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Discussion on Sinus infection treatment

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Rose Mary
New Member
Username: rbiegger

Post Number: 1
Registered: 12-2008
Posted on Monday, Jan 5, 2009 - 10:44 am:   Edit PostPrint Post

I have a 9 year old gelding who was treated for Lyme during the first half of this year, oral doxy and intravenous oxytet.

At the end of Aug he had a very slight cough. Mid Sept he developed a runny nose. It was mostly milky white, a bit from both nostrils but mostly from the left. It started to get yellowish and I had the vet look at him. We talked about bacterial, infected teeth and gutteral pouch and decided to give him a course of tucoprim - 7-10 days. He responded quickly, after only 1 1/2 days the discharge was reduced. We finished the meds and he seemed fine.

In less than 3 weeks there was a recurrence. One morning the discharge started again, yellowish, from the OTHER nostril, and he had a fever of 104. The vet took xrays and culture. The diagnosis was sinusitis with a clear fluid line in the right cavity, left was clear. We gave him tribrissin paste for 6 days, changed to enrofloxacin paste after the culture results and continued for 11 days. He improved with the tribrissin, plateaued with the enrofloxacin and then got worse. About the last 6 days of the enrofloxacin the discharge was increasing and changing from milky white to yellow. We switched to sulfamethoxazole 800mg and trimethoprim 160mg tabs. Again there was an immediate and dramatic improvement. We gave him 12 tabs twice a day (he is about 900 lbs) till the discharge stopped (8 days) and then another 12 days (total of 20 days). We did xrays and his sinus cavity was totally clear.

During all of this time he had lost a lot of weight. He is normally and easy keeper and even though we increased his feed he wasn't gaining back. However, with the second course of antibiotics, he started to gain weight again and is now almost normal.

Unfortunately, after about 3 1/2 weeks, we did a ride of about 2 1/2 hours. In the middle of the ride he did a few coughs and snorted a number of times and the discharge was just beginning again, a milky white. 2 days later it seemed a bit worse and again the cough. We started him on the SMZ/TM again and also Metronidazole. After 1 1/2 days he got colicky. He never has had any colic type problems and nothing else changed in his routine, so I stopped the metronidazole. He quickly recovered and has been fine.

I think that we have not given him a long enough course of SMZ/TM and now the bacteria might even be becoming resistant. I would like to continue his current course for 30 to 45 days. Is that too long? Do you think it would be a good thing to do?

Right from the beginning of this treatment, the vet has told me it might come down to surgery - drilling into the sinus cavity, culture and flush with antibiotics. I really don't like the idea of doing the surgery and am trying as hard as I can to avoid it. I think it seems very invasive and always, something unexpected can happen, like his reaction to the metronidazole.

Do you recommend the surgery? Is it a big deal? What is the recuperation like? Could I do some of the flushing myself? Is it usually successful?

Has anyone had the surgery who could tell me about it?
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Robert N. Oglesby DVM
Moderator
Username: dro

Post Number: 22068
Registered: 1-1997
Posted on Tuesday, Jan 6, 2009 - 6:58 am:   Edit PostPrint Post

Welcome Rose Mary,
Since we discuss all of your questions in the article on Nasal Discharge I am assuming you have not read it carefully. I would start there as it has in depth details on your questions of diagnosis and treatment of a sinusitis. If after reading this you still have questions bring them here. To read more about the use of SMZ/TMP be sure to follow the link in the article to the antibiotic page where you can learn more about the safety of this drug.
DrO
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Rose Mary
New Member
Username: rbiegger

Post Number: 2
Registered: 12-2008
Posted on Tuesday, Jan 6, 2009 - 9:49 am:   Edit PostPrint Post

Hi Dr. O,
Thank you for your prompt reply. I went back over the articles and links that you recommended.

I read that you recommended 14-30 days of SMZ/TMP. Do you feel that 45 days would be OK since it is the third time? I am giving him Spirulina, a vitamin/mineral/antioxidant supplement, and hope that it would help prevent any anemia brought on by extended use of the antibiotics.

I could not find any reference to the surgery that is being recommended to me. Where should I look?

Thanks again,

Rose Mary
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Robert N. Oglesby DVM
Moderator
Username: dro

Post Number: 22072
Registered: 1-1997
Posted on Wednesday, Jan 7, 2009 - 9:17 am:   Edit PostPrint Post

Rose Mary, the specific prescription for antibiotic administration needs to come from your veterinarian, I cannot make such decisions without an examination. Note well: the supplement is not likely to be helpful and in fact may potentiate toxicity if it contains the vitamin precursor folic acid. This is explained in the article on TMP/SMZ referenced above.

The surgery is discussed in the article under the headings of "Further Diagnostic Tests" and "Treatment".
DrO
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