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I have a goldendoodle who has frequent ear infections both

bacterial and yeast from allergy...
I have a goldendoodle who has frequent ear infections both bacterial and yeast from allergy. Drops do not seem to be working. What oral antiboitic can I use.
JA: I'm sorry to hear that. There are all sorts of infections the dog can pick up. I'll have you talk to the Veterinarian who'll sort out what is wrong and help you decide what to do about it. What is the dog's name and age?
Customer: remington six years
JA: Is there anything else the Veterinarian should be aware of about Remington?
Customer: He has food allergies, seems to be grains
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Answered in 8 minutes by:
9/16/2017
Dr. Kara
Dr. Kara, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 17,105
Experience: Over 20 years of experience as a veterinarian.
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Hello, I'm Dr. Kara. I have over 20 years of experience as a veterinarian and I'd like to help. Please give me a moment to review your concerns.

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Customer reply replied 2 months ago
do you give scripts if needed, or do I need to see my own vet anyway?
Customer reply replied 2 months ago
I am beginning to feel like I am in Mexico dealing with a street vendor, who keeps upping the ante.

I understand that Remington is uncomfortable due to an ear infection and ear drops don't seem to be working for him.

Of course the ideal situation is to see his veterinarian and have his ear debris tested to see what sort of infection he has to get him on the right medication, but I understand that may not be possible right away.

In general systemic oral antibiotics will not successfully treat an ear infection in a dog. Unlike people that get inner ear infections dog ear infections are in the outer ear canal, and systemic antibiotics don't penetrate the skin lining the ear canal or the thick, waxy debris in the ear well at all, so they don't work very well unless the infection spreads to the inner ear. If the infection spreads to the inner ear we can add systemic antibiotics, but we would still need to use topical medication.

There are some other systemic medications that can help prevent some of the predisposing factors for developing infections, and thus are useful for prevention, but it is extremely rare to be able to give an oral medication, especially an antibiotic, and cure an ear infection.

In some less common types of ear infection with very aggressive bacteria (pseudomonas for example) that cause erosions of the ear canal skin we may need to combine oral systemic antibiotics with topical medications too. That isn't the usual though.

While he does need to see his veterinarian in the meantime there are some things that we can do to help him feel more comfortable.

Since most ear infections are secondary to allergies and the inflammation they cause you can use a combination of antihistamines and high doses of omega-3 fatty acids to help with those. In combination fatty acids and antihistamines work synergistically, much better than either one alone.

You can try:

1)Benadryl (diphenhydramine only don't use the combination products with decongestants or acetaminophen as they can be toxic) at a dose of 1mg to 2mg per pound or one 25mg capsule per 15 to 25 pounds of body weight orally every 8 hours.

OR 2)Claritin (loratidine) at 5mg per 25 pounds of body weight once or twice daily.

OR 3)Hydroxyzine at 1mg per pound of body weight orally every 8 hours.

OR 4) Chlorpheniramine at 4mg to 8mg per dog once or twice daily.

OR 5) Zyrtec (Cetirizine hydrochloride) at 1/2 mg per pound of body weight orally every 24 hours. That would be one 10mg tablet per 20 pounds of body weight. Make sure it is NOT the formulation with a decongestant (such as Zyrtec-D) because dogs cannot tolerate decongestants.

Some dogs do better on one antihistamine rather than another. Give the one you pick a 3-5 day trial and if it isn't working to relieve his itching try another. Be aware that antihistamines can cause sleepiness or hyperactivity in some dogs. These side effects do wear off with repeated use.

Omega-3 fatty acids are fish oil products. 3V by DVM or Derm Caps ES are good brand name products. Use the high end of the dosing schedule for your pup's weight. I recommend an omega 3 fatty acid dose based upon the EPA portion (eicosapentanoic acid) of the supplement as if we do that the rest of the supplement will be properly balanced. Give him 20mgs of EPA per pound of body weight per day. For example an 85 pound dog could take 1700mg of EPA per day.

I also recommend using a gentle ear cleaner like Oticlens daily now to remove as much of the waxy debris as possible. This removes excess wax and keeps the ear pH at levels that discourage infections. When the ear is sore many dogs won't let you squirt things in their ear but if you soak a cotton ball with the cleaner, then place it at the top of the ear canal and massage the ear from the outside, putting pressure on the soaked cotton ball, the cleaner will be instilled easily. Wipe out excess cleaner and waxy debris with dry cotton balls.

Once you have his infection treated and cleared use the cleaner twice a week as that helps prevent infections and also allows you to know what a normal ear looks like and catch ear infections very early.

Sometimes with an early infection simply cleaning the ear daily is enough to stop it in its tracks.

If his ear canal skin surface is very red after cleaning you can apply a light coat of cortisone cream (like cortaid) to the ear skin with a cotton ball.

Then I recommend that he see his veterinarian as soon as possible.

Do not clean his ear the day of his veterinary appointment so they can gather a sample of the wax for testing.

I also want to add that since Remington has had repeated ear infections there is likely some sort of predisposing factor. In most cases it is allergic inflammation, particularly food allergies, so you might want to discuss feeding him a prescription true hypoallergenic diet with his veterinarian. I recommend Hills z/d, Purina Pro Plan Veterinary diets HA or Royal Canin restricted protein diets. It looks like you have tried some grain free foods, but these may not have been restrictive enough. Dogs are more likely to be allergic to a protein than a grain, although in some cases they have multiple allergies.

Over the counter foods may be labeled hypoallergenic but they are unlikely to truly be so.
The trouble with "limited ingredient", "hypoallergenic" or "low allergy" pet store brands is that the same machinery is used on multiple lots of food without sterilization cleaning in between. So for example even if a food says it has salmon and rice if the previous batch had beef and corn then you will get traces of those ingredients in your bag of food. Not a big deal if your dog isn't allergic to those ingredients but a waste of money thinking that the food was hypoallergenic, and not good for your dog if those happen to be allergens for your dog.
The veterinary brand true hypoallergenic foods are more expensive because it isn't cheap to thoroughly remove all traces of a previous food mixture from the machines used to process food or to hydrolyze the proteins in the food. And the only ingredients in that food, even at a trace level, are what is listed on the bag.
Even though some pet food companies may try to convince you otherwise there are no magic hypoallergenic food ingredients. A food allergy reaction is based upon the dog's body recognizing an allergen, so they must have been exposed to it before. Prescription foods are hydrolyzed, or broken down so the body cannot recognize the allergen, or use very unusual ingredients that the dog cannot have been exposed to in the past. They cannot develop an allergy to something they have never been exposed to.

Best of luck with your fellow, please let me know if you have any further questions.

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No need to accept the phone call offer, my apologies as the site automatically offers that.

I cannot help with writing a prescription. All states/provinces that license veterinarians do not allow us to write a prescription, unless we have previously physically examined a pet. Veterinarians, like human MD's & DO's, could lose their license for doing so. It would be poor medicine anyway without knowing for certain that your dog has an infection that would be helped by an oral antibiotic.

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Customer reply replied 2 months ago
I have been treating his infection with Trizultra+keto, made by Dechra. This does not seem to be helping and he hates having the ears cleaned as they are sore. This is what I got from the vet last time. She did verify that he likely has food allergies and he was having all kinds of skin reactions. he is not currently having the skin reaction to I assume the issue is bacterial. He is not having much discharge either and i suspect the infection is more than an outer ear problem
Customer reply replied 2 months ago
What are your thoughts about this treatment?
Customer reply replied 2 months ago
He is not itching, just shaking his head and whining when I touch his ear.
Customer reply replied 2 months ago
Am I waiting for a response, or have I been disconnected?

If his ears are very sore it would make sense that he is objecting to them being cleaned.

You cannot assume that because the rest of his skin looks fine that this is bacterial, although in general there are particular bacterial infections that are more likely to cause ulcerated skin (like pseudomonas OR MRSA). However both of those are also more likely to cause copious ear discharge, which he doesn't have.

Your fellow probably needs to he sedated and a sample collected for culture and sensitivity. He may indeed need an oral/systemic antibiotic, but it is key that we pick the right one, and use it for a long enough period of time.

Trizultra+keto, made by Dechra is used for both bacterial and yeast infections. It makes the ear inhospitable for growth by changing the pH and removing the food source (waxy debris).

Depending upon the infective agent (perhaps this is an early pseudomonas) we may add an antibiotic (enrofloxacin) to the solution and in some cases a systemic antibiotic too.

I think if he's shaking his head the ear hurts and is itchy, but so sore he isn't actively itching.

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Customer reply replied 2 months ago
I have also used some of left over ear drops from previous infection - these were antibiotic, but did not seem to help. This has been going on for at least three, probably four weeks now. Would agree that this likely will respond to an oral antibiotic? Likely, so there is no commitment on your part.. I understand the licensing laws and how you would be reluctant to tarnish that. I am also a licensed professional and would not treat a suicide patient on a first time phone call.
Customer reply replied 2 months ago
What class of oral antibiotics are typically given for a canine ear infection?

Many of the common antibiotic ear drops won't work for pseudomonas or MRSA, and that's why I suspect either one as a possible cause.

Any ear infection (even the very resistant bacterial types) need an appropriate topical along with an oral/systemic antibiotic.

A culture is essential for the type of infection he has given how long he has been affected, because we are most likely dealing with an infection that will only respond to one or two antibiotics. We definitely don't want to breed a superbug.

As far as antibiotics Chloramphenicol, Enrofloxacin, Marbofloxacin, or in some cases injectable/intravenous antibiotics like Vancomycin are needed depending upon culture results. This type of infection is not one we want to "try" antibiotics on. That is a dangerous idea.

With a very swollen ear canal (and his may well be given the chronicity) systemic steroids to open the canal and allow the right topical drops to get all the way down his ear canal may be needed.

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My other caution is that some of these pups have underlying hormonal/endocrine disease, such as hypothyroidism or hyperadrenocorticism, so that should be considered too.

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Customer reply replied 2 months ago
Thank you. sh

You are very welcome, my best to your pup.

Dr. Kara
Dr. Kara, Veterinarian
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