Pseudomonas Infection Now Antibiotic Resistant

[jessg]

That sounds promising Raffiki but sorry you later lost him. The idea of drilling into his head freaked me out. I didnt want him going through all this pain with still no chance but if its still an option and there is a bit of hope its worth a try.

As disheartening as it has got and seeing him go through all this I am not giving up!! He is still that happy boy who is my best friend and while I know he is happy and not suffering I will keep fighting!!

Thanks everyone for your replies. I am going to try and get an appointment with the specialist tomorrow. If I can't get in he normally speak to me on the phone which is good. I will keep you posted!!

Fingers crossed!!

Edited September 22, 2013 by jessg

[raffikki]

The thought of the drilling really freaked me out too, but they were only really small holes, requiring 2 stitches in each, and he was back to is normal self in a few days :D

Good luck with the specialist! Please let us know how you get on :)

As an added bonus, you might be lucky like I was, and meet Raffikki and the lovely Electra. :D

:D

[jessg]

Well I spoke to the specialist today who made me feel a lot better. The plan has now changed and we are going to let him have some time off the antibiotics for the next 2 weeks to try and boost his immune system and get his cushings under control. He freaked when he heard he has pretty much been on antibiotics for the last 9 months trying different ones. The uni docs were trying him on new ones all the time and so was his normal vet.

We are then going to get his bloods checked (cushings) then reassess the best treatment for the infection if its under control. We still have one drug left and he reminded me there was another drug that they couldn't test for as they had run out in WA. So we are not out of options!

So for now I just need to do everything to get his immune system improving!!

[CrazyCresties]

Glad to hear you are a bit more positive after seeing the specialist, it sounds like a nasty condition

If you are still thinking about trying the honey then I have seen this brand in quite a few stores around Perth :)

http://www.elixirrawhoney.com.au/our-products/jarrah-honey

Where to buy.

http://www.elixirrawhoney.com.au/distributors/where-to-find-in-wa

All the best for your boy

[Alyosha]

If I was in your boat I would be trying a high dose of vitamin C while waiting to get into the specialist. Certainly can't hurt, and can give the immune system a good boost. I use Sodium Ascorbate or Ascorbic Acid. It is a powder and can be added to food - I would be using a dessertspoonful a day.

Edited September 23, 2013 by Alyosha

[westiemum]

Hi again jess,

Yep apologies - misread your first post. Good to hear you are in specialist hands. Hopefully they'll work it through for you. But at the same time, don't be afraid of surgery if it comes to that - its made a huge difference to my Mac, even though it was in a different spot.

Good luck and will be really interested to hear how you get on .

[jessg]

Hi guys well we have had a little rest from the antibiotics and tried to get the cushings a bit more under control. He has put on nearly 2kgs and has a lot more muscle back thank god!! His normal vet says his cushing levels are good and to start him on the antibiotic that its not resistant too, not to waste time (He didnt want me taking a break from the antibiotics in the first place).

I went to the specialist yesterday and he went through the blood results are said his cushing levels are still way too high(ACTH stim test - returned, pre-sample 190, post sample 420). He now wants to try him cephalxin (however you spell) even though its resistant because he said that it still will do something, bring the numbers down. Then try him on the amikacin. I thought that made sense and also gave his cushings a bit more time to get better.

Then I got an email from my normal vet disagreeing with the specialist saying by leaving it and using the cephalixin it could make the Pseudomonas and dont waste time!!

So I am so confused now!!

[Rappie]

I'm glad his condition is improving. It is difficult when your treating vets don't agree - in this case you've got two different approaches, not just two different opinions. The ACTH results are too high, they aren't 'good'. Cephalexin is a 'little gun' as far as antibiotics go, it's very useful and commonly prescribed and although it probably won't have any effect on the pseudomonas it will help to clear up any other infection, and it is also useful for treating osteomyelitis (which is likely to be present if you've got a middle ear infection and bony reaction in the bulla). As far as time - resistant pseudomonas infections take time to develop and in a case like this where you have limited options, then taking a little time to 'optimise' the situation while monitoring closely seems sensible, particularly if your next step is amikacin (a 'big gun').

[Wundahoo]

I'm glad his condition is improving. It is difficult when your treating vets don't agree - in this case you've got two different approaches, not just two different opinions. The ACTH results are too high, they aren't 'good'. Cephalexin is a 'little gun' as far as antibiotics go, it's very useful and commonly prescribed and although it probably won't have any effect on the pseudomonas it will help to clear up any other infection, and it is also useful for treating osteomyelitis (which is likely to be present if you've got a middle ear infection and bony reaction in the bulla). As far as time - resistant pseudomonas infections take time to develop and in a case like this where you have limited options, then taking a little time to 'optimise' the situation while monitoring closely seems sensible, particularly if your next step is amikacin (a 'big gun').

Rappie, this dog's infection is nasal, not ear, so bulla osteitis or osteomyelitis should not be be the problem.

I am aware that some specialists will say that there can be a clinical difference between in-vivo and in-vitro sensitivities. Sometimes they will play a hunch and work from expereince rather than from evidence based lab results. It's possible that although the bug may have returned a resistant result to cephalexin, it could still be clinically sensitive if the drug is given in a higher dose than usual.

I have had something similar happen with one of my rescue dogs who had an extremely severe case of multi-organism, multi-drug resistant infections on his skin, in his ears and finally in his shoulder joint.

On extended sensitivity we had only amikacin and rifampicin to work with.

I was in the same situation as jessg in that I had two differing specialist opinions..... one from the dermatologist and the other from the orthopaedist that was treating the septic joint. The specialist dermatologist played a hunch and even though the multiple organisms (including pseudomonas and staph pseudintermedius) were apparently resistant, we initially went with high dose clavulox to reduce the bacterial load prior to commencing amikacin followed by rifampicin. The high dose clavulox helped very much in clearing away much of the load and we saw quite a marked improvement even though the lab results said that this shouldnt happen.

The amikacin treatment needed to be closely monitored due to the effect on renal function and we were not lucky enough to get the hoped-for 6 weeks of therapy so we switched to rifampicin which is usually given in concert with another antibiotic..... but we had no other, so it was given alone and again with careful monitoring, this time for liver function. Again we didnt get the full course completed and had to stop because of rapidly rising liver enzymes but it was enough to have done the job it seems. He is now 2 years post treatment .... off all drugs and is healthy and sound.

I'm sure that we would not have been as successful if we had not initially gone with the high dose clavulox even though the lab results said that the infection was resistant to that drug.

[Rappie]

I'm glad his condition is improving. It is difficult when your treating vets don't agree - in this case you've got two different approaches, not just two different opinions. The ACTH results are too high, they aren't 'good'. Cephalexin is a 'little gun' as far as antibiotics go, it's very useful and commonly prescribed and although it probably won't have any effect on the pseudomonas it will help to clear up any other infection, and it is also useful for treating osteomyelitis (which is likely to be present if you've got a middle ear infection and bony reaction in the bulla). As far as time - resistant pseudomonas infections take time to develop and in a case like this where you have limited options, then taking a little time to 'optimise' the situation while monitoring closely seems sensible, particularly if your next step is amikacin (a 'big gun').

Rappie, this dog's infection is nasal, not ear, so bulla osteitis or osteomyelitis should not be be the problem.

Quite right - I didn't look at the original post closely, evidently I thought this case was the dog with chronic otitis with vestibular signs one that was posted around the same time originally. Apart from the anatomical location though the purpose of the broad spectrum antibiotics is the same, there is often bony destruction and a predisposition to secondary bacterial infections (including pseudomonas) associated with nasal aspergillosis. As with your experience, long term +/- high dose broad spectrum antibiotic treatment can be used to reduce bacterial load prior to treatment with other more specific antibiotics.

Edited October 12, 2013 by Rappie

[jessg]

thank you for your replies. Its so hard when you have different opinions and one is saying dont leave it get the amakcin cos we have no other options and then if that doesnt work we are out of options and the other one is giving more hope. I am just scared that I may choose the wrong thing and make things worse for him. He has been on the cephalixin for 3 days now and there is a fair bit of snot but the colour is changing. Not green anymore, more yellow. Not sure if thats a good or bad thing!

Rappie he did have some bone destruction from the fungal infection only a small amount though in his nose not near the brain. Can I ask as my normal vet said that letting the cephalxin work and destroy other bacteria is not a good thing as then the pseudomonas will take over and spread. Is that correct? We think the fungal infection has nearly gone (the last rhinoscope looked 10times better) so its just this damn pseudomonas.

Wundahoo when your dog got sick did they say what would happen if you were out of options? I think the specialist is hoping what happened with your dog will happen with mine. I know I am!! I am hoping for the best but really scared as we only have the one drug left!