Rabbit UTI Treatment and Antibiotic Issues

[bunmomof2]

Hi everyone, this is my first post here and it is regarding my almost 7 year old spayed-female rabbit named Bailey. Bailey is a megacolon rescue bun and twice daily she takes colon rescue, Cisapride, metoclopramide, and Meloxicam. She has been on these medications for About three years now. She is also bonded to, and has been for 6 years, to my 10 year old neutered male named Reggie. Unfortunately on 10/12/2024 she began to have blood in her urine. She was seen by the vet that same day and was sent home with Bactrim and a probiotic to take for 2 weeks. However, her symptoms began to worsen on 10/14 and she began dribbling urine, heavily straining, and going in small amounts frequently. She was seen at the same clinic on 10/15 where she was X-Rayed, had an ultrasound, and had her urine examined under a microscope to confirm the presence of blood and lots of bacteria. She was sent home with enrofloxacin and given fluids and her symptoms dissipated. By Friday morning (10/18) all symptoms were gone. I was of course continuing to give her the enrofloxacin and probiotics. However, on Sunday night (10/20) she began urinating blood again. I immediately contacted her vet and she advised to continue giving the enrofloxican and if this continues or symptoms worsen by Tuesday, she can have her antibiotics changed. Well Tuesday came and she was still occasionally urinating blood and had a few accidents/dribbles outside of the litterbox. Our vet prescribed her azithromycin which I was very worried about giving her. She had her first dose this morning (10/25) and began experiencing discomfort within an hour of taking it. She has been receiving critical care throughout the day with the dosage/amount her vet recommended based on her weight. Tonight she started to eat a bit on her own, pooped, urinated a few times, and appears to be more comfortable. After discussing with our vet, we will not be giving her the azithromycin again. I was just curious if anyone could give any advice om a different antibiotic or treatment that I can try that won’t upset her already sensitive stomach. Or if anyone has dealt with difficult to treat UTI. I can’t even figure how she contracted this as I clean her litterbox twice daily and her free-roaming room is always kept very clean. To make matters even worse, her and Reggie have been separated by an x-pen since 10/14 as Bailey was being very territorial and aggressive of their 2 litterboxes and one of their hidey houses. She actually got so upset that she scratched his eye and he needed to be treated with 2 different types of eye drops. I tried putting them together again on 10/19 but she was still protective over the litterboxes and was very demanding in wanting him to groom her. I feel bad having them separated but cannot risk them injuring each other and I can better monitor Bailey’s urine, droppings, and food intake. Any advice on the matter would be  much appreciated!

[LBJ10]

These things just happen when they get older. Their immune system weakens as they age, creating opportunity for infections to creep in. The same is true for people. So your bunny having a difficult to treat UTI at her age is not unusual, especially if she has other health problems.

Bactrim and enrofloxican are often go-to antibiotics that vets will try first. Keep in mind that sometimes bunnies have to stay on antibiotics for longer courses than other animals and there may be setbacks along the way. It looks like she wasn’t on the enrofloxican for a long time. Perhaps she just needed to take it for an extended period of time to make sure all the bacteria was gone.

Azithromycin is more for difficult to treat infections. I had a lot of luck with it in the past with stubborn URIs, but it didn’t seem to bother my bunny. He just REALLY hated the taste and there was no disguising it.

Depending on the type of bacteria, you could try something like Doxycycline. It is used for UTIs in people and is listed as safe to use in rabbits. There is no note about potentially reducing appetite. But you have to remember that any antibiotic can cause digestive upset, so sometimes it’s just a matter of finding the right one (that will also be effective against whatever bacteria is causing the infection).

Is your vet able to do a culture?

[bunmomof2]

Thank you so much for your reply. My vet is about an hour and half away from us and round trip, the buns are typically in the car for over 3 hours. She is the best and most experienced vet I have been to which is why I continue taking them there.  She just prescribed metronidazole to begin taking along with the enrofloxacin and I am picking it up from a compounding pharmacy tomorrow. She advised if this does not resolve the UTI then she we can do a culture. The only reason we have not does this yet is because the car rides really stress her out and if reducing and eliminating them as much as possible is an option, that is what we lean towards.

[LBJ10]

You can combine enrofloxacin and metronidazole. They work in different ways. Is the vet recommending taking the enrofloxacin for an extended period? It is safe to give for longer periods. Metronidazole, however, is only supposed to be given for a short period of time. I’m sorry the vet is so far away. My bunny freaks out going to the vet as well, but at least they aren’t too far (about 10 minutes or so). Hopefully this will take care of things and you won’t need to traumatize her any further.

[bunmomof2]

Hello all, I just wanted to follow up on my initial post. Unfortunately, Bailey’s UTI has returned yet again and she is currently on her third round of antibiotics. To make matters worse, she has been experiencing cecal dysbiosis on and off for the last 2.5 weeks even when she was off of antibiotics. She has been on a diet of hay and 1.5 T of Oxbow Adult Rabbit pellets for the last 11 days. Most days it’s a very subtle or doesn’t occur at all but there has been two incidents in which it was a very large amount. When she experienced the soft cecals, it occurs at the same time each day. To be clear she is still having “normal” droppings throughout the day and her appetite is unaffected. (I say “normal” as she is an MC bun and has been on GI motility drugs for the last 3 years so they are nothing like that of a regular bun.)She just began the third round of antibiotics this past Friday (12/27) after she began to have subtle streaks of blood in her urine yet again.  She was initially taking enrofloxican and metronidazole but because of a bout of cecal dysbiosis, she is now only taking metronidazole. Her dose is 0.28 ml twice daily for a 100mg suspension and she weighs 3.53 lbs. The bacteria strain she was tested for at the beginning of November is one in which could be treated with enro and metro. However, do you think I need to have the reevaluated? And do you think I should request a blood work panel?

Reggie and Bailey still have there room separated by a pen due to aggression and possessiveness towards different hides and their litterboxes. They were together for about two weeks but Bailey was controlling when he was allowed to eat and use the litterboxes. This worried me as he is almost 11 and I didn’t want him to loose any weight. During this time, he spent most days hiding and was very reclusive which led his arthritis to worsen from inactivity. Prior to dividing their room, they ended up getting into a fight in which they were chasing each other throughout their room and nipping. Which to me, was the final straw. They still see each other all day, groom each other through the pen, and have supervised free roam visits

These last few months have been challenging to say the least. I would greatly appreciate anyone’s opinions or advice on the above. Also, anyone have any recommendations or suggestions on treating her UTI for good and preventing/stopping the cecal dysbiosis? Not sure if this is even possible, but is anyone aware or heard of any treatments that do not involve antibiotics? If so, I can definitely discuss with my vet. At this point I am open to trying anything.

[LBJ10]

I’m sorry you’re still dealing with this. Did the vet check from crystals in her urine? Larger crystals can cause irritation and sometimes blood too. And you’re sure it’s blood?

As for the cecal problem, have you tried any probiotics or a bland (i.e., hay only) diet to try to get things back on track?

So this is another round of the same antibiotics? Well, just the one I guess. How long was she on the antibiotics before this and now? Sometimes, if something isn’t working, then it’s best to try something else. There are other antibiotics available… but with her microbiome being messed up, it’s hard to say what might be helpful and what might make things worse.

[bunmomof2]

Thank you so much for your response. Back when the UTI initially began in October, she was given Bactrim which she took for 3 days and her symptoms worsened and increased. So her vet switched her to Enro and we did x-rays and what I believe is called a urinalysis which my vet advised there were some crystals but that this was incredibly common. After 10 days on Enro she was still experiencing blood in her urine, frequent urination, inconsistency, and dribbling. My vet decided to switch to azithromycin which caused her severe Gi upset and took her a few days to recover from. My vet then decided add the metro to take with the enro which she did for an additional 12 days. About two weeks later, she began to urinate blood again (which I confirmed with a dip stick test) and started going more frequently. Her vet recommended to do a 14 day course of both antibiotics again. Then unfortunately on this past Friday I noticed the streaks of blood in 3 of her urine spots but all others were normal and have been since. She didn’t have any other symptoms besides that. She has been taking a probiotic with every single course of antibiotics. She has been experiencing some gi upset today with her megacolon and possibly the antibiotic usage so I decided to give her the probiotics and skip tonight’s dose hoping that will help. If it is just crystals, what would the symptoms be?

[bunmomof2]

Thank you so much for your response. Back when the UTI initially began in October, she was given Bactrim which she took for 3 days and her symptoms worsened and increased. So her vet switched her to Enro and we did x-rays and what I believe is called a urinalysis which my vet advised there were some crystals but that this was common. After 10 days on Enro she was still experiencing blood in her urine, frequent urination, inconsistency, and dribbling. My vet decided to add the metro to take with the enro which she did for an additional 12 days. About two weeks later, she began to urinate blood again (which I confirmed with a dip stick test) and started going more frequently. Her vet recommended to do a 14 day course of both antibiotics again. Then unfortunately on Friday I noticed the streaks of blood in 3 of her urine spots but all others were normal and have been since. She didn’t have any other symptoms besides that. She has been taking a probiotic with every single course of antibiotics. She has been experiencing some gi upset today with her megacolon so I decided to give her the probiotics and skip tonight’s dose hoping that will help. If it is just crystals, what would the symptoms be? Its so disheartening that this is continuously occurring. I spend hours (not exaggerating) a day on their care and keeping them clean only for this to happen 🙁

[LBJ10]

Both bladder stones (larger crystals) and sludge can cause blood in urine, dark colored urine, frequent urination due to irritation, dribbling, etc. Bladder stones can potentially lead to difficulty urinating if they get big enough (blockage). And sludge will have a paste or sand-like appearance. The symptoms vary and change as things progress.

Something else to keep in mind, infections can lead to bladder stones and/or sludge. This can be bacterial… but it can also be EC. And EC can cause other urinary symptoms depending on whether it’s attacking the bladder or kidneys.

And yes, crystals in the urine are common and normal in rabbits since they excrete calcium via their urine. So I don’t know what the vet saw, if it was normal or something more substantial. But if the antibiotics have having no effect then maybe it’s time to explore other possibilities. Has EC been discussed at all? We have have buns on here with EC and their only symptom was incontinence.

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