Orbax (orbifloxacin) for Snakes?

[PsychoSnake]

My vet prescribed this for my retic's secondary bacterial RI as her current Rx for Fortaz (worked great in the beginning!) is losing momentum. She keeps getting sick after stopping Fortaz despite great environment settings (the snake room feels like a jungle in SE Asia!). While she is still on Fortaz he wanted to try this oral medicine for typically cats and dogs. He's experienced with reptiles and has been very helpful. My question is has anyone had experience using it?

[Albert Clark]

Orbax is probably being prescribed bc the synergistic effect is greater than with only the fortaz alone. Depending on the c & s results may also weigh in the vet's decision. Just my two cents, keep the change. Fortaz is a great antibiotic with almost no adverse effects. Orbax is a flourquinolone whose actions are similar to Batril but has a different half life and may be indicated in targeting different organisms..

[PsychoSnake]

You're right! She hasn't responded 100% to Fortaz and since she's been on it for 6 weeks now the vet wanted to try another option. He wants to avoid Baytril cause the injections cause necrosis at the injection site and the oral route he said tastes disgusting. He said Orbax was a middle of the road approach as it wasn't so off putting that it would further stress the snake. So what he said to do was inject a mouse with it and feed it to her. So fat she has had two and is enjoying her "treats".

[MDT]

The big question though...was there a culture done and based on the sensitivity, what antibiotics is the isolated organism susceptible to?

Sounds like your vet is throwing stuff at the wall to see what sticks.

[PsychoSnake]

No culture done, because he doesn't want to put her under anesthesia and further stress her. If this round doesn't work (one week trial) then he'll probably go down that route. But cost is the other problem.

Anesthesia: $400
Sensitivity: ~$200

He's hoping an even broader spectrum of antibiotics should take care of it before getting expensive and invasive.

[Albert Clark]

Wow, that's understandable. I was told by my vet some time ago that the necrosis is really minimal and can be decreased even further by altering the injection site. Also that injectable medication is more effective than the oral route. I guess it's a trade off. Has to do with absorbtion rates too. You should bring it up with the vet. Hoping to see her back in form soon, good luck PS....

[Aaron_S]

The big question though...was there a culture done and based on the sensitivity, what antibiotics is the isolated organism susceptible to?

Sounds like your vet is throwing stuff at the wall to see what sticks.

The good doctor with the comment of the day!

No culture done, because he doesn't want to put her under anesthesia and further stress her. If this round doesn't work (one week trial) then he'll probably go down that route. But cost is the other problem.

Anesthesia: $400
Sensitivity: ~$200

He's hoping an even broader spectrum of antibiotics should take care of it before getting expensive and invasive.

To my knowledge, snakes aren't put under anesthesia for this type of culture. It's a tracheal wash I believe. It'll suck for sure as a tube and liquid goes down the throat but the snake isn't put under for it.

Your vet may not want to go down that route but without it you're just going to waste more and more money on antibiotics. Finally when/if this oral one doesn't work he'll want the $600 for this test and the meds on TOP of it afterwards...plus everything beforehand. Should have just started with the culture.

[MDT]

Aaron is correct, tracheal aspirate shouldn't need anesthesia, unless he/she was going to do a bronchial lavage(?).

Psychosnake, please take this the right way, I am not busting on you...but your snake (if I'm reading this right) is really no better off after slapping a bunch of antibiotics on it.

The problem is, you START with a broad spectrum antibiotic, then with the sensitivity, you may have to narrow it down to a more efficacious medication.

There is no such thing as a "middle of the road" approach, or a "synergistic effect", or even a "stronger antibiotic"... if you appropriately select the medication for the identified bacterium or bacteria (if more than one species identified), it will kill the bacteria. Fortaz and Orbax are used for different reasons. There is some overlap of a few bugs, but they are used for fairly different infections. As far as oral vs injectable, some antibiotics (Levaquin- a human cousin of Orbax- for example) is 100% bioavailable whether oral, IV, or injected. So route of administration doesn't matter. Some antibiotics, IV or IM administration is mission critical..but not across the board.

Now, you have an animal on antibiotics for six weeks. If you were on antibiotics for six weeks, you'd likely either have a hellacious yeast infection or be in the hospital with C. diff colitis.

You don't know if your snake has an untreated or partially treated bacterial infection (and just needs a better selected antibiotic) , a fungal pneumonia (which none of the meds you listed would even touch), a prolonged viral infection (which NOTHING will cure except time and chicken noodle soup) or if something physiologic is wrong (pulmonary edema, heart failure, etc)...

You vet may be a great guy/gal.. and obviously, I'm trying to equate human medicine to reptile medicine (there are some glaring differences, you know the whole one lung thing)...but overall, just make sure you ask informed questions,and get good answers for the best outcome for your snake (and your checkbook).

[PsychoSnake]

Thanks guys, I appreciate the feedback. Trust me I do ask questions! We've talked about putting her on probiotics once the antibiotics have been finished, which reminds me now he said we would have to wait a week off antibiotics to get a proper culture. I am going to ask for blood tests to rule some things out. She has already had xrays of her lungs and they looked okay. Her Dx right now is primary viral infection with secondary bacterial infection and mite infestation (a whole other story).

Meanwhile her setup is about as ideal as it can be with raised temperatures.

[MDT]

Great! Sounds like you're on it...best of luck, keep us updated!!

[Albert Clark]

There is no such thing as a "middle of the road" approach, or a "synergistic effect", or even a "stronger antibiotic"... if you appropriately select the medication for the identified bacterium or bacteria (if more than one species identified), it will kill the bacteria. Fortaz and Orbax are used for different reasons. There is some overlap of a few bugs, but they are used for fairly different infections. As far as oral vs injectable, some antibiotics (Levaquin- a human cousin of Orbax- for example) is 100% bioavailable whether oral, IV, or injected. So route of administration doesn't matter. Some antibiotics, IV or IM administration is mission critical..but not across the board.

@ MDT: Okay, Here we go. There typically is no " middle of the road " approach as you put it however there certainly is a "synergistic effect" as it relates to antibiotics whether you want to acknowledge it or not. I referenced c & s in my earlier comment. As well as the differences in Fortaz and Orbax. In the cases where a vet is trying to treat multiple organisms he or she can certainly go with a "synergistic" approach to treat effectively with more than one antibiotic. How dare you say there is no difference in absorbiton rates in oral vs. Injectable. That is a basic pharmacotherapeutic concept. But I see where you want this to go and I have said my piece. Have a happy New Year.. Oh, now you want to compare a "human" cousin of a medication to one that is used for animals?????? Really!

[PsychoSnake]

Guys let's be civil. I'm just collecting info to ensure the best quality of care for my baby. And we shouldn't fight about what's best as she is young and appears to have several problems going on. My vet is an exotics specialist and has an oncall snake specialist. He's not above asking other's opinions if I bring questions.

[MDT]

I'll tell you what Albert, when you go back to school, and either get your Pharm. D/MD/DO/DDS/DVM....or a PA/NP degree, you and I can have a coherent discussion about the mechanisms of antibiotics... until then, stay away from Google.

Treating multiple organisms with combination therapy is standard of care in several types of infection (I never said it wasn't), however, they each do their own thing. Fortaz is not "made better" by Orbax. They each stand alone to kill their respective organsims by different mechanisms (hence it's good to know what you're trying to kill).

As far as bioavailability goes, I very clearly stated "some antibiotics".. and yes, it's true, some drugs do have equal efficacy regardless the route of administration. Hey btw, Doctor Albert, Fortaz is a "human drug" being used on an animal in this case... so what?

Simmer down dude...

[MDT]

My vet is an exotics specialist and has an oncall snake specialist. He's not above asking other's opinions if I bring questions.

this is what you need... good to know.
Hang in there!

[Albert Clark]

When you become a DVM instead of MDT then you can review the concepts of Pharmacotherapeutics as they relate to absorption and modes of administration. I am already a NYC NYS certified Paramedic with a army education in nursing and emergency medicine You will be the last one to know when and if I decide to pursue additional degrees. Good night..

[MDT]

Oh, Albert, one thing is certain...your responses are predictable if nothing else.

Very truly yours,
Dr. MDT

[Aaron_S]

There is no such thing as a "middle of the road" approach, or a "synergistic effect", or even a "stronger antibiotic"... if you appropriately select the medication for the identified bacterium or bacteria (if more than one species identified), it will kill the bacteria. Fortaz and Orbax are used for different reasons. There is some overlap of a few bugs, but they are used for fairly different infections. As far as oral vs injectable, some antibiotics (Levaquin- a human cousin of Orbax- for example) is 100% bioavailable whether oral, IV, or injected. So route of administration doesn't matter. Some antibiotics, IV or IM administration is mission critical..but not across the board.

@ MDT: Okay, Here we go. There typically is no " middle of the road " approach as you put it however there certainly is a "synergistic effect" as it relates to antibiotics whether you want to acknowledge it or not. I referenced c & s in my earlier comment. As well as the differences in Fortaz and Orbax. In the cases where a vet is trying to treat multiple organisms he or she can certainly go with a "synergistic" approach to treat effectively with more than one antibiotic. How dare you say there is no difference in absorbiton rates in oral vs. Injectable. That is a basic pharmacotherapeutic concept. But I see where you want this to go and I have said my piece. Have a happy New Year.. Oh, now you want to compare a "human" cousin of a medication to one that is used for animals?????? Really!

I don't think you know the meaning of synergistic. It doesn't mean when using two things at the same time. It would be using two antibiotics at the same time and both work better together than alone.

this is what you need... good to know.
Hang in there!

This is true! Hope for the best!

[Andy_G]

Nohing like a retired paramedic telling a currently practicing doctor to stay within his scope of practice...yikes.

Step 1 is and should always be C&S and please insist that this be done, Psychosnake. Best of luck, sounds like you've got the right people in your corner.

[Albert Clark]

Retired Paramedic in the mecca of emergency medicine and practice. A city renowned for its F.D.N.Y. emergency medical service and hospitals and overall medical care. Not the type location that sees occasional "true emergencies " or just "mountain medicine" but the hallmark. That's for you 3 musketeers.

[MDT]

Ok...good to know... I was knew that my residency in emergency medicine and board certification, along with 20 years of practice wouldn't cut the mustard with the "true emergencies" you waded through. Glad you're here Albert... I'm gonna put you on my phone a friend list when I have a perplexing case and need a consult on appropriate antibiotic utilization.

[Aaron_S]

Alright I have to nip this in the butt here. The medical conversation was fine as it did have information pertinent to the topic but now we're off topic so all future posts need to be about the RI. No subtle jabs either... consider this the warning before the ban.

[Andy_G]

What Aaron said. Back on topic.

[Albert Clark]

I'll give you a 3 minute pass on the ban because you may not have seen my post. But this off topic banter is now done.

[PsychoSnake]

Alright I have to nip this in the butt here. The medical conversation was fine as it did have information pertinent to the topic but now we're off topic so all future posts need to be about the RI. No subtle jabs either... consider this the warning before the ban.
Thank you Aaron.

On the brighter side of things Mango (the sick snake) seems perkier after her 3rd dose of Orbax. She struck the mouse and lightly coiled it, an improvement on her lethargy/weakness! I will continue to monitor.

Other things when going to the vet's is he taught me how to check her mouth. Last visit (12/27) her mucous was down but the right vein on the roof of her mouth was still quite swollen. Overall inflammation was down after the Fortaz monotherapy.

I seem to remember him saying to try Orbax but continue Fortaz as a back up in case it's not effective and we don't go back to square one again. Fortaz did get rid of her worst RI symptoms and she is breathing well now. (The visit before the previous visit he had to pick her boogers cause her nostrils were so clogged she could only breathe through her trachea.)

[PsychoSnake]

Update: Mango is definitely feeling better! Activity is up and she is returning to her normal behaviors! I'm just afraid of what will happen post antibiotics.

[Tsubaki]

Im glad Mango is doing better! I'll wait for updates, hope she'll make a full recovery!

[MDT]

This is very good news PS.. Congrats!

[PsychoSnake]

So Mango's been on Orbax for five days and her appetite, activity, strength and curiousity is up. We talk to the vet again tomorrow. She has not completely returned to her previous behavior (escape artist, wanderlust, pushing the envelope), and she owes me poop from two weeks ago. Four rats just do not disappear and they should have come out when she shed last week, but alas no poop. None. Plenty of pee though.

She's definitely better with only very subtle symptoms, but I'm not sure if she's plateauing, she has psychological trauma from the 6 weeks of injections every other day, or if I'm fussing too much about it.

Her mites seem under control for the moment and has gone through two Frontline spray treatments (vet recommended, 1x per week plus immediate bath). Her environment has been bleached twice and Provent-a-Mited twice.

[dave himself]

Happy days :) glad to hear she's doing better

[PsychoSnake]

Update! Mango is doing well and is still on Fortaz and Orbax (second bottle).

Meanwhile my other retic Trevor has been off of antibiotics for more than a week and the same RI pattern that Mango has is emerging. Today he went to get a culture and sensitivity with anesthesia. (Turns out there was a huge miscommunication about the pricing.) The vet flat out refuses to not do a long tracheal wash without anesthesia due to possible complications.

The sample was sent out to the lab and the vet didn't find any evidence of mites or lung worms.

[MDT]

The vet flat out refuses to not do a long tracheal wash without anesthesia due to possible complications.


That part makes sense. Keep us posted!

[PsychoSnake]

Okay, kinda freaking out now since I got Trevor home. He hasn't really moved at all for hours and is almost unresponsive to touch. He's been resting in a very awkward position so I moved him to a more natural pose. He's stiff. He responds to me lifting the lid off his vivarium and that's about it. No ambition. Almost dead weight.

Is he still sedated?? He had his procedure done about 12 hours ago. I'm calling the vet in the morning. The vet told me he might gurgle or cough up some blood but not that he'd be a total zombie. Respirations seem depressed and he's not thermoregulating in his usual pattern.

[MDT]

How did he recover from the procedure before you brought him home? Was he moving then with good muscle tone? Or was he pretty flaccid then too?
If he only received inhaled anesthetic, those are offloaded pretty fast.

[PsychoSnake]

I don't know because I didn't pick him up, my dad did as I was still at work. The Vet said he was doing fine though. The vet used only preanasthetic either by IM or IV injection at his tail. He doesn't use use inhaled anesthetic since he once had a bearded dragon wakeup in the middle of a procedure (something to do with reptiles being able to hold their breath for a long time).

He is doing much better now. He's normally responsive now when I touch him. Respirations are normal. He's still out of it, doesn't want to be bothered and is pretty lazy but no where near as bad as last night. I was worried he was going to stop breathinh on me.

[PsychoSnake]

Update: Results are in! No culture could be produced. The vet is now assuming it's viral. Both retics are off all medications and will begin probiotics once a week to help regulate digestive flora. Also Mango finally pooped (and slithered through it)!

I just can't wait for winter to be over.

[MartinD]

Thats good news, here's to a speedy recovery