Antibiotic-Induced Colitis - Send Jingles as the Saga Continues

[PrinceSheik325]

Has anyone dealt with a case of antibiotic-induced colitis that resulted in secondary complications, which then required additional antibiotic treatment? If so, did your horse have a second reaction? Which antibiotics did you use?

I ask because I’m going through this right now. My horse developed antibiotic-induced colitis as a result of taking oral minocycline. Horrible diarrhea, extremely high heart rate (90 bpm), fever, anorexia, depression. Though it was awful, she made it through the endotoxemia stage after fluids, plasma, and treatment with polymyxin B, gentamicin, and metronidazole among other supportive measures. No reactions to those antibiotics. Her fever went down, her poop returned to normal, and she seemed to be on the mend, and then she developed rhinitis from all the gastric tubing and mild to moderate pneumonia. Of course, she needed another antibiotic to treat the pneumonia. After culturing, we decided on chloramphenicol as the best option. She did well for several days, and then demonstrated loose manure again (not pipe-stream, but wetter than cow patty). No other reactions to the chloro. Interestingly, with the minocylcine, once her diarrhea started, she was also anorexic and depressed. With the chloro, she never got to that point. Though we weren’t sure whether this reaction was to the chloro or to misoprostal, which she had just started the day before due to confirmed ulcers, we immediately stopped the chloro, and decided to instead treat the rhinitis and pneumonia via nebulizer with non-systemic doses of amikacin and ceftiofur. Her poop is now back to cow patty state. While her lungs are improving, her fever is back. Yesterday, the vet confirmed two jugular thromboses, likely caused by the endotoxemia, which she said actually was somewhat of a relief because these are likely causing the fever given that the pneumonia appears so improved. So, now we are faced with putting her back on the chloro to treat the thromboses and hoping she doesn’t have another reaction.

This has been a long, terrible journey, and unfortunately, there’s not much literature out there analyzing the likelihood of horses to have reactions to multiple antibiotics. I would love to hear any experiences you may have had dealing with antibiotic-induced colitis and administering antibiotics in the horse who previously had a reaction. Thanks in advance!!

[Feathered_Feet]

Oh man, I’m so sorry you’re dealing with this. I don’t have answers to your direct question to add unfortunately, as when my horse had colitis (source unknown) it was relatively mild.

However, I do think her colitis contributed to a long-term general GI malaise that resulted in somewhat loose manure for the better part of a year before I finally “fixed” it using 1) the Succeed Challenge, and 2) a grazing muzzle to limit grass intake (we have really rich grass where I am in the mid-Atlantic). With all the antibiotics you horse has been on, I’d be quite generous with the best gut supplement I could find. In my experience, the one I see most vets (including university researchers) recommend is Assure Guard Gold. Even if you can’t afford it long term, I wouldn’t hesitate to try it for a few months. Personally, I’d probably use a multi-pronged approach with several GI/pre-/probiotic supplements to get your horse’s microbiome back on track. Sounds like there’s been a lot of trauma.

[PrinceSheik325]

Thanks for your reply. It’s definitely helpful to know that your horse had somewhat loose manure for a while afterwards.

Unfortunately, this isn’t my first rodeo with colitis. My old horse had it, too, but it was relatively mild and the source was unknown. Antibiotic-induced colitis has definitely seemed to be more severe.

Thanks for your suggestions - they are right on-point! My mare currently is on Assure Guard Gold, probios, electrolytes, saccharomyces, sulcralfate, misoprostol, and daily transfaunations to help her gut. We’re also making sure she eats a fair amount of hay and grain just before getting her dose of chloro.

I’m at my wit’s end with worry and trying to figure what we do moving forward if it turns out she can’t tolerate any broad-spectrum antibiotics.

[EmilyM]

this won’t solve your problem, but i think Probios are useless. i’ve never had them make any difference. Platinum Balance is a great probiotic.

My horse got colitis last year (he had mild fecal water syndrome prior to). Now managing his fecal water syndrome takes so many supplements and pastes it’s a nightmare, but at least he’s stable. the colitis was scary. Did the vets do anything like biosponge or neonorm to help? some of those helped mine during colitis. Also, pepto bismol really really helps him. i dose him at 180 cc orally 2 x per day. i found 150ml dosing tubes on amazon.

[PrinceSheik325]

Thanks for the reply! I’m so sorry to hear about your horse’s fecal water syndrome, but glad he made it through the colitis.

Thanks for the suggestion regarding Platinum Balance. I’ll have to check that one out.

[PrinceSheik325]

Well, I’m back with another update. We ended up treating with chloramphenicol, and she’s been on it about a month. She improved enough to be sent to a rehab center (her thromboses were much improved and her lungs looked almost normal!). That lasted for about 10 days, and then she started spiking fevers again. The vets reultrasounded her jugulars, and found the thrombosis in the vein that was least affected had expanded considerably. My horse is now in the hospital again spiking fevers. They also found three thromboses in her legs, but remarkably, her body is forming collateral vessels to maintain blow flow. They cultured the jugular vein and were able to grow staph. The thought is that the dose of chloro she is receiving isn’t enough to treat the staph, so now we are yet again faced with the question of whether to switch to another antibiotic. If we don’t switch, and the infection doesn’t resolve, she could get something even worse, like endocarditis. I feel we have no choice but to try and treat this. We are switching to enrofloxacin today, and boy am I nervous! My sweet girl has been such a trooper through all this, and clinically is still very bright and upbeat despite the fevers. It’s hard to fathom this might restart her colitis. If it does, we may be at the end of the road.

This has been an insane couple of months, and honestly, I am at my wit’s end. It’s hard to reconcile that my horse has gone from a healthy, vibrant 6 year old to critically ill fighting for her life all because of an antibiotic. Please send jingles…we need them.

[lenapesadie]

Big jingles

[ThreeWishes]

Jingling like crazy. I’m so sorry. And sending every good thought your horse’s way

[MorganMaresVT]

So very sorry. Sending all the healing thoughts your way.

[ATXmom]

Oh my goodness! Sending healing thoughts for your good mare.

[NaturallyHappy]

@PrinceSheik325, My dog was in the hospital the week between Christmas and New Year’s Day for surgery due to an abscess in his chest cavity that had no way to drain without it. It’s a long story and not the point here.
He came home on Amoxicillin and Enrofloxacin. The fluid was cultured and came back as the bacteria Beta Hemolytic Staff. His surgeon called and took him off Enrofloxacin. He said that isn’t strong enough for staff…it can grow through it. My dog is now on Amoxicillin for 6 weeks.

[PrinceSheik325]

@NaturallyHappy Ugh - so sorry to hear about your dog! Hope he’s doing better now!

Thankfully, they were able to do sensitivity testing on the staph. It came back as susceptible to the enro, which appears to be the case. Her temperature pretty rapidly came back down to the normal range, and one of her jugulars is completely cleared of the thrombophlebitis already. Hoping it keeps working!

[NaturallyHappy]

That is outstanding news!!! Good for you both. Thank you…my beloved dog is doing very, very well.

[PrinceSheik325]

Back with another update…we switched my mare to another antibiotic, and she didn’t have a reaction. Things were looking cautiously optimistic (no fevers - yay!, and she was eating really well). We even thought she might be discharged this week. Well, yesterday she started spiking fevers again. She’s still eating well and overall pretty happy. But this means that the bacteria has become resistant to the antibiotic, the infection has moved to her heart, or both. We are waiting for some additional sensitivity testing on the blood culture, which should show which other antibiotics might be an option. The really bad news, though, is the only ones we haven’t tried are the ones that come with an increased risk of colitis. So, in other words, we could be back at square one.

I’m really devastated and torn. My horse is wonderful and everything I have ever wanted…super brain, super fancy, extremely talented, and a fantastic personality. I got her for a deal, but replacing her at this point would cost in the upper five figures. The reality is, though, I have sunk boatloads of money into this (probably could have bought a boat, to be honest), and I’m starting to wonder when is it too much? Thankfully, I have a good job and have been able to afford her care to this point, but it’s not lost on me that I could have used this money for something else. I’m feeling selfish that I have spent such a large chunk on my interest and my hobby when I could have (and maybe should have) used it for my family. Of course my family has been very supportive throughout this whole process, but when is it too much?

Sorry for the rant…just feeling very down.

[NaturallyHappy]

I’m so sorry….I’m glad you have family support and I wish you well.