Mouth culture

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Mouth culture

Postby Rainycat » Tue Sep 18, 2012 6:05 am

so part of Mr Skinks mouth culture is back and there is aerobic bacteria present- :cry: gonna wait a few more days for the fungal results before vet decides what to administer, she is suggesting injections--- which I am hoping I'll be able to do, any advice or has anyone dealt with this before.. thanks
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Re: Mouth culture

Postby kl » Tue Sep 18, 2012 12:46 pm

Was the lizard showing any symptoms prior to the culture?

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Re: Mouth culture

Postby Rainycat » Tue Sep 18, 2012 1:53 pm

about a mo ago, he had a piece of substrate wedged like a splinter in the side of mouth, I pulled out w/tweezers.. and kept an eye on it,
he seemed okay and it didn't look bad / although substrate would stick occasionally, about a week ago it looked a little gooey so I took him to vet and she wanted to do mouth culture, of course now not eating like he used to, but she couldn't get his mouth open to get a look and when she swabbed him, there was a little blood, but I think that was from her trying to force him to open with a metal lite- there is no white patches or such on his gums (he occasionally opens his mouth wide after eating) his gums do look darker red around the rim, (kinda like stomatitis in a cat) I hand fed him some egg today, but not interested in his other food, she is waiting for the fungal portion of the culture to come back,before she prescribes injection: she did an Aer/Anaer/Fungal C & S culture
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Re: Mouth culture

Postby kl » Tue Sep 18, 2012 6:33 pm

Sounds like a classic case of mild stomatitis. Your vet sounds he is being very careful before offering treatment by having cultures done first. They can do sensitivity tests to determine what antibiotics will be best rather than start it on a broad spectrum antibiotic before they know for sure if that antibiotic will work against that particular problem.

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Re: Mouth culture

Postby Rainycat » Wed Sep 19, 2012 2:40 am

Hi Kim,

Thanks for your input, do you know how much longer sensitivity tests take? I took him to vet 9/8, & am anxious to tx but of course want to get it right first go around. She did give me hexedene flush (chlorhexidine with other stuff mixed in); bit have read this may damage tissue.

Lorraine
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Re: Mouth culture

Postby kl » Wed Sep 19, 2012 4:31 pm

My vet gave me a list of 4 choices to use of which I picked Hibiclens (mainly because the pharmacy did not have some of the others). It's main ingredient is 4% Chlorhexidine. I too wondered about it's safety because the warning labels say external use only. I read a few reptile sites about Stomatitis and many did say Chlorhexidine was one of the choices to treat it. They all stressed the need to dilute it before using it.

It's been a while since I had a vet do a sensitivity culture but I don't seem to remember it taking much longer than a week or so.

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Re: Mouth culture

Postby Rainycat » Sun Sep 23, 2012 8:56 am

So after not hearing from the vet I called and left message, On Satureday, she had me pick up meds (after she gave me misinformation) so I asked for a copy of culture results that came in last Tuesday, is says: mouth aerobic culture = acinetobacter - sensitve to ceftazidime baytril, so I am a little upset she didn't have me pick up meds on Tuesday, and how come she is not givine both ceftazidime & the baytril.. I need to find a new vet who knows what to do, and on the phone I asked about Silvedene and could she call it into my local pharmacy, she hesitated and then said she has it there, what she gave me was Baytril Otic (which from research on web .. it is okay to put on mouth) it is a liquid though. at least Mr Skink is now getting treated, but I could of started this 5 days ago, so I am hoping for improvement, in the meantime have to find a reputable reptile vet, just in case...and I wasn't even told to bring him back for a follow up.. going to clean his cage today and put him on paper towels.. I know he will bum out! I'll make him another hidey hut out of a box so he has another hiding retreat since he won't be able to burrow. in 2 wks his new tank will be here so I'm excited about that 4ft x 2ft.. hoping he makes a full recovery on the baytril,, does anyone think I should pursue the ceftazidime too or what to see if the baytril does the trick (I'm just hoping she gave me right dosage!!!)
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Re: Mouth culture

Postby El Lobo » Sun Sep 23, 2012 7:14 pm

I have seen this prescribing both ceftazidime and Baytril (active ingredient enrofloxacin) a few times now and don't understand why they are used concurrently as both are effective against gram+ and gram- bacteria. Maybe the vets are simply following the cascade protocol and using the animal approved Baytril and adding off licence abx because they think they are more effective. It just seems like double dosing.

Regarding dosage, this information is from a Reptile Formulary:

Ceftazidime (Fortaz). This human cephalosporin drug has proved to provide good broad spectrum activity in a variety of reptiles with the advantages that its half life is long and it kills Pseudomonas. Dose is 20 mg/kg IM or SC Q 72 hours

Enrofloxacin (Baytril). A quinolone compound that appears to be safe and effective in reptiles. May be used IM, SQ and PO at a dose of 5-10 mg/kg/day for 7-21 days. May be diluted with sterile saline since the concentrated form (2.27%) may be irritating.

Abbreviations are as follows:

PO = orally
IM = intramuscular
SQ or SC = subcutaneous
Q = every

To accurately calculate the dosage the strength of the abx needs to be known (particularly in the case of Baytril as it comes in a few different strengths) and the level of active ingredient, usually expressed as mgs/ml. The weight of the animal is also necessary to complete the calculation.

Hope this helps.
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Re: Mouth culture

Postby Rainycat » Mon Sep 24, 2012 7:12 am

El Lobo wrote:I have seen this prescribing both ceftazidime and Baytril (active ingredient enrofloxacin) a few times now and don't understand why they are used concurrently as both are effective against gram+ and gram- bacteria. Maybe the vets are simply following the cascade protocol and using the animal approved Baytril and adding off licence abx because they think they are more effective. It just seems like double dosing.

Regarding dosage, this information is from a Reptile Formulary:

Ceftazidime (Fortaz). This human cephalosporin drug has proved to provide good broad spectrum activity in a variety of reptiles with the advantages that its half life is long and it kills Pseudomonas. Dose is 20 mg/kg IM or SC Q 72 hours

Enrofloxacin (Baytril). A quinolone compound that appears to be safe and effective in reptiles. May be used IM, SQ and PO at a dose of 5-10 mg/kg/day for 7-21 days. May be diluted with sterile saline since the concentrated form (2.27%) may be irritating.

Abbreviations are as follows:

PO = orally
IM = intramuscular
SQ or SC = subcutaneous
Q = every

To accurately calculate the dosage the strength of the abx needs to be known (particularly in the case of Baytril as it comes in a few different strengths) and the level of active ingredient, usually expressed as mgs/ml. The weight of the animal is also necessary to complete the calculation.

Hope this helps.


Thanks El Lobo,

The bottles are not labeled... (weird) but the typed up label on the bag says 2.27%, I'm giving him .3cc every 12 hrs PO; he weighs 2 pds; supposed to give for 14 days. He has been pretty easy to dose so far & doesn't fuss (although some dribbles down his chin..), such a good boy. I must admit I really don't trust this vet and wish I could confirm somehow this is correct dosage, I am also smearing the baytril otic on the sides of mouth where it is sore. I am going to look into vets experienced in reptiles in Boston area (don't think we have any herpatologist close to me) in case he doesn't clear up and for any future visits. I think i put this vet off by telling her I was researching his condition on line and requested the silvadene; and by insisting some sort of tx. Just worried especially when he wouldn't eat. I did get him to eat small amount of scrambled egg and some Merrick dog food (hand feeding) on Saturday & I have seen him at his water bowl so I'm hoping he is drinking. again thanks for your input, he is my first bluey I rescued from a store and I have became so dearly attached to him (have had him since December) & couldn't imagine losing him.

Lorraine
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Re: Mouth culture

Postby El Lobo » Mon Sep 24, 2012 7:33 pm

The dose of PO Baytril seems to be about right.

This is how I have calculated. Note it is much easier to do calculations in metric:

Multiply Baytril 2.27% x 10 to convert from percentage to mg/ml = 22.7 mg/ml.
Bluey weighs 2 lbs = 0.908 Kg.
Recommended dose from formulary is 5-10mgs
Formula is dose x weight / concentration of drug.
Dose - 5mg/kg x weight .908 = 4.54 divided by concentration 22.7 mg/ml = 0.2mls
Dose of 10mg/ml would of course be 0.4mls. The higher dosage generally means increased due to resistant infection.

It seems the vet has taken the middle ground with a dose of 0.3mls.

Please check my method and calculations with another reference though. A simple mistake can be disastrous.

The culture identified acinetobacter.spp has several sub-species, did they identify which it could be?

Something that may be of interest regarding Baytril Otic, is it is a fluoroquinolone. There is some evidence to suggest acineobacter.spp is resistant to fluoroquinolone.

ETA. The dosage rate suggested by the formulary as well as anapsid.org is q 24 whereas he is currently being dosed q 12 as per vet's instruction, so getting 0.6 mls per 24 i.e. 1.5-3 times the dose as recommended by the sources I checked. Reptiles are usually dosed with much longer intervals between than mammals because of their far slower metabolism.
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Re: Mouth culture

Postby kl » Mon Sep 24, 2012 9:11 pm

Who is the vet you are using in New England area. I live in Massachusetts.

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Re: Mouth culture

Postby Rainycat » Tue Sep 25, 2012 5:48 am

kl wrote:Who is the vet you are using in New England area. I live in Massachusetts.

KL


Hi KL:

Thank you so much for the info, I wasn't sure how to do the calucations when I looked up this stuff (think I found it in the Merck Vet Manual on line).
your calculation looks correct, but now I'm worried he is getting too much at .6cc a day instead of .3-- I'll look up the baytril otic, I have read online that silver sulfadiazine helps with stomatitis which is what is in the baytril otic. Of course we are quessing this is mouth rot, this whole issue started when I pulled a spinter of substrate out of his mouth so I don't know if it is an infection from that or he already had something, there is no white splotches or curdy stuff when I look in his mouth (on the rare occasion he opens wide!) but I do see a small lining of darker pink around his gums.. I'm assuming this is not normal. (when my cat had stomatitis, that is what it looked like), I have the culture results at home I'll double check, I don't think it mentioned anything other than aerobic and acinetobacter; I am told the whole culture is not back, but I'm guessing I won't hear from the vet again. I took Mr. Skink to All Creatures in Salem, Dr. Elizabeth Bradt, She was very very good with my parrot.. but I wasn't impressed with the reptile care. I have found a vet at Angell Memorial trained in exotics- Dr. Simone Freilicher however I was hoping to find somewhere closer to home as it is a 40 min drive from me and she is only avail Mon-Friday; of course to consult with another vet even if I have questions about the meds will mean another visit, poor thing is already upset (on paper towels and is desparatly trying to burrow!!! he has managed to not only burrow under shredded towels but the whole towel on the bottom as well.) Oh and yesterday, I managed to get bit while medicating him... geeessshh that smarts, and I didn't think he was gonna let go at first! got me on the middle of the thumb nail and underneath, is still numb and sore, I was a little more careful today!!!! :P
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Re: Mouth culture

Postby El Lobo » Tue Sep 25, 2012 6:22 pm

I was going to link the Merck manual earlier but the dosage pop-up wasn't working.

It might be worthwhile contacting the vet about changing the frequency from Q 12 to Q 24 in light of 3 separate sources giving that advice.

I hope there is an improvement soon.
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Re: Mouth culture

Postby Rainycat » Wed Sep 26, 2012 5:31 am

Hi El Lobo,

Funny the vet called me before I had a chance to call her! (but she caught me off guard..)She asked how he was doing & I said the .6cc seemed an awful lot every 24 hrs (.3cc 2x day); she said she would double check,, did,, and then told me once a day dose of .3cc is okay- ( some does dribble out, so hopefully he hasn't gotten the .6cc full dose the past 2 days), but I forgot to ask her if it was 5mg or 10mg! When I told her his appetite was off, but I hand fed him a couple bites scrambled eggs & a bite or two of dog food, she read me the riot act about he should NEVER get dog food & egg is too much protein & he should just be eating just greens.... if she had read his medical record, she would of seen the diet I normally feed him. (which of course at the time was cat food mixed with greens, some fruit); she also told me that his environment needs to be about 70% humidity, she then proceeded to tell me that his fungal culture was negative but still waiting on the bacterial (well I have a copy of the the bacterial in my hand that I requested when I picked up the meds from the front desk).. I didn't even call her on it... was at work and didn't want to say stuff for the office to hear! she says she will f/u in a week... if my guy doesn't get better, I'll take him to Angell Memorial or the Odd Pet Vet in South Weymouth, a bit of a drive but worth getting the expertise, you all on the forum have been more help as well as my own research, which baffles me if I can find this info, you'd think she'd take the time to research Blue Tongues.. or read the formularly correctly. Mr. Skinks spirits are normal & I'm hoping the meds will start to kick in, thanks everyone for your comments and insight, very much appreciated!
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Re: Mouth culture

Postby kl » Thu Sep 27, 2012 5:50 pm

She said never feed it dog food? A vet here lashed out at me for feeding cooked, fresh meats from the deli rather than dog food. This vet worked at Franklin Park Zoo. You can now see why many of us, including me, are never quite sure what is best for our lizards. Personally, I've gone from almost never using canned animal foods to now using mostly canned foods. I never noticed any issues before both from health standpoints and in breeding success. Did I make the right move? I've still not sure. Anyway, I'm getting off topic.

If you are unsure of things such as doses, etc. call Dr. Stahl in Virginia once you have the bacteria culture results. He's considered about the best in the states. He does telephone consultations for a small fee. By the way, what is Baytril Optic and is it effective for the mouth issues. I've never heard of this form before.

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Re: Mouth culture

Postby El Lobo » Thu Sep 27, 2012 6:09 pm

One of the many things I like about the vet I see the most is that when he is writing a prescription he ALWAYS weighs the patient, goes to the on-line formulary with his calculator in hand and then reverses his calculations as a check. It doesn't instil a lot of confidence when the vet has checked and then agreed that our calculations were correct, not hers.

So long as he keeps eating enough and behaving normally his condition doesn't seem to be a high risk, but as always we would prefer to see them without any signs of illness/injury. I have no idea why the vet would make such dietary recommendations for an omnivore. I have found with mine that as they are now four years old they are more inclined to eat a better balance of vegetable and meat protein but there are still the times when they will pick out all the meat and only eat a small quantity of vegetable. I tend to take the view they know more about their needs than I am ever likely to and so long as they are not offered too much sugary fruit they seem to get the balance right over a few feeds.

I can understand the reluctance with Baytril; it does taste awful. I taste test any oral drugs our pets are prescribed to get a bit of an idea the likely response and I would have to say you wouldn't line up for Baytril. :)
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Re: Mouth culture

Postby El Lobo » Thu Sep 27, 2012 6:21 pm

kl wrote: If you are unsure of things such as doses, etc. call Dr. Stahl in Virginia once you have the bacteria culture results. He's considered about the best in the states. He does telephone consultations for a small fee. By the way, what is Baytril Optic and is it effective for the mouth issues. I've never heard of this form before.
KL


Baytril Otic is used as a topical treatment for ear infections, mostly in dogs. :?
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Re: Mouth culture

Postby Rainycat » Fri Sep 28, 2012 12:20 pm

Thanks all for your replies, feeding day today, we will see how he does, he was quite active yesterday up and about on his log, climbing up his leaves etc..so I am hoping that is a good sign, the inside corners of his mouth still look somewhat red and sore (could be from getting forced open by vet!!!) She has called me again to check on him, I think she realizes she messed up his dosage & his culture results, anyhoots, cant fret too much, and she said she'd checkin next week, If anything maybe her knowledge of this particular reptile will help her with future skinks! I asked for her to call in the silvadene originally & she said I could use the baytril otic (has 1%silver sulfazidine (sp?) in it.. ).. and yes it is for dog and cat ear infections and sores, etc.. somewhere on the internet I have seen others have used this so am hoping it will help too. Will keep you posted, he liked his acorn squash the other day, so off to the kitchen I go!
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Re: Mouth culture

Postby Rainycat » Fri Oct 05, 2012 5:39 pm

so it is the end of week 2 on Baytril.. really hard to tell if improvement, I really don't think so..I started once day .3cc... spill some so upped it t . 4- using the otic on mouth.. am hoping his shed in a couple of weeks will make me see a difference, as I can't open his mouth to look, I catch glimpses when he yawns,, doesn't look like what mouth rot is described. I got an extra week of baytril which will bring it to 3 wks, then I go away for a week.. so I am hoping to see some improvement, he is eating but have to hand feed (think he is just spoiled as I always have had to hand feed him some), just added sweet potato and acorn squash to his diet, which he does seem to like. I have been feeding him every other day, but I see some folks here do once week with adults,,, so I will lengthen out the time and maybe he will eat on his own. I am worried about not being here to care for him for a week, (hubby & daughter are though).. and his new cage is ready next sunday, and I was hoping to make his home a home (he is on paper towels now.. as the substrate was sticking to the corners of his mouth) don't know what more I can do other than wait, if the baytril doesn't work, can try a new vet (herpatologist) take paperwork and try the fortaz which the culture said it was sensitive too... I just don't know if I can do the injections... the oral meds are hard enough..

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