Need advice on URI treatment

[Stanly]

Ok so a few weeks ago I noticed Max (my 6-7 month old male panther) opening his mouth from time to time. there was no noticable mucus, no excess saliva, no discharge from the nose and he didn't do it while sleeping (basicaly none of what I had heard are the classic symptoms of URI).
I would have thought it was from heat but sometimes it would be when he was at a cool spot and had not been basking for some time.

anyways since I didn't know what it was I decided to take him for a vet visit, I way only able to find one "exotics" vet around but they said they seen chameleons (I don't think they see many tho, based on the curiosity of the staff, and some questionable things the vet told me)

the vet seemed pretty good and sounded like she dealt with herps some, how ever a few things make me 2nd guess her judgement. first she wanted to put him on antibiotics befor taking any test because she said it MAYBE the start of a URI (which is kind of why I brought him in). but from reading the forums I thought a that sounded a bit rash, so I asked her if we could do a test first.
which she did (test results just came in today).
she also said I was keeping his temps to low (mid 70s ambient and about 85 basking) she was basing this on veiled chameleons, I tried to tell her panthers like it a bit cooler (maybe she has only dealt with veileds?)

one thing she did find was some slight discoloration along the gum line which maybe the start of mouth rot (no noticable swelling, and not visable with the mouth closed)

anyways test showed 2 type of bacteria. below is a copy of the results and her sugested treatment, I'm hoping some one who has dealt with URI in chameleons can chime in on if this sounds like a good course of action, also one of the meds is a injection (every 72 hours for 30 days, which would be 10 shots) she suggested the shots but said there is a oral it just isn't as effective. I'd like to avoid shots (for his and my sake) but if you all agree it's best I guess I will do them.

Comments:
Mr. Wilson,
Here are the culture results for Max. My first choice treatment plan would be to use Ceftazidime injections - 1 every 72 hours for at least 30 days (10 doses) along with Metronidazole for possible anaerobic bacteria - this would be orally once a day for at least 1 month. The 2nd option would be Ciprofloxacin - oral antibiotic every 48 hours for 1 month along with the Metronidzole.
If you want to do the Ceftazidime, please make an appointment for us to show you how to give the injections. If you just want oral medications, these would need to be compounded - my first choice of compounding pharmacies around here is Trivillian's.
Please call us if you need any more information.
Carey Cornett, DVM

IDEXX VetConnect
1-888-433-9987

Client: WILSON
Patient: MAX
Species: REPTILE
Breed: CHAMELEON

Date: 6/1/2011
Gender: MALE
Weight:
Age: 6M

Requisition #: 10743-1
Accession #: H3132040
Ordered by: CORNETT, DVM, CAREY

ANIMAL CARE ASSOCIATES
840 OAKWOOD ROAD
CHARLESTON, WV 25314
304-344-2244

Account #83162




AVIAN/REPTILE AEROBIC CULTURE

Test Result Reference Range Low Normal High

SOURCE: OROPHARYNGEAL
STATUS: FINAL
DIRECT GRAM STAIN 1
COMPLETED CULTURE RESULTS Klebsiella oxytoca - 4+Aeromonas hydrophila - 4+--Gram Stain results based on these criteria: Rare = <= 1 organism/HPF1+ = 2-5 organisms/HPF2+ = 6-10 organisms/HPF3+ = 11-20 organisms/HPF4+ = >20 organisms/HPF


Comments:


1.
2+ Gram-negative rods






SUSCEPTIBILITY

Test Result
ORGANISM Klebsiella oxytoca
4+

AMOXICILLIN Resistant ( ug/ml )
AMOX/CLAV ACID Sensitive ( <=2 ug/ml )
PIPERACILLIN Resistant ( ug/ml )
CEPHALEXIN Sensitive ( <=4 ug/ml )
CEFOVECIN Sensitive ( ug/ml )
CEFPODOXIME Sensitive ( <=0.25 ug/ml )
CEFOTAXIME Sensitive ( ug/ml )
CEFTAZIDIME Sensitive ( ug/ml )
CEFTIOFUR Sensitive ( <=1 ug/ml )
IMIPENEM Sensitive ( <=1 ug/ml )
AMIKACIN Sensitive ( <=2 ug/ml )
GENTAMICIN Sensitive ( <=1 ug/ml )
TOBRAMYCIN Sensitive ( <=1 ug/ml )
CIPROFLOXACIN Sensitive ( ug/ml )
ENROFLOXACIN Sensitive ( <=0.12 ug/ml )
MARBOFLOXACIN Sensitive ( <=0.5 ug/ml )
TETRACYCLINE Intermediate ( 8 ug/ml )
CHLORAMPHENICOL Sensitive ( <=2 ug/ml )
TRIMETHOPRIM-SULFA Sensitive ( <=20 ug/ml )


SUSCEPTIBILITY

Test Result
ORGANISM Aeromonas hydrophila
4+

AMOXICILLIN Resistant ( >=32 ug/ml )
CEFOVECIN Sensitive ( ug/ml )
CEFPODOXIME Sensitive ( 1 ug/ml )
CEFTIOFUR Sensitive ( <=1 ug/ml )
IMIPENEM Sensitive ( <=1 ug/ml )
AMIKACIN Sensitive ( <=2 ug/ml )
GENTAMICIN Sensitive ( <=1 ug/ml )
TOBRAMYCIN Sensitive ( <=1 ug/ml )
CIPROFLOXACIN Sensitive ( ug/ml )
ENROFLOXACIN Sensitive ( <=0.12 ug/ml )
MARBOFLOXACIN Sensitive ( <=0.5 ug/ml )
TETRACYCLINE Sensitive ( <=1 ug/ml )
CHLORAMPHENICOL Sensitive ( <=2 ug/ml )
TRIMETHOPRIM-SULFA Sensitive ( <=20 ug/ml )

sorry for the long read, I don't really under stand the test results but I know a lot of you do, if you can be of any help I would really appreciate it, do these seem like the right meds? should I go with injections (as suggested) or oral?

oh btw he still isn't showing any other symtoms and if anything is opening his mouth less (haven't seen him do this at all in the past few days)

 

[bridgofaith]

Here are a few links regarding RI:
https://www.chameleonforums.com/theres-no-such-thing-uri-14277/
https://www.chameleonforums.com/back-vet-medication-questions-39302/

Ceftazidime (Fortaz) is an excellent antibiotic for treating RI. Metronidazole (Flagyl) is commonly used to treat parasites. Flagyl will need to be kept refriderated and Fortaz should be kept in the freezer until ready to use. I think most vets will give you prefilled syringes. I see the infection is also susceptible to Enrofloxacin (Baytril) as well, which is the treatment that I have used and been successful in treating RI and it is oral. I also tried the Fortaz, but in my case it didn't work as well.

I would suggest increasing the temps a few degrees. Why? Because a reptile can not produce a fever to help fight the infection. Also what seems to help, and has helped me greatly, is adding a warm mist humidifier to the cage. The warm mist helps to thin any mucus and helps the animal expel it. I would also get the cham into the sun as much as possible. He may want to bask more and for longer periods of time. You may even see him sitting directly in the warm mist too.

 

[Psi]

I'm a supporter of Fortaz use.
It has few side effects then Baytril (I lost a Ball Python that had an RI due to Baytril).

Fortaz is going cost you more then Baytril I assume, but there's a better chance that he'll be cured from it.

 

[jessica]

I would go with Ceftazidime injections if it were my chameleon, its just worked better for me.

Once you learn how to give the injections and you've giving it a few times you get a routine down.

I wrap the chameleon in a towel and take them outside and sit with the wrapped chameleon on my lap to give the injection. After the I finish the injection I unwrap the towel and the cham is so distracted by being outside to even realize what I just did lol

I've also giving the Metronidazole at the same time without an issue. As mentioned it is commonly used for parasites but it also treat anaerobic bacteria.

Like when giving any medication hydration is key.

Just my 2 cents

EDIT: I just seen this post was yesterday so you've more then likely talked to the vet lol. Well here's my 2 cents anyways

 

[Stanly]

Thanks for the replies and good info. I take it fortaz can't be given orally? Man I really hate to do shots as I've never done it.

 

[Stanly]

I would go with Ceftazidime injections if it were my chameleon, its just worked better for me.

Once you learn how to give the injections and you've giving it a few times you get a routine down.

I wrap the chameleon in a towel and take them outside and sit with the wrapped chameleon on my lap to give the injection. After the I finish the injection I unwrap the towel and the cham is so distracted by being outside to even realize what I just did lol

I've also giving the Metronidazole at the same time without an issue. As mentioned it is commonly used for parasites but it also treat anaerobic bacteria.

Like when giving any medication hydration is key.

Just my 2 cents

EDIT: I just seen this post was yesterday so you've more then likely talked to the vet lol. Well here's my 2 cents anyways

I have talked to the vet but wanted to get y'alls input because I know y'all have experience with chameleons. Thanks

P.s. The towel ideal is a good one, if I go with shots I may do that.

 

[bridgofaith]

Thanks for the replies and good info. I take it fortaz can't be given orally? Man I really hate to do shots as I've never done it.

Fortaz needs to be injected, the absorption orally is poor and should not be given that way. Your vet will thoroughly go over the procedure with you on how to inject it properly. It may be difficult the first couple of times, but you will quickly figure out the easiest way to do it. Jessica's advice is excellent.

 

[kinyonga]

You need to go with antibiotics that the bacteria are sensitive to...so if you go with FORTAZ you need to pick one from the second list to kill the other bacteria...or you could chose one that they are both sensitive to like CIPROFLOXACIN, ENROFLOXACIN or TRIMETHOPRIM-SULFA.

Klebsiella is found normally in the gut in humans...so maybe that's true of chameleons too?...
http://www.wisegeek.com/what-is-klebsiella-oxytoca.htm

Aeromonas hydrophila is an opportunistic bacteria...
http://en.wikipedia.org/wiki/Aeromonas_hydrophila

 

[Stanly]

You need to go with antibiotics that the bacteria are sensitive to...so if you go with FORTAZ you need to pick one from the second list to kill the other bacteria...or you could chose one that they are both sensitive to like CIPROFLOXACIN, ENROFLOXACIN or TRIMETHOPRIM-SULFA.

Klebsiella is found normally in the gut in humans...so maybe that's true of chameleons too?...
http://www.wisegeek.com/what-is-klebsiella-oxytoca.htm

Aeromonas hydrophila is an opportunistic bacteria...
http://en.wikipedia.org/wiki/Aeromonas_hydrophila

Thanks for that info, I didn't even notice that only one was sensitive to Fortaz, perhaps the vet didn't either. Because when I spoke with her she said it would be a med that both were sensitive to.

Her 2nd choice was CIPROFLOXACIN, anyone have any experience with it? Or the other 2
Kinyonga mentioned?

 

[jessica]

Good catch Kinyonga! You should use one that takes care of both.

I have used Ciprofloxacin and it did the job without ill effect.

Like I mentioned before just keep him hydrated

 

[bridgofaith]

Cipro is a very good antibiotic, though I have not used it to treat any of my chams. Enrofloxacin is Baytril, which is widely used in treating chameleons for various infections. Sometimes too widely used. The other, Trimethoprim-Sulfa, I also do not have experience with.

 

[Stanly]

Thanks again you guys, and yes big thanks to kinyonga for catching that!

So cipro vs. enro ? Any reason to choose one over the other? If not I guess I'd go with cipro as the vet already suggested it .

 

[kinyonga]

Never used cipro (but that doesn't mean its not good) but enro has always done well when its been used. Cipro seems to be the one most often chosen these days over enro in my experience.

 

[ferretinmyshoes]

Ciprofloxacin and Enrofloxacin (baytril) are both fluoroquinolone antibiotics and have very similar spectrums. Cipro is the human version of enro basically. Cipro can be given IV, which is of benefit over enro in some cases, but for all intents and purposes here there's not many appreciable differences in the two drugs. Baytril is more commonly used in reptiles in my experience because it's the actual veterinary product but either should be fine in this case. Fun facts for the day.

 

[Stanly]

Thanks, going to go with cipro I guess since the vet suggested it?

 

[Stanly]

Got his meds today, one says "30 ml metronidazole 3mg/ml" (give 1 ml by mouth every 24 hours) the other says "30 ml ciprofloxin 1.5 mg/ml" (give 1 ml every 48 hours by mouth)
I asked the pharmacist about it being spelled ciprofloxin rather than ciprofloxacin and she assured me it was the same med and said someone had made a typo.

So does this seem to be the correct dosage/time? Sorry if I sound a bit paranoid but since the vet prescribed one med that wouldn't have been affective on one of the bacteria, and now someone made a typo (I know it can happen) I just want to be sure I don't O.D. my guy.

I also have a warm mist humidifier going at nights now, and adjusted is basking light to the upper 80s at the closest branch, thanks again for the help all.

OH one last question (for now) any tips or tricks for giving oral meds?

 

[kinyonga]

If you drip water on the chameleon's nose until it starts to drink, you can ease the meds into its mouth using a needleless syringe while its drinking. I bring the syringe up from below so its less likely to see it coming....if you know what I mean.

 

[Stanly]

If you drip water on the chameleon's nose until it starts to drink, you can ease the meds into its mouth using a needleless syringe while its drinking. I bring the syringe up from below so its less likely to see it coming....if you know what I mean.

Thanks, I'll give this a try. He's not really a avid drinker, at lest not by hand (managed to get him to drink from the hand mister once but I think it was just good timing). Most the time he just wants to climb on the spay bottle...

they did give two needless 1 ml syringes.

What about sneaking it in as he's chewing his food, or is that a bad ideal?

Maybe he'll drink from the sprayer (dipping), it would be nice especially while he's on meds so I know how much he's drinking.

Thanks a lot y'all have been a life saver!

 

[kinyonga]

You can sneak it in when he's eating too. You can also slide the end of the syringe in between the lip and the gum and ease it in there...but there's more risk of injuring the tissue if you do that.

 

[Stanly]

I've been super busy lately but I thought I'd update everyone, Max is almost done with the meds and showing no symptoms of RI (no more open mouth). The cipro did seem to effect his appetite, he went from eating about 6 large crickets a day to one or two most days (a few days he would seem to get his appetite back and eat five or six, then go back to 1-3).

Other than appetite he seem to be doing well, urates have been mostly white, perhaps some what less active but still alert.

Anyways just wanted to say thanks again for the great advice and info!
I hope not to need any such again for a long time but it's great knowing y'all are here when I (or others ) do.