There have been many exciting advances in rabbit medicine and surgery in the past twenty years. Some of these advances have revolutionized treatment of common problems like gastrointestinal stasis, dental disease, abscesses, and nutritional imbalances. Twenty years ago veterinary care specifically oriented to rabbits was rare. Now veterinarians and organizations have improved rabbit medicine so significantly that rabbits are the third most common mammal to seek veterinary services.
In 1988, House Rabbit Society was founded. This one group has been a primary, fundamental supporter for many of the advances in rabbit medicine. Through their membership and educational support they are the most influential group changing the lives of rabbits today. They are responsible in for getting rabbits out of the backyard and into the house and becoming an integral part of the family.
The first significant new medication that came out in 1989 was Baytril.® This was the first fluoroquinolone antibiotic to enter the veterinary market. The fluoroquinolones are also the first major new class of antibiotics since the sulfonamides in the 1940’s. Because of the normal bacteria in a rabbit’s digestive tract, many antibiotics used in other species are not safe for use in rabbits.
Enrofloxacin (Baytril, Bayer HealthCare, introduced in 1989), orbifloxacin (Orbax, Schering-Plough, introduced in 1997) and marbofloxacin (Zeniuin/Zeniquin, Pfizer Animal Health, introduced in 1999) have two major advantages: high bioavailability and activity against Pseudomonas (and many other gram negative and gram positive bacteria). The fluoroquinolones are broad spectrum and bacteriocidal. This class of drugs is the first that is effective in an oral form to fight Pseudomonas. It is also extremely effective against other common causes of infections in rabbits like Pasteurella multocida, Mycoplasma sp., Staphlococcus sp., E. coli, Salmonella, and many others. A caveat is that some bacteria are developing resistance to Baytril because of its overuse. This can happen when any antibiotic is used inappropriately or indiscriminately.
The next medication is a new sulfa antibiotic sulfadimethoxine/ormetoprim (Primor,® Pfizer Animal Health), it is very similar to sulfamethoxazole/trimethoprim (Bactrim,® Roche) except the trimethopim was replaced with ormethorpim. This drug was introduced in 1993 and is broad spectrum, bactericidal and anti-protozoal (will treat for coccidia).
Another new anti-protozoal drug called ponazeril (Marquis,® Bayer HealthCare) was introduced in 2001. This drug kills coccidia by targeting the plastid body in the protozoan and only requires two days of treatment. This drug is coccidiacidal not coccidiastatic like sulfadimethoxine (Albon,® Pfizer Animal Health) and other sulfa drugs. This drug has also recently been used for Encephalitazoon cuniculi with promising results.
There are several other drugs now available that weren’t available twenty years ago that increase gastrointestinal motility, reduce pain and inflammation, and provide long term local concentrations of antibiotics.
A new small promotility medication called cisapride (Propulsid,® Janssen Pharmaceutica) was introduced in 1992 and the mechanism of action is to normalize concentrations contractions in the stomach, acts in multiple points throughout the gastrointestinal tract and doesn’t cross the blood brain barrier (like metoclopramide does). So this drug only works locally, not centrally and cannot cause any changes in mentation.2
The strongly anticipated non-steroidal anti-inflammatory drug (NSAID) called meloxicam (Metacam,® Boehringer-Ingelheim) was introduced in the United States in 2003. In rabbits some NSAIDs can have severe side effects. Metacam is a preferential COX-2 inhibitor and has 50-100% fewer potential side effects when used conservatively.
There are also medications that can be placed surgically. Antibiotic impregnated polymethylmethacrylate beads (AIPMMA Beads) and pluronic gel (Poloxomer 407) are two ways of placing a particular antibiotic at a local site in an abscess that will give a locally acting long-term antibiotic exposure. This has increased the success rates for treatment of jaw abscesses, dental disease, and abscesses throughout the body.
Rabbit dentistry has improved the most in the last ten years. Dental disease is responsible for many of the sick, anorexic rabbits that are seen in veterinary clinics today. We now have appropriate instruments to treat these problems. Since 1996, many dental instruments specific for rabbits have been commercially reduced. Cheek dilators and rabbit mouth gags allow better visualization & protect the tissue in the mouth. In 1997 the molar extraction forceps and molar cutters were made available. These instruments made it more successful to at remove large spurs and fractured or infected cheek teeth.
In 1998 the Crossley rabbit incisor luxator, and in 2000 the Crossley molar luxator were introduced into the veterinary market. These two instruments revolutionized dental extractions, making veterinary dentistry more successful and less traumatic. As our patients are living longer this certainly improves their quality of life.
Rabbit nutritional advances have been tremendous in the last fifteen years. Diet recommendations used to be that pellets make up 80% of the rabbits diet with the other 20% being hay and veggies. Today, the recommendations are that hay and veggies be 80-90 percent of the rabbit’s diet with pellets ideally as low as possible, from 10 to 20 percent. There are now numerous feed companies that sell excellent quality grass hays, nutritionally excellent rabbit food pellets and formulas specifically for syringe feeding sick rabbits.
We still have to travel a long way to understand and cure some of the problems facing our house rabbits, but the last twenty years have produced so many advances and fundamental changes in general husbandry, medicine, surgery and supportive care, as well as the development of new drugs and instruments that rabbit medicine has become a very competent and progressive field in veterinary medicine.
Notes
1. Coccidia are tiny internal parasites (Eimeria spp) that live in the cells of the rabbit’s intestines. The tiny oocysts containing the infective stages are passed in the feces and are picked up by other rabbits through contaminated feed and water.
2. The process of reasoning and thinking
3. Lack of appetite
Other Resources
Orsini, James. The Compendium. 1992. pages 1491-1495.
Hillyer, E.V. and K E. Quesenberry. Rabbits, Rodents and Ferrets. Philadelphia, 1997. pages 212-214.
Cory, Gary MD. Sterile Vancomycin Pluronic Gel. International Journal of Pharmaceutical Compounding Vol. 7 No. 5. Sept/Oct 2003. pages 354-358.
Lin, S.S., Ueng S.W., et al.. . Development of a Biodegradable Antibiotic Delivery System. Clin Orthop. 1999; 362: 240-250.
Aucoin DP. Fluoroquinolone Antibiotics: Use in Companion Animal Medicine. Vet Messenger 13-23, 1989.
Paul, Allan. Clinical Advances: Imidicloprid Suppl. Compend Contin Educ Pract Vet Vol. 19 (5), 1997.
Soave, OA. Diagnosis and Control of Common Diseases of Hamsters, Rabbits and Monkeys. JAVMA Vol 142: p 285-290, 1963.
Franti, CE. Aspects of Pet Ownership in Yolo County California. JAVMA Vol 164 (2): p 166-171, 1974.
Harkness, JE. Rabbit Husbandry and Medicine. Vet Clin North Am. Small Animal Pract. Vol 17 (5): p 1019-1044, 1987.
Vancuster, PM. The Fluoroquinolone Antimicrobials: Structure, Antimicrobial Activity, Pharmacokinetics, Clinical Uses in Domestic Animals and Toxicity. Cornell Vet Vol 80 (2): p 173-186. 1990.
Advances in Information and Knowledge Sharing
Twenty years ago, most veterinary schools limited instruction in rabbit medicine to an elective course covering laboratory species, including rabbits, rats, mice and primates. Today it is rare that a university veterinary program does not have a department for exotic animal medicine in some form, providing much more extensive training in rabbit medicine. However, you will still want your rabbit cared for by a doctor with a specialization in exotic animal medicine. In addition to other sources for locating one, you might contact your local or state veterinary medical association who may have referrals for veterinarians with special interest in exotic species. In April 2008, the American Veterinary Medical Association (AVMA) granted provisional recognition to the first completely new veterinary specialty since 1993, called Exotic Companion Mammal Practice (ECM). This will hopefully set even higher standards for exotic mammal care but there may be many highly qualified practitioners who cannot yet invest the resources necessary to become board certified.
There are now several organizations for veterinarians who share an interest in exotic mammal medicine:
The Association of Exotic Mammal Veterinarians (AEMV) was established in 2000. Paid members have access to an online AEMV Internet Forum, as well as to AEMV Journal articles published quarterly in The Journal of Exotic Pet Medicine. One of the largest sources for veterinarians to access on-line information about exotic mammals is the Veterinary Information Network. (vin.com) They have a forum just for rabbits which is run by veterinarians at both the academic and practice level who are experts in the field. Zoological Education Network website is home to Exotic D.V.M. magazine and other materials including veterinary texts and client education materials. They sponsor a free online discussion group called the ExoticD.V.M. On-Line Forum, designed to promote and facilitate discussion of exotic animal medicine among veterinarians who wish to provide quality care of non-traditional companion animals. Subscribers to this chat group must be either licensed veterinarians or veterinary students enrolled in an accredited institution.
House Rabbit Society hosted the first conference for veterinarians devoted entirely to rabbits in 1997. Although this has thus far been the only rabbit exclusive conference, many of the larger veterinary conferences including the AVMA annual conference now routinely include speakers on small exotic mammal medicine. Two of the largest whose exotic programs are always extensive are the North American Veterinary Conference and the Western States Veterinary Conference. 2009 marked the 16th year for the Annual Mid-Western Exotic Animal Medicine Conference.
Prior to 1989 there were very few medical textbooks focusing on rabbits: The Biology and Medicine of Rabbits and Rodents, By John E. Harkness and Joseph E.Wagner. 1st Edition, 1977, 5th Edition 2010. ISBN: 978-068303919.
Resources now available are extensive:
- Manual of Exotic Pets by Peter Beynon and John Cooper 1994, BSAVA ISBN-13: 978-0813822945
- Rabbit Medicine and Procedures for Practitioners. House Rabbit Society Veterinary Conference Program 1997, hrs rabbit center vhs.videos Laboratory Medicine Avian and Exotic Pets By Alan Fudge 2000, W.B. SAUNDERS ISBN: 978-0721676791
- Manual of rabbit Medicine and Surgery By Paul Flecknell 2000, BSAVA ISBN: 978-0905214467
- Textbook of Rabbit Medicine By Francis Brown 2002, Butterworth ISBN: 978-0750640022
- Ferrets, Rabbits and Rodents 2ND EDITION, By Katherine Quesenberry 2004, w.b. saunders ISBN: 978-0721640235
- Radiology of Rodents, Rabbits, and Ferrets By Sam Silverman and Lisa Tell 2005, W.B. saunders ISBN: 978-0-7216-9789-5
- Exotic Animal Formulary 3RD EDITION, By James Carpenter, and others 2005, W.B. SAUNDERS ISBN: 978-0-7216-8312-6
- Rabbit and Rodent Dentistry Handbook By Vittorio Capello 2005, Wiley-Blackwell ISBN: 978-0-9706395-1-6
- Exotic Pet Behavior: Birds, Reptiles, and Small Mammals By Teresa Bradley Bays, Teresa Lightfot, Joerg Mayer 2006, AVIAN PUBL. ISBN: 978-1-4160-0009-9
- The 5-Minute Veterinary Consult: Ferret and Rabbit By Barbara Oglesbee 2006, Wiley-Blackwell ISBN: 978-0-7817-9399-5
- Anesthesia of Exotic Pets By Lisa Longely & Matthew Fiddes & Michelle O’Brien 2008, W.B. SAUNDERS ISBN: 978-0-7020-2888-5
- Veterinary Diagnostic Imaging Bird, Exotic Pets and Wildlife By Charles Farrow 2008, Mosby ISBN: 978-0-3230-2527-0
By Keith Gold, D.V.M.
House Rabbit Journal Spring 2010: Volume V, Number 5