Posted 14 February 2008 - 07:38 PM
Apologies for the delay responding - I'm on hols and my Uk vet has also been away.
I hope Busta's ear problem has not worsened in the meantime and that the res. is still helping.
Here are the comments from my vet friend in the UK:
>>>
Your american friend has found her cause by the sounds. The pseudomonas is the worst one you can have.
Needs the sensitivities now. Some , but not all respond to baytril. But from my limited knowledge of the ones in here, you need a topical programe of treatment. Antibiotics help, but cannot be relied upon alone.
With the ones here, they are often too sore to clean out away and require a GA in the 1st instance.
1. GA and flush the ears with sterile saline only until no disch. May take 30 mins or so per ear to do properly. using a thin dog catheter to get to base of canal. No ear cleaners until can see ear drums a week or 2 down the line.
2 IMPT to make sure canal is as dry as possible - pseudomonas needs moisture.
3. Keep on oral prednisolone for the first week or so since the canal will be so sore.
4. Use approp antibiotic here - may be baytril ( I use the 5% injection. - get a 100ml bottle of epiotic ear cleaner. take out 20 ml cleaner. replace with 20 ml baytril. Use that mix to put only up to 2 ml twice daily down the ear. small volume so not wet, but right stuff) The ph of the epiotic inhibits pseudomonas and malassezia growth and the baytril prob kills it.
5. Do that daily and review around 10 days, when may need to GA the dog again for a thorough clean again if still sore.
6. at all times impt to keep ear as dry as poss.
7. If bug doesnt resp to baytril, then use tiamentin antibotic powder, mixed with water for injection. ( use if in people). Here put in 2 mls of that solution daily.
8. Reswab ideally at the 10 day stage for culture and microscopy.. So you know how you are doing.
9. baytril tabs can help, but far better diligence and ear cleaning.
10. You then tend to find that when you reculture, you have often wiped out the pseudomonas but got the malassezia yeast instead. A common temporary blip.
If thats so, the epiotic ph will still attend to this in the long run, but I add in sporonox antifungal tabs for 3 weeks then by mouth and that works well.
11. Once youy get your negative pseudomonas and your hopefully neg malassezia, you go on for a further 2 weeks with the same drops. But I tend to let the owner loose with another bottle of epiotic cleaner to use perhaps twice a week at home. Canuse large volumes but must be meticulous and dry at end of each session.
12. As the ear gets under control and repopulates with healthy bugs, we tend to finish the sporonox, get them off reducing preds and end up in the end on epiotic ear cleaner once or twice a week.
13. over the longer term you clean less and less.
A few things - occ they react to epiotic and the ear goes red. In which case change eg to clean aural.
Also make sure no underlying allergies or low thyroid etc.
I quite enjoy these ears, but they always take a bit of faith to persevere and a logical plan.
As to oral tribrissen , well not much of a fan. The staphs/streps in ears dont seem much of a problem. Just get rid of pseudomonas and malassezia!
>>>
Seems you may well have your work cut out to resolve the problem even over a lengthy period of treatment.
Good luck again (to Minni too!)