DRUG INFORMATION

[RamaMama]

JD Marx has a sinus infection of ... Enterobacter aerogenes. I think Rama may also have it...... but have not had the mucus in his sinus tested.

Looking for information and possible help dosing an antibiotic called...

Nitrofurantoin > > > which on JD"'s LAB Report for the Enter Aer is listed as CMI 64 Intermediate. That is not super but.....

The two other drugs that are listed as S - Sensitive are ONLY available within a hospital setting.
One is Amikacin, which I am sure many of you are familiar with.

I asked pharmacies, a Dr friend and a Surgeon I know.... nope. Can't get a script outside the Hospital.

Asked a Wildlife Rehab....... they have access BUT..... they will not sell any to me and if I brought JD Marx they would confiscate him and due to his
not being able to be released he would be put down.

I may have to do that anyway if I can't get him treated but at least I would know it would be done with gentleness and Love.

Thanks for ANY info about this drug.
RamaMama in Costa Rica

[SamtheSquirrel2018]

JD Marx has a sinus infection of ... Enterobacter aerogenes. I think Rama may also have it...... but have not had the mucus in his sinus tested.

Looking for information and possible help dosing an antibiotic called...

Nitrofurantoin > > > which on JD"'s LAB Report for the Enter Aer is listed as CMI 64 Intermediate. That is not super but.....

The two other drugs that are listed as S - Sensitive are ONLY available within a hospital setting.
One is Amikacin, which I am sure many of you are familiar with.

I asked pharmacies, a Dr friend and a Surgeon I know.... nope. Can't get a script outside the Hospital.

Asked a Wildlife Rehab....... they have access BUT..... they will not sell any to me and if I brought JD Marx they would confiscate him and due to his
not being able to be released he would be put down.

I may have to do that anyway if I can't get him treated but at least I would know it would be done with gentleness and Love.

Thanks for ANY info about this drug.
RamaMama in Costa Rica

Hi RamaMam:
Please look back at your Thread regarding Amikacin. ( https://thesquirrelboard.com/forums/showthread.php?69047-Need-Amikacin ). There were some important and very pertinent questions that were asked about your Squirrels' condition:

"Hello again RamaMama:
Thanks for posting the Culture & Sensitivity report! This still begs the questions asked earlier and now another: "Why were your Squirrels cultured? Are there signs of infection in both Squirrels and if so, what are you noticing and what area(s) of their bodies seem affected." The new question I have is how were the "sinus mucus" specimens obtained and was there enough mucus to determine if it really looked like mucus which is clear or if it appeared to be colored or look like pus (white)? What I am wondering is whether there is really an infection and in both Squirrels or whether the collecting swabs or whatever was used might be contaminated. If this is possible, using them can introduce potentially harmful bacteria to these Squirrels. Another possibility that may exist is that if this particular bacterium is present on your Squirrels, it may be what is called colonization and not infection. Colonization is where bacteria are present but they are not causing infection, illness or disease. In many cases of colonization, no treatment is necessary and further, with repeated exposures to antibiotics, there can develop some very resistant bacteria. It sounds as if this strain of K. aerogenes is very resistant to antibiotics.
Regards,
SamtheSquirrel"

In regard to Nitrofurantoin; this medication is used for treating lower urinary tract infections and is not used for treating infections elsewhere. Also, I do not know if there is any evidence that this medication has been safely and effectively administered to Squiirrels even for UTI's and hopefully for our general information, someone who has experience can comment on this.

Regards,
SamtheSquirrel

[RamaMama]

An infant nose suction syringe was used to obtain the mucus which was immediately expelled into a sealed specimen cup ..... the mucus is not clear various from white to yellowish.

JD has Odontoma...... he gets infections off and on which have always been treated.... this is the worst so far due to meds not being available
and infection getting worse.
No, he cannot have the odontoma removed.......... vets here in Costa Rica do not know nor treat squirrels.
He can't breathe through his mouth therefore when he tries to eat, he chokes and will end up choking to death
if I can't get meds to treat him.
He is lethargic and wants to stay in his sleeping sack all the time....... his eye is also being affected by the infection which also always happens
when infection flares up.

As far as Amikacin I have tried every avenue here to get it -- not gonna happen.

I was hoping someone had use the Nitro........ for a squirrel in the past and knew what it was.
What I read was that it is primarily used for UTI but is also used for other infections.
It is the only med available to me here which was listed on the Lab Report.

I can't let him choke to death.
That is the bottom line.

[CritterMom]

What DO you have, Rosie?

When Dr. E does odontoma surgery, she normally treats them after with clavamox (amoxicillin clavulanate).

I think that looking at what you can get your hands on and working from that list is going to be the only real option here.

[RamaMama]

Rama has similar symptoms..... I think he may have the same infection due to early on, they were sharing a "playroom".

I continue to try to get a specimen but so far, he snorts all the time, and the mucus pops out, so I have not been able to get
a viable sample He also has odontoma. Although Rama sometimes has blood in his white sinus mucus { the blood could be from infection
or the odontoma } he is not near as sick as JD Marx

[RamaMama]

Someone finally found information in a Veterinary Guide which states that " Nitrofurantoína " cannot be used in rats
which means "rodents" so I can't give it to Mr JD Marx anyway.

[RamaMama]

What DO you have, Rosie?

When Dr. E does odontoma surgery, she normally treats them after with clavamox (amoxicillin clavulanate).

I think that looking at what you can get your hands on and working from that list is going to be the only real option here.


JD Marx Lab Results show " Enterobacter aerogenes " in his sinus mucus.

Previously he was on Amox when he had a different infection....... it helped for a while then not. Shortly after that was when he began to
become worse, snorting, honking, choking, intense labored breathing. Sinus sounding FULL of liquid but can't get it out..... did another
lab test. That was when it showed he is supposed to have Enter..... aero........ Only drug on the lab result that squirrels can use that would be effective
is Amikacin. Amikacin is not available in CR.
I had hoped to have some shipped to a friend and have her mix it in with other items and MAYBE it would be missed by Customs.
I hope to have another lab test done to be sure the lab is CORRECT in the result.

Your thoughts ? ? ?

[CritterMom]

https://pubmed.ncbi.nlm.nih.gov/12226801/

Enterobacter spp. are intrinsically resistant to ampicillin, amoxicillin, amoxicillin-clavulanate, first-generation cephalosporins, and cefoxitin owing to the production of constitutive AmpC beta-lactamase. The derepression of this enzyme is increasingly frequent among clinical isolates and confers resistance to third-generation cephalosporins, and ureido- and carboxypenicillins; fourth-generation cephalosporins retain reasonable activity against depressed strains. Most isolates of Klebsiella spp. and Enterobacter spp. are susceptible to fluoroquinolones, trimethoprimsulfamethoxazole, aminoglycosides, and carbapenems. In some instances, treatment of severe infections caused by these microorganisms may benefit from the combination of beta-lactams (or fluoroquinolones) with aminoglycosides. Because of the high risk for developing resistance during treatment, all severe infections should be carefully watched during therapy.

Fluoroquinolones include baytril and cipro. The second one is SMZ-TMP. Have you tried either of those? I would do the cipro or baytril first given how effective it seems to be on respiratory infections.

[RamaMama]

https://pubmed.ncbi.nlm.nih.gov/12226801/

Enterobacter spp. are intrinsically resistant to ampicillin, amoxicillin, amoxicillin-clavulanate, first-generation cephalosporins, and cefoxitin owing to the production of constitutive AmpC beta-lactamase. The derepression of this enzyme is increasingly frequent among clinical isolates and confers resistance to third-generation cephalosporins, and ureido- and carboxypenicillins; fourth-generation cephalosporins retain reasonable activity against depressed strains. Most isolates of Klebsiella spp. and Enterobacter spp. are susceptible to fluoroquinolones, trimethoprimsulfamethoxazole, aminoglycosides, and carbapenems. In some instances, treatment of severe infections caused by these microorganisms may benefit from the combination of beta-lactams (or fluoroquinolones) with aminoglycosides. Because of the high risk for developing resistance during treatment, all severe infections should be carefully watched during therapy.

Fluoroquinolones include baytril and cipro. The second one is SMZ-TMP. Have you tried either of those? I would do the cipro or baytril first given how effective it seems to be on respiratory infections.

JD was very sick and had a Lab test done 10/18/22 - Diagnosis " Staphylococcus aureus" Lab results showed SMZ-TMP <=10 S
All others either were strictly IV in hospital or R. Cipro was included as R >=8

JD was dosed with the SMZ-TMP medium to low dose.... within 3 days showed some improvement then just as fast became very bad....
Medication was increased to med high to max dose for his weight.... improved for some days.... middle of November right back to same original symptoms but much
worse.

FIANLLY got another specimen....... Lab Report 12/09/22 showed the Enterobactor
Below is Lab Report

ANALISIS
Cultivo por bacterias Positivo
Tipo de Muestra: Secrecion Sinus

Organismo aislado: Enterobacter aerogenes

Enterobacter aerogenes
Antibiótico CMI Interpretación
Amikacina 4 S
Ceftazidime 32 R
Ciprofloxacina >=4 R
Ceftriaxone >=64 R
Cefazolina >=64 R
Ertapenem <=0.12 S
Cefepime >=32 R
Gentamicina >16 R
Meropenem <=0.25 S
Nitrofurantoína 64 I
Trimetropim/Sulfa >=320 R
R = Resistente S = Susceptible I = Intermedio
CMI = Concentración Mínima Inhibitoria (µg/ml)
Método de Identificación Bacteriana y Antibiograma: Vitek 2 Compact

QUESTION - JD had to stay in his cage and bag all day yesterday due to Stosh & I being out of town...... This morning I let JD go on the branches in the foyer to be sure he would potty.... he has been
breathing through his mouth all day as yesterday I did not give him any Benadryl as I was hoping to get more mucus to do a second "test".... Now his tummy is super big and he absolutely refuses to
come to me or Stosh. I have had his cage halfway out there hoping he will go into his bag so I can then treat him..... so far after two hrs of his cage being available, he refuses to do anything except
stare into space unless I go out there which then he moves away from me........ never had a squ with this much air in it's tummy....... could this be deadly? ? ? ? I am very worried but he simply will
not let me get close. I know he must be in pain.

[SamtheSquirrel2018]

QUESTION - JD had to stay in his cage and bag all day yesterday due to Stosh & I being out of town...... This morning I let JD go on the branches in the foyer to be sure he would potty.... he has been
breathing through his mouth all day as yesterday I did not give him any Benadryl as I was hoping to get more mucus to do a second "test".... Now his tummy is super big and he absolutely refuses to
come to me or Stosh. I have had his cage halfway out there hoping he will go into his bag so I can then treat him..... so far after two hrs of his cage being available, he refuses to do anything except
stare into space unless I go out there which then he moves away from me........ never had a squ with this much air in it's tummy....... could this be deadly? ? ? ? I am very worried but he simply will
not let me get close. I know he must be in pain.

Hello RamaMama: The air in JD's tummy is not in itself "deadly" BUT what is implied by this is extremely worrisome! Squirrels and rodents in general are what are called Obligate Nose Breathers. Human infants are also obligate nose breathers. This means that ordinarily, they never normally breath through their mouths and cannot simply switch over to mouth breathing or back and forth as adult humans can when their noses get stuffy or blocked. Yes, Squirrels will breath through their mouths if this is the only way for them to get air and they do not do this well and it is abnormal for a Squirrel to be breathing through his mouth. Most likely JD's distended abdomen is from what you suspect and that is air. In his attempts to breath through his mouth he is probably swallowing a lot of air because again, mouth breathing is not a natural way to breath for a Squirrel. Another complicating factor of the air being in the stomach is that this "swelling" of the abdomen make breathing all that more difficult because it interferes with full movement of the diaphragm and rib cage. It may be possible to gently push on his abdomen to hopefully expel some of the air from his stomach but you must be very careful as aspiration of any stomach contents into his his lungs could result. If you are going to attempt this, it must be done gently and JD must be held fully upright.

I know you suspect that he is in pain and I do to but I also believe he is suffering primarily from his breathing difficulties; both emotionally and physiologically as his normal breathing method (through his nose) is not functional or minimally functional. I am so sorry that there has been no opportunity for surgery to correct the odontoma or appropriate antibiotics available. If you have any antibiotics other than the SMZ-TMP (which has already be used and the Sensitivity reports indicates that the organism is resistant to it anyway) or the Nitrofurantoin; it may be worth trying that. Again, I wish JD well but I am very worried for him! I wish him and you peace! I'm sorry for his current situation and state of health.

Regards,
SamtheSquirrel

[TubeDriver]

Can you give him Gas-X? It should have no effect on his overall condition but does work to eliminate gas.


JD was very sick and had a Lab test done 10/18/22 - Diagnosis " Staphylococcus aureus" Lab results showed SMZ-TMP <=10 S
All others either were strictly IV in hospital or R. Cipro was included as R >=8

JD was dosed with the SMZ-TMP medium to low dose.... within 3 days showed some improvement then just as fast became very bad....
Medication was increased to med high to max dose for his weight.... improved for some days.... middle of November right back to same original symptoms but much
worse.

FIANLLY got another specimen....... Lab Report 12/09/22 showed the Enterobactor
Below is Lab Report

ANALISIS
Cultivo por bacterias Positivo
Tipo de Muestra: Secrecion Sinus

Organismo aislado: Enterobacter aerogenes

Enterobacter aerogenes
Antibiótico CMI Interpretación
Amikacina 4 S
Ceftazidime 32 R
Ciprofloxacina >=4 R
Ceftriaxone >=64 R
Cefazolina >=64 R
Ertapenem <=0.12 S
Cefepime >=32 R
Gentamicina >16 R
Meropenem <=0.25 S
Nitrofurantoína 64 I
Trimetropim/Sulfa >=320 R
R = Resistente S = Susceptible I = Intermedio
CMI = Concentración Mínima Inhibitoria (µg/ml)
Método de Identificación Bacteriana y Antibiograma: Vitek 2 Compact

QUESTION - JD had to stay in his cage and bag all day yesterday due to Stosh & I being out of town...... This morning I let JD go on the branches in the foyer to be sure he would potty.... he has been
breathing through his mouth all day as yesterday I did not give him any Benadryl as I was hoping to get more mucus to do a second "test".... Now his tummy is super big and he absolutely refuses to
come to me or Stosh. I have had his cage halfway out there hoping he will go into his bag so I can then treat him..... so far after two hrs of his cage being available, he refuses to do anything except
stare into space unless I go out there which then he moves away from me........ never had a squ with this much air in it's tummy....... could this be deadly? ? ? ? I am very worried but he simply will
not let me get close. I know he must be in pain.

[RamaMama]

Can you give him Gas-X? It should have no effect on his overall condition but does work to eliminate gas.

Hi TubeDriver
Thanks for coming on here.
I have been giving JD GasX off and on for many days. It just happened that today after I let him go on to the branches in the foyer he would not come to me
nor return to his cage on his own so he went all day without treatment. I tried to give him food and drink over and over and snacks, but he would just run away.

Once he did finally go into his cage and his sleepy sack I let him calm for a bit then gave him Benadryl and Gas X. About a 1/2 hr went by and I gave him
some food. He ate a little, not much but a little is better than nothing.... he did not choke nor gag or gasp. That was a little bit of happiness.

It is a HUGE bummer that I can't get the powdered Amikacin, I was going to have it mailed and at least try to get it past customs but can't
seem to find anyone who has it or is willing to sell some to me. Another bummer.
I have heard from several sources that the drug " Nitrofurantoin " which is listed as Intermediate on the Lab results, and IS available to me here in CR
is that rats should not be given this medication. Geeze. Tied Hands.

Contemplating what to do here.
thanks again
RamaMama