Reptile & Amphibian Forums

One of my yearling Womas has developed a rapid case of gingivitis. Both I & the vet have never seen quite such a debilitating onslaught. Unlike the usual cheesy exudate, this is true "rot." The vet prescribed twice-a-day Silverdine swabs. That was 2 weeks ago & there's no real improvement. I'm intubating twice daily with Pedialyte & today switched to twice daily mouth rinses with Sulfa Methazine. This is something I used years ago with a good degree of success but REALLY want some feedback on it's proper use & dosage.
Thanks for whatever help you folks can offer!!

Silverdene or silver sulfadiazine, and sulfamethazine are both sulfonamide class antibacterial agents that have been around for a long time. The problem is that many types of bacteria have developed resistance to sulfonamides, and they are no longer used to a great degree as much more effective antibiotics are available. Silverdene is a topical antibacterial that will not penetrate well into tissue and so is not of much use on severe cases of stomatitis (mouth rot). Sulfamethazine is a systemic drug, does not work well topically, and so is of little use applied directly to the mouth. Additionally, the bactericidal activity of sulfonamide drugs drops rapidly around dead or decaying tissue.

For severe cases of stomatitis like your woma has, injectable antibiotics will be required to eliminate the infection. Good antibiotic choices would be Amikacin, or cephalosporins like ceftriaxone (Rocephin), or ceftazidime (Fortaz). Amikacin is dosed at 2.5 mg/kg every 72 hours. Rocephin and Fortaz are dosed at 20 mg/kg every 72 hours. I have seen both amikacin and ceftriaxone work wonders on even severe cases of stomatitis. Always use these drugs under vet supervision. Good luck and let us know how it goes.

Kelly

Can't add much to that. Systemic is the way to go, as long as the exudate is cleaned out of the mouth. The less trauma in the mouth...the better.
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1.1 Blackheaded pythons
1.1 Woma (Juvie female)
2.1 Aussie Olives
1.1 Timors
1.0 Angolan Juvie
1.1 Savu
1.1 Juvie Bloods
1.1 Juvie Balls
1.1 IJ Carpets
1.1 Coastal Carpets
1.2 Macklotts
1.1 Papuan Olives
1.0 Jungle Carpet
2.2 Scrubs (on breeding loan)
0.1 Jungle/Diamond cross
0.1 child, CB
0.1 wife, WC

Thank you two so much for your good advice. It's back to the vet on Wednesday & we'll definitely carry with us a copy of your posts! We've good faith in the vet but a little outside advice can only help in the overall effort. Thanks again. We'll post his progress.
Dan & Loraine

The advise given is good. Amikasin is the drug of choice. I have had excellent results with Choramphenicol but it has a record of possible kidney damage. On the amikasin, I would use an initial dose of 5 mg/kg then 2.5 every three days.

A most horrible case of "mouth rot" that I have ever seen I treated successfully with removal of loose tissue in the mouth and flush with hydrogen peroxide along with the injectable antibiotic.

Make sure that you use hygenic procedure or you are going to spread this to your other animals.

Thank you all for your advice. He is now on Amikacin injections every 72 hours. Something I neglected to ask the vet today was, what should I use for an oral rinse? Hydrogen peroxide?
Thanks, all!

studies have shown it to cause some minor tissue damage and it also appears to slow the healing process somewhat. Diluted Betadine and it’s generics would be easier on the tissue than H2O2. See the excerpt below that I pulled from a medical site a few months ago for a more detailed explanation:

Hydrogen peroxide is less used now as a debriding agent than in the past. When hydrogen peroxide is applied to a wound it combines with catalase produced in the tissues and decomposes into oxygen and water, producing effervescence (Potter and Perry, 1993). The rationale was that this helps to loosen materials that might hinder wound recovery and enables them to be washed off more readily. Six-percent w/v hydrogen peroxide (known as ' 20 volume' solution) liberates twenty times its own volume of oxygen upon decomposition (Thomas, 1990a), and is generally diluted 1 in 3 for the irrigation of wounds. The release of oxygen also kills some anaerobic bacteria such as the tetanus bacillus or Escherichia coli that might otherwise infect the wound. This anti-microbial action of hydrogen peroxide can be amplified 100-fold by the addition of L-cysteine (Berglin et al, 1982).

The problem with hydrogen peroxide and some other traditional debriding agents is that they also damage the healthy cells (keratinocytes and fibroblasts) that are needed for wound healing and inhibit their necessary migration into the damaged area (Tatnall, Leigh, and Gibson, 1990; Tatnall, Leigh, and Gibson, 1991; O'Toole, Goel, and Woodley, 1996). In current practice the emphasis has moved away from the use of cytotoxic materials to those which promote healing, including the use of natural signalling molecules such as platelet-derived growth factor (Higgins and Ashry, 1995). In the British National Formulary (1996) hydrogen peroxide is now listed under "Astringents, oxidisers and dyes", and not as a desloughing agent.

The application of hydrogen peroxide has been replaced with the use of saline wash, substances such as Debrisan and Intrasite Gel for the removal of necrotic tissue, and the application of hydrogel dressings such as Granuflex. Varidase is a desloughing agent with wound cleansing properties, and contains streptokinase and streptodornase (Thomas, 1990b).

References

Berglin, E.H., Edlund, M.B., Nyberg, G.K., and Carlsson, J. (1982) Potentiation by L-cysteine of the bactericidal effect of hydrogen peroxide in Escherichia coli. Journal of Bacteriology, 152(1), 81-88 (Oct).

British National Formulary (1996) 13.11.6 Astringents, oxidisers, and dyes: hydrogen peroxide. Joint publication of the British Medical Association and the Royal Pharmaceutical Society of Great Britain (p. 492).

Higgins, K.R., and Ashry, H.R. (1995) Wound dressings and topical agents. Clin Podiatr Med Surg, 12(1), 31-40 (Jan).

O'Toole, E.A., Goel, M., and Woodley, D.T. (1996) Hydrogen peroxide inhibits human keratinocyte migration. Dermatol Surg, 22(6), 525-529 (Jun).

Potter, P.A. and Perry, A.G. (1993) Fundamentals of nursing: concepts, process & practice (3rd edition). St. Louis: Mosby-Year Book, Inc (p. 1666).

Tatnall, F.M., Leigh, I.M., and Gibson, J.R. (1990) Comparative study of antiseptic toxicity on basal keratinocytes, transformed human keratinocytes and fibroblasts. Skin Pharmacology, 3(3), 157-163.

Tatnall, F.M., Leigh, I.M., and Gibson, J.R. (1991) Assay of antiseptic agents in cell culture: conditions affecting cytotoxicity. Journal of Hospital Infections, 17(4), 287-296 (Apr).

Thomas, S. (1990a) Wound cleansing agents. In Wound Management Dressings. The Pharmaceutical Press (Chapter 11, p. 76).

Thomas, S. (1990b) ibid p. 78.

Kelly,
Your advice is always so professional & helpful. Are you a vet?
Thanks so much for your input!
Dan & Loraine.

I am not a vet but have worked with a few of them over the years. Also worked in an analytical chemistry and biological laborartory for about 15 years doing everything from heavy metal analysis to bacteriological work. Thanks much for your comments,

Kelly

Keep us informed of the progress.

"Kelly, Your advice is always so professional & helpful. Are you a vet?"

No, but she plays one on TV
-----
1.1 Blackheaded pythons
1.1 Woma (Juvie female)
2.1 Aussie Olives
1.1 Timors
1.0 Angolan Juvie
1.1 Savu
1.1 Juvie Bloods
1.1 Juvie Balls
1.1 IJ Carpets
1.1 Coastal Carpets
1.2 Macklotts
1.1 Papuan Olives
1.0 Jungle Carpet
2.2 Scrubs (on breeding loan)
0.1 Jungle/Diamond cross
0.1 child, CB
0.1 wife, WC