Clindamycin IM/SC

[Toni80]

I hope I`m in the right subforum...

So...does anybody know the right dosage for IM or SC application of clindamycin?
I went through a number of topics and couldn`t find a word about it AND I googled my ass off the last 3 days...
The only piece of information I could find is here on the ratguide: http://ratguide.com/meds/antimicrobial_agents/clindamycin.php

But 7.5mg/kg seems fairly low dosage, I`m worried about developing resistence.

A little background:
My beautiful Aria is a Eurasian squirrel (Sciurus vulgaris), she weighs 344g and she`s been diagnosed whitlow/felon which spread to surround tissue (tendons), joint and possibly even the bone!

A few days ago she stopped eating and drinking from all the pain. I took her to the vet, and they administered carprofen for 3 days (poor thing peed every 30 minutes from it and had mucus in her stool), now she`s on dexamethason for the last few days, and it seems to be working. She`s eating plenty and drinking fluids but the inflammation in her toe isn`t subsiding in spite of dex and a variety of antibiotics (she`s been on them for more than a month!).

First I dosed her with cefalexin PO 60mg/kg/day* 12 days
Then I gave her amoxicillin/clavulanic acid 100mg/kg/day*, PO, 10 days
And it didn`t make any difference!

Finally, I added clindamycin (45mg/kg/day, PO*) to the Clavamox but after 5 days, when it started to get really BETTER, she developed esophagitis!
Couldn`t eat any dry, solid food! She was eating only fruit and veggies for 2-3 days. Now she has recovered from esophageal injury but our vet was VERY reluctant to put her on clindamycin IM, and she`s been giving her enrofloxacin (Baytril) IM for 5 days, and except for the diarrhea it gave her, it wasn`t doing much else.
Yesterday, I managed to persuade her to continue the treatment with clindamycin IM but we are unsure of the dosage.
We started with 7.5mg/kg SID, and today, on my initiative, she dosed her with 15mg/kg and it seems that clindamycin really stings in this dosage!
Poor little thing looked like she was washed and blow-dried :eek I know that`s a sign of pain :sadness

Our vets are great and very gentle (two are treating her) and understanding but they are, like any other vet here, inexperienced with squirrels.

So can anybody help us, please?

P.S.
They are advocating amputation of the affected toe if the treatment shows to be unsuccessful in the next 4-5 days! :argue :(

*I dissolved the medicine in 20ml of water and put it in her water dispenser, and she would drink it over the course of 4-5 hours

P.P.S
Sorry for my english, I`m not a native speaker :grin2

[HRT4SQRLS]

Toni, I think we can help you. Unfortunately, I'm not able to address this thoroughly right now but will post in a few hours.

By the way, your English is beautiful. It's actually better than most native speakers. :rotfl

[Toni80]

Thank you so much!:hug

I forgot to mention that she is 5 years old and otherwise she was a healthy and a happy squirrel.
I`ll post some pictures in the introduction section of the forum when I manage to get a good one, she doesn`t care much for the camera :grin2

[HRT4SQRLS]

Hi Toni80

:Welcometo The Squirrel Board

I'm sorry to hear that your friend has an infection that's lingering on.
I think your treatments are on target but I do have some suggestions on delivery of the medication. I don't dose medications in the water at all. I don't feel it's a very accurate way of dosing and I'm also afraid to put anything in the water that would cause them to reject water. The Clindamycin is especially bad as it does have a horrible taste. I would be very surprised to see a squirrel drink from a water bottle that has Clindamycin in it. Your dosing is very high but I just can't see a squirrel drinking 20ml of tainted water. By the way, the 'blow dried hair look' is also a sign of dehydration so I would push the fluids.

I also am not one that will use injectable antibiotics. I know that veterinarians use injectables and that's fine but I don't have the experience with them to be recommending them or their use. I will say this, The Rat Guide is an excellent resource. We very often refer to it for information. I find it to be well researched and the information is an excellent resource for treating squirrels. I see their recommendation for the injectable is 7.5mg/kg q24hours. This was your original dosing. I would be very hesitant to double that dose of an injectable. I'm not sure about Clindamycin injectable but some injectable antibiotics cause tissue necrosis in rodents. Baytril injectable is one that can cause necrosis at the injection site. I personally won't use it as an injectable because of this.

Of the 4 antibiotics that you have used, I would say the first 3 are the best. In my opinion the Baytril is worthless for wound/abscess infections. We have had very good luck with Clavamox (20mg/kg BID) when used alone or in combination with Clindamycin for treating this type of wound. Clindamycin is an excellent antibiotic for bone involvement as it does penetrate bone. If you choose to continue the Clindamycin shots you should know in a few days if it's working. Personally I would switch to the oral dosing. If the infection is in the bone, longer dosing will be needed and I would not want to make a pin cushion out of her with daily shots. We have had squirrels that were on Clindamycin for several months without adverse reactions. I would give daily probiotics to help with any GI issues. We dose Clindamycin orally at 5mg/kg twice a day initially but if bone involvement is suspected the dosing is 10mg/kg twice a day. If you would like to try the oral Clindamycin, I can dose that for you. All I would need is the concentration of the pill/tablet, powder or oral suspension that you have. I have the other 2 needed values....the weight of your baby (344g) and the dosage I would start with 5mg/kg twice a day) The dosing is very specific based on weight, dosage and concentration of the antibiotic. It's much more accurate than dosing in a volume of water.

There are 2 potential problems with the treatment. Clindamycin has been developing increasing resistance and it does have a limited spectrum. This could cause treatment failure. Another issue is if the infection is caused by an MRSA. If that was the case, the organism would be resistant to the Cefalexin, Clavamox, Baytril and quite possibly even the Clindamycin. In that case, Sulfamethoxazole/Trimethoprim (SMZ-TMP) would be indicated.

Could you post a pic of the foot? It will give us an idea of what the wound looks like. One last thing, I would not discount amputating a toe if treatments have failed. I would sacrifice a toe to save the foot. A squirrel would bearly miss a single toe. I have a flying squirrel that is missing several toes on the front paws and you would never notice it. I would be very watchful because squirrels will self mutilate and she might chew the foot. If you need dosing help I will be glad to assist with that.

I would love to see a pic of Aria the Eurasian squirrel. They are awesome. :grin2

[Toni80]

5mg/kg, twice a day?
OMG I was really overmedicating her!:eek

I was guided by the ratguide dosage 7.5-25mg/kg, BID or TID and by this:
http://www.justanswer.com/veterinary/7na5u-squirrel.html
so I decided on her weight to give her 15mg in her water dispenser.

It does taste HORRIBLE! But I witheld the fruit and veggies until she would drink most of her medicine (of course sweetened and with a drop of banana flavour), and she would, poor thing :hug
I tried to dose her with a syringe but she REFUSES to open her mouth :facepalm
I tried to hide it in a ball made from her favourite cookie but it was, again, a no go.:tap

I have 300mg capsules, so based on your recomendation (for bone infection) that would be around 3.5mg twice a day? Do you have any other suggestion how to make her take it?
And what would be the recommended dosage for SMZ-TMP? Can I stack it with clindamycin? Is it horrible tasting too?
Here I found much greater recommended dose for squirrels than the ratguide:
http://www.irishwildlifematters.ie/animals/squirrel-drugs.html

:thankyou

I`ll try to post a video later, I think it would be better than a pic.

[HRT4SQRLS]

5mg/kg, twice a day?
OMG I was really overmedicating her!:eek

I was guided by the ratguide dosage 7.5-25mg/kg, BID or TID and by this:
http://www.justanswer.com/veterinary/7na5u-squirrel.html
so I decided on her weight to give her 15mg in her water dispenser.

It does taste HORRIBLE! But I witheld the fruit and veggies until she would drink most of her medicine (of course sweetened and with a drop of banana flavour), and she would, poor thing :hug
I tried to dose her with a syringe but she REFUSES to open her mouth :facepalm
I tried to hide it in a ball made from her favourite cookie but it was, again, a no go.:tap

I have 300mg capsules, so based on your recomendation (for bone infection) that would be around 3.5mg twice a day? Do you have any other suggestion how to make her take it?
And what would be the recommended dosage for SMZ-TMP? Can I stack it with clindamycin? Is it horrible tasting too?
Here I found much greater recommended dose for squirrels than the ratguide:
http://www.irishwildlifematters.ie/animals/squirrel-drugs.html

:thankyou

I`ll try to post a video later, I think it would be better than a pic.

My impression is that the way we dose antibiotics is very different than the way you're trying to do it. When I dose antibiotics the suspension is very concentrated therefore the volume needed for a single dose is VERY small. We are talking in the realm of drops from a syringe. I know squirrels really hate antibiotics especially the Clindamycin. If I have to I will wrap them in cloth like a burrito with the head sticking out. I slip the tip of the syringe in the corner of the mouth. I move it around until the mouth opens slightly and blast away. Because it's such a small volume, it's over in a flash. I INTENTIONALLY make the suspension concentrated so that the volume is small. I don't want to wrestle a squirrel to get a large volume of nasty tasting liquid into them. They hate that and so do I. You might even dip the tip of the syringe in honey or syrup AFTER you pull the antibiotic into the syringe. Aria will taste that and might open the mouth a little so that you can push the antibiotic in. They get smart to that pretty fast. :tilt

I will send dosing in a Private Message. We don't dose on the open board. The dosing is specific to your girl and we don't want someone coming along later and trying to adapt her dosing for someone else. Every situation is different. I will send dosing for the SMZ-TMP later. Because of her esophagitis in the past I would try this first.

I would encourage her to drink fluids and would definitely offer her juicy fruits for the additional hydration. You want her fully hydrated.

I know this is another subject but we need to talk about diet. It is the number one issue we see around here. CALCIUM is a HUGE issue for squirrels.

I will be off the board most of the day but others can sound in also. I'll check back with you later today. :)