Bah 
I’m sorry. Crossing everything that a little longer on drugs does the trick.
Strep zoo can be difficult, and unfortunately not all bacterial infections are difficult to treat solely because of antimicrobial resistance. The antibiotic needs to be able to get to the site of infection, which can be challenging at some body sites, including the sinus. For example, TMS is inactivated by pus/purulent material, so other methods like lavage may be needed to locally clean up and allow the drug to get to the bacteria.
Pantoea is typically an environmental contaminant (it is really common all around us) and very rarely pathogenic. You could consider having someone on your team consult with a veterinary microbiologist if they have questions about its role in this case.
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I would be interested to consult one at this point- still pus in the wound and I’m trying to get that microgen culture sent out but logistics seem to be challenging. Do you have someone you would recommend?
I would absolutely believe that the current antibiotic isn’t working because of an issue other than sensitivity/resistance, having dealt with a similar issue in a dog a while back. I’m not sure how many of the other routes are possible for this specific wound but it’s interesting to think about. I know he had the wound flushed yesterday
Sadly it looks significantly worse today Had the vet back out and they switched him to doxycycline so we will see. Vet said give it 10 days and if not better he will need another CT scan
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Jingles! What a nightmare…
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So sorry he isn’t improving. I am jingling for you both.
Rebecca
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Oh, boo! Lots of jingling from here and a kiss for his nose. Also hugs for you
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Jingles!!! I hope he’s better soon!
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Jingles for you dear horse and big hugs for you !
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Sorry it’s not improving. Jingles for you both.
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Sending you some major jingles for your boy. I went through the sinus thing 18 months ago and then again this year with my mini.
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I just had a friend lose her horse to bacterial meningitis from a sinus infection . He was at a major university hospital also. As you are all too familiar, these are not to be taken lightly. Massive jingles to you.
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I would never presume to double check the excellent care and diligence you have experienced. What a road you have been on; you and your sweet friend 
I would ask the vet if the cultured for fungal infections ( which can take up to a month to grow) and could there be a hidden secondary issue
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You know that’s a good idea- I’m hoping this microgen culture would cover it but I forgot fungal would take a long time to grow. Initially they ruled it out because they thought there would be visible granules (? Something like that) but at this point it seems worth revisiting
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I have a friend who had a horse go through a sinus infection from hell too. She opted for flap surgery - not as extensive as yours. I remember the care thereafter not being not for the faint of heart - especially feeding the tube through the bone to flush. We had to do lavage for a while because he was not improving with typical ABX course. I had to do it a few times since it was hard for her - it’d be hard for me too if it was my horse. If I remember she had him on some serious ABX - I think Excede first and then gentimicin. Some sort of oral ABX too. It sounds like you are doing everything right and aren’t missing anything at all; sinus infections can be very difficult to resolve.
I don’t think a fungal culture is a bad idea. Btw, we discovered that the Roma Lycra fly masks with the open visor style eye piece was the best thing ever in keeping his head clean and dry. She opted to keep him out since there was some concern about shavings and barn allergens making things worse.
Sending you two some big jingles. He’s so cute. I hope he feels better soon.
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I was thinking of mentioning Excede…
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To update the class- we did another CT last week which showed significant improvement and one small additional sequestrum which they hope will resolve without need for additional surgery. He was one of the apparently less than 1% of horses that the microgen culture doesn’t find any additional species on, go figure, so now we are up to five cultures showing strep zoo with no known resistance issues. I wouldn’t hesitate to try that again on a different weird infection type issue, though. Two more weeks of doxy and we will come off and see how he does. Either he will be fine or the other sequestrum will do what it’s going to do.
He is still, naturally, the best boy though the stall rest did possess him to attempt kicking the trailer on the ride up. I was aghast. He has since been returned to evening turnout and his temporary transit specific demonic possession has since resolved.
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Yay for a good report! Still jingling for him!
Yay! Thank you for sharing this. Do they sedate for the CT? Your horse is a very good boy 
