Shorshe Ear Infection: Posatex? Ciprofloxacin?

[Shorshe’s Mum]

Hello all. Shorshe has a stubborn and recurring ear infection. Here is the lab for culture and sensitivity from ear swab. I had been cleaning with trisOtic solution and it was doing so much better recently: no more scratching, head shakes etc. But the exudate is increasing in quantity since yesterday and the scratching is back.

I have been recommended Posatex to be used for her ear infection. It contains steroids (mometasone fuorate 0.9 mg/ml) antibiotic (orbifloxacin 8.5mg/ml) and anti fungal (posaconazole 0.9mg/ml).
Shorshe also recently had very high liver values. She is on Samylin (small breed) and her last test was on 31 July with ALT 299 and AST 176

Of the three vets I consulted, two said it should be fine to use posatex for 7-10 days. A third one told me that Posatex or any antibiotic drop (for instance Ciprofloxacin ear drop without steroids) could potentially affect liver and I shouldn't use more than 3 days. Ciprofloxacin is known to cause acute hepatic injury in humans in rare cases.

I really want to address her ear infection as that might be contributing to increased BG, but not sure how to proceed.

 

[Diane Tyler's Mom GA]

Hello all. Shorshe has a stubborn and recurring ear infection. Here is the lab for culture and sensitivity from ear swab. I had been cleaning with trisOtic solution and it was doing so much better recently: no more scratching, head shakes etc. But the exudate is increasing in quantity since yesterday and the scratching is back.

I have been recommended Posatex to be used for her ear infection. It contains steroids (mometasone fuorate 0.9 mg/ml) antibiotic (orbifloxacin 8.5mg/ml) and anti fungal (posaconazole 0.9mg/ml).
Shorshe also recently had very high liver values. She is on Samylin (small breed) and her last test was on 31 July with ALT 299 and AST 176

Of the three vets I consulted, two said it should be fine to use posatex for 7-10 days. A third one told me that Posatex or any antibiotic drop (for instance Ciprofloxacin ear drop without steroids) could potentially affect liver and I shouldn't use more than 3 days. Ciprofloxacin is known to cause acute hepatic injury in humans in rare cases.

I really want to address her ear infection as that might be contributing to increased BG, but not sure how to proceed.

@Wendy&Neko
@Bandit's Mom

 

[Nimi S]

Hi again @Madhura/Maddie

I’d shared just the medicine details with you a few weeks back on WhatsApp but thought I’ll share some more details about my cat Shen’s ear infection, in case you want to explore something more/ different with Shorshe’s vet(s).

Shen had an ear infection in May - lots of scary-looking black gunk with some gooey discharge from one of his ears.

The first vet I took him to said that it was probably ear mites and to let the spot-on work for a few more days (had applied it a few days before the discharge started). She said not to try cleaning the ears as it was painful for him and that the discharge was blood from him having scratched his ears.
I wasn’t very comfortable with leaving his ears like that so I tried looking in deeper with a camera flash and it looked too bad to leave alone.
Got a second opinion from another vet who took an ear swab and said that it was a fungal + bacterial infection both. No ear mites.

He initially prescribed Pomisol ear drops but when I pointed out that it had a steroid ingredient in it, he prescribed 2 non-steroidal ear drops - 3 drops of each ear drop in each ear twice a day for 10 days.

These were the 2 ear drops (regular human ones)
Candid - Lidocaine (2% w/v)+ Clotrimazole (1% w/v)

Ciplox - Ciprofloxacin (0.3% w/v)

He advised to start cleaning the ears after the 5th day with Epiotic ear cleanser although I pretty much tried to clean daily, as much as Shen would allow.
Also got prescribed gabapentin for 5 days to help with the pain and discomfort.
The BG also came down a few days into the 10 day course (had gone up to 310 )

I did use Ciplox for 10 days but didn’t get another blood panel post treatment, so I don’t know if Shen’s liver values were adversely affected by the use.

Shen does have recurring black gunk which I always thought was ear mite poop to be treated with regular spot on - I checked with the vet about what it could be, if not ear mites. He said it could be ear polyps but those could only be detected with an otoscopy under anaesthesia and which can usually be removed surgically. Didn’t really explore this further since he got better with the ear drops and I continue to clear his ear gunk regularly.

I’d read that recurring ear infections may also be due to frequent ear cleaning that might disrupt natural ear flora and cause inflammation, causing infection. If not completely eliminated, ear infections caused by ear mites/ bacteria/ fungi might also keep recurring. Have heard of ear mite infections taking a couple of months to treat sometimes.

I couldn’t figure if you’ve started Shorshe on any of the ear drops. Posatex seems to have a more potent formulation than Pomisol - would be more effective against resistant bacterial/ fungal strains.

 

[Shorshe’s Mum]

Hi again @Madhura/Maddie

I’d shared just the medicine details with you a few weeks back on WhatsApp but thought I’ll share some more details about my cat Shen’s ear infection, in case you want to explore something more/ different with Shorshe’s vet(s).

Shen had an ear infection in May - lots of scary-looking black gunk with some gooey discharge from one of his ears.

The first vet I took him to said that it was probably ear mites and to let the spot-on work for a few more days (had applied it a few days before the discharge started). She said not to try cleaning the ears as it was painful for him and that the discharge was blood from him having scratched his ears.
I wasn’t very comfortable with leaving his ears like that so I tried looking in deeper with a camera flash and it looked too bad to leave alone.
Got a second opinion from another vet who took an ear swab and said that it was a fungal + bacterial infection both. No ear mites.

He initially prescribed Pomisol ear drops but when I pointed out that it had a steroid ingredient in it, he prescribed 2 non-steroidal ear drops - 3 drops of each ear drop in each ear twice a day for 10 days.

These were the 2 ear drops (regular human ones)
Candid - Lidocaine (2% w/v)+ Clotrimazole (1% w/v)

Ciplox - Ciprofloxacin (0.3% w/v)

He advised to start cleaning the ears after the 5th day with Epiotic ear cleanser although I pretty much tried to clean daily, as much as Shen would allow.
Also got prescribed gabapentin for 5 days to help with the pain and discomfort.
The BG also came down a few days into the 10 day course (had gone up to 310 )

I did use Ciplox for 10 days but didn’t get another blood panel post treatment, so I don’t know if Shen’s liver values were adversely affected by the use.

Shen does have recurring black gunk which I always thought was ear mite poop to be treated with regular spot on - I checked with the vet about what it could be, if not ear mites. He said it could be ear polyps but those could only be detected with an otoscopy under anaesthesia and which can usually be removed surgically. Didn’t really explore this further since he got better with the ear drops and I continue to clear his ear gunk regularly.

I’d read that recurring ear infections may also be due to frequent ear cleaning that might disrupt natural ear flora and cause inflammation, causing infection. If not completely eliminated, ear infections caused by ear mites/ bacteria/ fungi might also keep recurring. Have heard of ear mite infections taking a couple of months to treat sometimes.

I couldn’t figure if you’ve started Shorshe on any of the ear drops. Posatex seems to have a more potent formulation than Pomisol - would be more effective against resistant bacterial/ fungal strains.

Thanks so much for the details. I sent off for another liver test today morning. I want to try posatex because I have seen it work wonders for my other cat (lives with me in bangkok) who had extremely resistant streptococus ear infection. Also I have previosuly tried non antibiotic and non steroidal ear formulatiob (zymox otic) for shorshe and it didn't do much. I will probably try her on posatex for 3 days and repeat the liver test. If the values are more or less the same I will continue for the whole course.

thanks so much for talking me through this!