Pseudomonas ear infection - help!

[missbattenburg]

Battendog has been fighting an ear infection for the last couple of months. A swab test revealed it to be pseudomonas which I understand is a bugger to shift.

His ears have been flushed twice under sedation. He was on easotic drops every day and more recently this has been paired with a vinegar wash and marbocyl tablets. Whilst his ear looks much better than it did at the start, at today's check up the vet could still see infection in there and has swapped the easotic drops for aurizon ones.

It's just been going on so long for him and it's meaning he now has a full of fear reaction at the vet because of the frequent visits resulting in painful examinations (because the ear is sore). I am obviously keen we try and get him cured asap.

Anyone had experience with this type of infection with any suggestions on what else we could try? Please.

[fivedogstofeed]

Ddog2 has similar ( spaniel ears). Aurizon worked well as long as I kept going even after her ears seemed clear.
I now use colloidal silver as a preventative, which does seem to work as before this she'd had a year of recurring infections.
this is a good product specifically for ears, though I have also use a straightforward colloidal silver spray intended for human use.

[missbattenburg]

Thanks very much five. Good to know the aurizon is effective and - perhaps more - so, good to know what can be used as a preventative after the infection is gone.

How often do you use the colloidal silver?

[LuckyKitty13]

Hi, I'm a vet, these are a nightmare. Some never get better unfortunately. And say some vets are clueless. You need an aggressive approach. They are usually allergic based at the route of it all, or inappropriate use of antibiotics has led to a massive resistance issue. Our approach is the following:

• steroids! These are a must. High oral dose from the start. Twice daily. This will be remove the massive inflammation and most of the pain.
• aurizon usually, but MUST be based on a swab choice (massive antibiotic resistance issues otherwise)
• triz chlor or some other chlorhexadine based ear cleaner (low % chlorhex to avoid toxicity) 3x daily.
• flamazine ear wash (9 parts water to 1 part flamazine) , it's a burn cream but actively kills pseudomonas. 1-2 x daily.
• swab every 10-14 d to check you're. winning.

Additional pain killers if dog is still in pain, as it very painful

More than one ear flush under sedation is not needed.

Remember it lives in the discharge so ths ear must be as clean as possible.
If it's all failing then radical surgery (a TECA) to remove the ear is the only other option.

[LuckyKitty13]

And dont stop anything until the swab results are clear!!!!

[LuckyKitty13]

Sorry I did write in bullet points but they have gone! Pleass ask if it doesn't make sense!

[missbattenburg]

It makes perfect sense thanks very much luckykitty.

He had some steroid injections when the inflammation was at it's worse. Plus pain killers.

Right now his ear looks good - from the outside. A nice pale pink colour, no sign of swelling and no discharge. It shows no sign of irritating him and in the last few days has started to ask for ear rubs again.

However, I am concerned that if we don't get this licked properly ASAP then we risk developing a resistance to the anti-bs we are using. Your post has lots of helpful things I can talk to my vet about. Thank you.

It started with a piece of foliage (grass?) in his ear. That was removed under sedation but when his ear didn't clean up the vet did it again and found some more of the same stuff. He shows no other signs of allergies.

Is there anything special we should be doing with the other two dogs in the house and infection control? They are JRTs so have smaller open ears so presumably lower risk?

[mrsjoyfulprizeforraffiawork]

Goodness, good luck Miss Battenburg! It really is awful to shift. My previous dog had recurrent vaginal weepy sores that (at my suggestion after ordinary antibiotics weren't working on latest bout), a swab was done on and grew Pseudomonas. At that time (2016) there was only ONE oral antibiotic available that worked on that kind of pseudomonas infection(and vet and I did not think she would tolerate a lot of injections). It did work initially, but she developed lots of other problems to do with her age. I think an ear infection with Pseudomonas would be a less complicated issue than we had.

[LuckyKitty13]

Very unusual for such a serious infection to develop after a foreign body. I wonder if the associated bacteria was resistant to the initial antibiotic treatment.

Just normal handwashing and try to stop the other dog licking his ears. Take care if anyone at home is immunocompromised as it is quite dangerous for them.

Whens your next visit? Will you update us - I'd love to hear how he does 😁

[LuckyKitty13]

Sorry meant to say, the oral antibiotics are likely doing nothing (I dont use them!) As they have really poor uptake in the ear. Your vet needs to focus on the ear meds (and oral steroids). One dose of aurizon once a day isn't enough.

[missbattenburg]

I wonder if the associated bacteria was resistant to the initial antibiotic treatment.

This could well be the case - two other anti-b's were tried first before the swab was taken to narrow down what the infection was.

We have two people here without spleens so very interesting re the immunocompromised...

Our next check up is in a week - so next Wed. In between we are washing with the vinegar solution and using the aurizon solution plus the oral marbocyl.

I have some trizchlor and can get more so can add that to the routine. I just want to get this bloody infection gone.

p.s. @mrsjoyfulprizeforraffiawork that sounds like an absolutel nightmare. I am suddenly glad battendog is a boy...

[LuckyKitty13]

Happy to private message you links to veterinary articles to back up my methods, if your vet isn't happy with the discussion

[missbattenburg]

Sorry meant to say, the oral antibiotics are likely doing nothing (I dont use them!) As they have really poor uptake in the ear. Your vet needs to focus on the ear meds (and oral steroids). One dose of aurizon once a day isn't enough.

Ah - that's really frustrating! At least I have another (good) viewpoint though that I can push them on. TBH there have been a couple of things lately that have made me question the vet I use and I wonder if I should start looking for someone else.

[missbattenburg]

Yes please to the backup articles. That would be super useful!

[BiteyShark]

TBH there have been a couple of things lately that have made me question the vet I use and I wonder if I should start looking for someone else.

Sorry to hear about BattenDog .

Is your vets a practice? I go to different vets at mine depending on the problem as they all have their 'areas' that they are better in.

[LuckyKitty13]

That is shocking that 2 antibiotics were used before a swab!! Really bad practice. I'd be going elsewhere I'm afraid. I'll look them up and PM you

[missbattenburg]

Thanks Bitey - bloody spaniel ears, eh?

It is a practice and they've not been terrible and have some good points, such as genuinely warm staff that appear to care a great deal about the animals in front of them. That goes a long way. They did some lip surgery for him that seemed really well done.

But he had a reaction after taking Bravecto recently. I called up and they basically said they would see him if I insisted but it did sound like a reaction to Bravecto and since it was already in his system there was nothing they could really do. I took that on trust and he did slowly get over it. They said a note would be put on his file but when the manufacturer called them, there were no notes.

Wth this ear I took him twice and each time they gave him more generic anti-bs. When I went the 2nd time the vet said to come back in 7 days or sooner if I thought it was getting worse/not getting better. I called after 5 days and was basically told the same thing by the nurse: that there wasn't anything more they could really do as he was already on anti-b and painkillers and I should just wait until the 7 days were up. Then, when I went in there was new things the vet suggested so I got frustrated that I was told there was nothing more when clearly there was. Luckykitty has also just suggested even more things we could try. It made me doubt what I'd been told with the Bravecto.

The thing is, whether they are right or wrong, if I don't 100% trust them then it's not much cop, is it?

Building up a network of vets might be the answer.

[LuckyKitty13]

Agree - trust is everything! I'm trying not to frighten you, but you can really mess up an ear like this if the vets not careful. You need another swab doing on Wednesday (to be sent away for culture and sensitivity) to see where you are. He needs a treatment overhaul - new meds and a very clear plan.

If you're calling round other vets to get a feel, ask if any have an interest in dermatology. (I do! And behaviour too - an interesting mix). Ears come under dermatology.

[missbattenburg]

That is shocking that 2 antibiotics were used before a swab

Worse than that - one was used at a lower strength and then upped after a few days in which it didn't work. I am no medical expert by a long shot but questioned at the time because that seemed like the perfect way to encourage a resistence in a bacteria.

Not totally sure it works like that but it was just another thing that made me

[BiteyShark]

Yes you definitely need to have a good relationship and trust so sounds like it might be time for you to move.

The other thing to ask before moving to a new practice is a specialist referral as I know when we have been referred the large vet hospital near us had a variety of specialisms including dermatology.

[missbattenburg]

luckykitty I am really sorry to keep asking you questions, but in your opinion would it now be worth seeing someone like these ear and skin specialists who are near enough for me to get to:

leicesterskinvet.co.uk/

[LuckyKitty13]

Yes that would be an excellent place to go to. I would probably be going there rather than continuing at your vets. Its gone on way too long.

And yes, that is also poor practice and a good way to cause resistance!

[missbattenburg]

Thanks both - you've convinced me to give this new place a call tomorrrow.

[LuckyKitty13]

How did it go today?

[mrsjoyfulprizeforraffiawork]

That is interesting about vet trying 2 antibiotics before swab - same problem I had with our vets. They just kept giving me the antibiotic that worked on the first infection (about 18 months before) for my dog's vaginal sores and I was so desperate when it wasn't working on the (several infections later) current infection that, as I work in the health service, imagined what we'd do if it was a human and asked them about doing vaginal swab ("Oh, yes, we can do that if you like" ). It does make you rather lack confidence in them that you have to nudge them into the right direction.

[BiteyShark]

I do have some sympathy with vets as you have lots of people that automatically think they are trying to extract money whenever they suggest diagnostic tests or not the cheapest option as evidenced on MN (very rarely the doghouse as usually it's on the general threads about vets being 'money grabbers').

However, I expect the vets to get to know you as mine know I want the scientific backed type answers I am not phased by the cost so the cheapest answer isn't what I want to hear if that isn't the best medically.

Given that most of us on the doghouse are fairly clued up with dog care in general I do think if your vet doesn't give you all the options and discuss all the possibilities then it's time to look elsewhere.