt was to do with the middle ear infection.i decided against it as he fuctioned well with the head tilt.bisolvon was used to dry up the nasal discharge.

 

[Bill & Ted]

Sending you and Theo big hugs, what an awful time you’ve both been through. I hope you can get this beautiful little piggie through this nasty infection, you are doing a marvellous job caring for him, he has a real zest for life x

 

[dhill_cb7]

I’m so sorry you boy theo is going through this! He is a handsome boar. I hope he fully recovers and you get to the bottom of this illness! Fingers crossed and prayers for your family and Theo!

 

[Merab]

Handsome Theo is clearly in excellent hands with you.
Hope he recovers quickly now

 

[Potatofriend]

Just an update on Theo.
He’s been on a mix of sulafatrim, baytril and doxycycline for nearly two weeks now, and his symptoms are not abating but they are stable.
He’s a little congested but there’s no drool (I suspect the drool is from breathing through his mouth when his nose is blocked); he’s still very tilted- although this varies through the day. Sometimes he’s nearly fully 90 degrees, sometimes barely 15.
At our last vet visit on Thursday, I mentioned the Zithromycin (which I think is the same as the azithromycin or ZIthromax?). This appears to be good at getting to infections and pus sites as it seems to hitch a ride with leucocytes and get released in the infected area, which is good for inner ear infections. The vet said he felt Theo was on enough antibiotics already, and that we couldn’t keep him on antibiotics forever, and was again approaching putting him down.
Theo has put on weight and is nearly at 500g, and is still lively, running around with his friends, being interested in the vegetable bowl, bedding changes, and being curious about life, so I said I didn’t we were quite there yet (I’ve decided that given the long fight we’ve had, when we get to a point where he’ll need syringe feeding we’ll call it a day). I asked if we could have another week with the doxycycline, as at that point he’d only been on it for a week - the vet agreed, and he’s back again tomorrow. He had a lovely Christmas, and is very fond of his festive treats.
For the vet, I’m thinking of suggesting we drop either bayrtil or doxycycline to make room for attempting the azithromycin; I’m also going to ask again about doing tests to find out exactly what the responsible bacteria is so we can target it with the right antibiotics instead of playing trial and error (this time I’ll suggest a nasal swab, bacteria grown in Petri dish, instead of a blood test). I’m also going to enquire about a nebuliser, and bisolvon, as mentioned above.
I’ve googled around and it looks like I should ask for a 4 week course of the azithromycin; does anyone know if that’s about right? Do my antibiotic switches make sense, or do you disagree with them?
I’ve thrown in some festive photos of the boys.

 

[Merab]

I can’t add any advice but want to add support.
Holding you in my thoughts.

 

[Potatofriend]

Ok vets in about an hour - I’ve attached a photo of the plan of things to discuss, and also a photo of Theo from this morning when he had his medicines. I’ll update with how it went.
Does anyone have anything I may have missed?
I’d also appreciate some encouragement- Theo has been popcorning, investigating bedding changes, taking from the veg bowl, and put on weight, but the vet keeps pushing for euthanasia. Am I doing the right thing trying to keep him going until he’s not happy?
A note on Clyde- Theo and Clyde were adopted at the same time, both were sneezing, Theo was snotty - I took them both to the vets at first but Clyde never developed any of the other symptoms that Theo did- he’s had a dry nose, no tilt, etc, just sneezing more than he should. I figured it was environmental like the first vet said so I took steps such as trying dust free hay, heating pads, a humidifier, changing the detergent, and he still sneezes- so I’m taking him with to see if there’s a link.
I read a post on here about someone who had Bordatella (which is one of the possible infectious agents at work here) and they dosed all their herd with sulfatrim even the non symptomatic pigs to get rid, so I’ll discuss that with the vet too.
Theo now weighs 520, and so does Clyde who is 2 weeks younger- so Theo isn’t growing as fast as he should be but he is growing!

 

[Qualcast&Flymo]

Theo is very cute! I hope you can get to the bottom of his issues. It would be a shame to pts when he has such zest for life.

Azithromycin (Zithromax being the usual brand name over here) is indeed usually the best antibiotic for infections with pus such as abscesses. @furryfriends (TEAS) always recommends it for abscesses. I wouldn't think that you would have it in addition to the other drugs, especially if they aren't working. It would seem better to drop one or more of the ones he has already got, though I can't advise which.

I first used Zithromax for a URI, after repeated courses of Baytril or Septrin had been ineffective. My piggy tolerated it better than Baytril though I've heard it doesn't suit all piggies so well.

PS Where were Theo and Clyde adopted from? Did the place have rabbits maybe?

 

[Merab]

To me, and I’m not a health expert, it looks as if you have it covered.
On a personal note, Phoebe goes back to the vet tomorrow when hopefully it will be clearer what the problem is.
If it is a mass as the vet thinks is one possibility then I have to decide whether to let her go now or leave it.
She’s pain free, eating well, regain weight and feistiness.
As long as she has quality of life I would leave her, and if that means Metacam for the rest of her life then that’s what it will be.

You know Theo best and if you can afford the vet bills, medications and he has a good quality of life then the decision is yours to make.
Holding you in my thoughts.

 

[Viennese Furbabies]

I can't add anything to the treatment, but my Chelsea was suffering from head tilt when she was little (a much lighter case than your boy though, but it was a hard time) and she came through and lived to nearly 5 years.
She was on antibiotics for quite some time and I wouldn't give up as long as he has got so much life left in him.

But of course it's your decision and you're the only one who can judge of how he is doing.

 

[Scooter Pie]

Just adding support for you and your piggies! Good luck at the next appointment

 

[Potatofriend]

The vet has agreed to Azithromycin and Bisolvon alongside the Sulfatrim, for 2 weeks. He didn’t think a nasal culture would show us much information, so we didn’t do that.
Clyde was looked at as well, he said there was no harm in giving him a week of sulfatrim and seeing if it fixed his sneezes (he didn’t sneezes the whole time we were at the vets because of course ) but he didn’t have any theories about cross infection either way, and didn’t seem to detect any further symptoms.
There was a further chat about him being uncomfortable giving him such a long period of antibiotics, he’s said he can’t be on robotics forever again, and said next time we need to discuss referring Theo to a specialist who is a 90 minute drive away (which is a bit awful because I have no car, so I really hope it doesn’t come to that).
I haven’t been able to find a specialist where I am (Lincoln, UK), would anyone be able to recommend one nearby? I looked on the forum lists but all those seemed quite far away sadly.
Well, hopefully it won’t come to that- come on Theo! Good luck!

 

[Potatofriend]

But no, as far as I’m aware they haven’t been near rabbits - the rescue didn’t seem to have any, but I don’t know if they were born there or elsewhere, or if their mothers were housed with rabbits - it’s not known they’ve been in contact with rabbits but we can’t say for certain they haven’t.

 

[Eriathwen]

As long as quality of life is good, I do not see the necessity of euthenasia? While no, they can't live forever on antibiotics, there's no harm in calling it palliative care and keeping him on antibiotics until QOL deteriorates. It's something I have done previously with palliative animals, and I have one now on baytril until we can make a second attempt at bloodwork mid January.

Theyre not on the approved forum section, theyre relatively new, but have you heard of The Small Pet Vet? (She has a Facebook page) Adele is a vet who travels to treat animals in their own home, from what I've seen of her work it's to an excellent standard, I even enquired about her travelling down to me when I was having issues with a gerbil, she isnt hugely far from you if I remember right, may be worth a try for a second opinion if your vet is getting pushy.
I do find it helps to make it very clear that euthenasia isn't an option until its the only reasonable option, if that is your belief.

I hope you're able to find a way to fix the issue!

 

[Potatofriend]

Thank you for the recommendation! I have been considering this palliative care, given the vet has been thinking Theo will need to be pts since mid November. Sometimes in look at him and think how awful it is I won’t get to see him grown up, but then I think to just remember each day is a gift and to make it as good for him (and the other pets I have) as I can; other times I think well what if there is an antibiotic that can treat this? But the vet says he’s not comfortable prescribing antibiotics for so long (I forgot to ask him why again, but I can ask in 2 weeks after the arythromycin course.
I’ll check out the Facebook page and get in touch, see if she’s available. Thank you!
Theo has had his medicines and is now running round the room looking for cool stuff

 

[Potatofriend]

Just an update
Theo has been on the Azithromycin/Bisolvon/Sulfatrim/Metacam course for 3 days now - I’m not sure if he’s getting the Bisolvon or shaking it off the vegetables (plus the unit “a pinch” bothers me as a chemist This is not SI!) but the Azithromycin is definitely being administered, at a dose of 29.6mg/kg (0.37ml of 200mg/5ml) once a day.
His sniffly nose has cleared up an absolute treat which is fantastic! His tilt is difficult to gauge but I feel his balance is less good than when he was on the Baytril/Doxycycline/sulfatrim/metacam mix, but not terrible? He just jumped over a bowl perfectly which made me go yay Theo well done! He then went to drink some water and when he turned he lost his footing on his back legs and fell over (but only the back half, and he righted himself fast).
My hope is that the Azithromycin will fix everything and he’ll be ok at the next appointment on the 12th; my fear is that he’ll go downhill instead. So far I can’t really tell either way.
I’m assuming that the sniffles being fixed Is the Bisolvon, but it could be the Azithromycin as well.
It’s so unfortunate that there aren’t more effective medicines available for respiratory infections - given that “Guinea pig” is the literal nickname for any test subject, you’d think there’d be a massive list of antibiotics tested on them that were effective!
He’s been less inclined to cuddle and fall also on me and more inclined to wonder off- not sure if that means he has more energy or if he just really hates the new medicine and doesn’t want to risk being given more!

 

[Eriathwen]

I'm glad the discharge from his nose has cleared up! I would try to avoid gauging his recovery based on his tilt and balance, unfortunately sometimes the infection causes irreparable damage to the inner ear and the tilt and balance issues remain. That's not to say he can't still have a great quality of life with those issues however, I have 3 head tilt pigs, 1 due to E.cuniculi and 2 from neurological issues from being lethal whites, one of my lethals likes to raise his head so high sometimes he falls backwards! But they still very much enjoy life and are doing wonderful. It's just a case of altering the layout and contents of the cage to keep them from injuring themselves
But fingers firmly crossed by the 12th he has recovered well!

 

[Potatofriend]

This morning when I got Theo for his 6am medicine I found that he’d started having diarrhea overnight. I’ve spent the morning giving him critical care and his usual fibreplex. His poops are becoming firmer, and there’s no more leakage. He’s eating and drinking fine.
This is likely to be a side effect of the Azithromycin or the Bisolvon I think, so I gave him only a half dose this morning of azithromycin (along with the normal sulfatrim) as that is to combat what I cannot see, and skipped the Bisolvon as his sniffles have cleared up. I plan to not give him Azithromycin tomorrow, see how he is then.
I’ve sent a message to the small pets vets, just waiting on a reply for when they get back. I haven’t got in touch with my usual vet because I don’t think Theo needs euthanasia yet, as he’s eating, drinking, kicking Clyde out of the hay cube, etc, and don’t seem to be suffering.
As of now my intention is to continue with sulfatrim and see how he gets on; I don’t think putting him back on the Azithromycin is an option once it’s down to affect the digestion?
I guess now it’s just the hope that the Azithromycin provided the final push needed to clear the bulk of the infection and the sulfatrim can mop up what’s left.

 

[Potatofriend]

Theo is still with us, he hasn’t had diarrhoea since yesterday morning. I’ve given him some critical care to give him a boost, 3ml yesterday, 3ml today - he does seem to be eating hay though. He had no veggies yesterday but I’ve given him a tiny slice of lettuce (smaller than his head) to see if he’s eating and he managed it (normally I’d give a pea flake but he’s gone off those today).
He’s lost around 100g, so is down from 520 to 420 by my scales. I’m torn between thinking it’s nearly time for him go and hoping that if I can get him through this rough patch he’ll be ok- I’m sure you all know how it is. He’s had six weeks longer than the vet thought he’d have, and he’s had a lovely time, but oh I want more for him.
Here he is at 20:30 yesterday, leading Clyde in a Guinea train (note how he looks back for him before entering the tunnel, and again when leaving, before bravely leading him across the deserted wasteland that is the carpet on the way to the door)

 

[furryfriends (TEAS)]

Personally I’d keep him on the Zithromax and stop the sulfatrim. I’ve never given both together, but Zithromax is by far the better antibiotic for an inner ear infection.

 

[weepweeps]

I love a piggy train. . He looks quite perky there. You know Theo best and I’m sure you will do your best by him. Good luck. Sending healing vibes.

 

[Potatofriend]

Personally I’d keep him on the Zithromax and stop the sulfatrim. I’ve never given both together, but Zithromax is by far the better antibiotic for an inner ear infection.

The issue is that the Zithromax is, I believe, what caused the diarrhoea- he was on it for only 3 days before it happened, whereas he’s been on the sulfatrim for about 6 weeks now. I know that the Zithromax is his best hope, which is why his bad reaction to it has been so upsetting. I might try and give him a smaller dose once his weights back up, see if he handles it better? Does anyone have any feedback on that?

 

[furryfriends (TEAS)]

The issue is that the Zithromax is, I believe, what caused the diarrhoea- he was on it for only 3 days before it happened, whereas he’s been on the sulfatrim for about 6 weeks now. I know that the Zithromax is his best hope, which is why his bad reaction to it has been so upsetting. I might try and give him a smaller dose once his weights back up, see if he handles it better? Does anyone have any feedback on that?

I think giving both would be what caused the issue, not the Zithromax as such. I’ve never had a piggy with diarrhoea whilst taking Zithromax and have been using it for around 15 years.