Spiral bacteria have been found in various portions of the respiratory tracts of cockatiels and lovebirds. Common signs of infection with this bacterium include red clogged nares, sneezing, reddened and blunted choanal papillae and pharyngeal redness. Infected birds may also show signs of lethargy, anorexia and weight loss. Conjunctivitis, sinusitis and periorbital swelling may also be noted but are less common signs. A survey of 148 cockatiels seen by a veterinary practice in New York indicated that 37 (25%) were found to be infected with spiral bacteria with most of these having clinical signs of upper respiratory tract infection and red choana. The infection rate was higher in birds <2yrs old and in birds fed poor diets, suggesting that spiral bacteria are opportunistic organisms that cause clinical signs in young and compromised birds.

Spiral bacterial infections in cockatiels have been successfully treated with oral administration of doxycycline hyclate at 25mg/kg orally every 12 hours for 3 weeks. However, this regimen requires twice-daily capture and forced administration of doxycycline liquid suspension, which is apparently not palatable to birds. The stress caused by this regimen to both birds and owners caused researchers at the North Carolina State University College of Veterinary Medicine to determine the feasibility of administering doxycycline via drinking water. A group of 11 cockatiels naturally infected with spiral bacteria were offered solutions of doxycycline at 400mg per liter as the sole source of drinking water and 7 other naturally infected cockatiels acted as the control group receiving untreated tap water as the sole source of drinking water for a treatment period of 30 days. For the first 14 days, spiral bacteria were isolated from all 18 birds in both the treatment and control group, but after day 21, spiral bacteria were no longer seen in the treatment group.

For this study, doxycycline drinking water was prepared by emptying the contents of 4 x 100 mg doxycycline hyclate capsules into a liter of deionized water and stirring with a magnetized stirrer for 4 minutes and made fresh every 24-36 hours. As most bird owners do not have magnetic stirrers at home, and as the doxycycline hyclate capsules contain excipients other than doxycycline that do not go into solution and settle out at the bottom of the drinking bowl, our compounding pharmacy can provide bird owners with a more efficient method of doxycycline hyclate delivery by preparing 400mg capsules or packets of pure doxycycline hyclate, which the owner can stir into a 1 liter bottle of sterile water for irrigation (eliminating the possibility of contamination as well as preventing any binding of doxycycline by cations in tap water). It is interesting to note that doxycycline monohydrate is more palatable than doxycycline hyclate, but unfortunately, doxycycline monohydrate is not soluble in water and would not be a useful salt for this method of drug administration.

J Am Vet Med Assoc. 2008 Feb 1;232(3):389-93 Administration of doxycycline in drinking water for treatment of spiral bacterial infection in cockatiels. Click here to access the PubMed abstract of this article.
In avian species, the most frequent causes of infection have shifted from gram-negative bacteria to gram-positive bacteria and Candida (often non-albican) species. There is a decreased susceptibility of many non-albicans species to available antifungal drugs, perhaps as a consequence of nondiscriminate azole use.

The efficacy of terbinafine has been improved when administered in combination with azoles for treatment of azole resistant oral candidiasis and aspergillosis. Because terbinafine was administered successfully in an African gray parrot at 15 mg/kg every 12 hours for 30 days without adverse effects, it may have potential for use in systemic aspergillosis in these azole-sensitive species. Caution should be used in avian patients with liver or renal disease.

Veterinary Clin North Am Exot Anim Pract. 2003 May;6(2):337-50, vi Antifungal drug therapy in avian species. Click here to access the PubMed abstract of this article.
A Solomon Island Eclectus parrot, female aged 1.5 years, presented in a weakened state. Examination and culture revealed a systemic Aspergillus infection. Due to its significant cost as well as concern for the pet, the owner was highly motivated to treat the parrot.

Treatment posed a challenge because the parrot only eats brightly-colored foods, and there was no commercially available clotrimazole solution for nebulization for veterinary use. The veterinarian contacted the local compounding pharmacy to discuss how compounded medications might help solve this therapeutic dilemma. It was decided that an oral suspension flavored with equal parts orange, banana, and strawberry could mask the bitter flavor of itraconazole, and that a customized dosage (20mg/ml) could be compounded for the parrot. The veterinarian also prescribed clotrimazole 1% for nebulization.

The owner administered 0.2ml (4mg) of itraconazole suspension to the bird each day by mouth using an oral syringe. Therapy continued for three months. Clotrimazole 1% solution was nebulized (1ml BID to TID) by placing a pediatric nebulizer mask over the cooperative bird's head. After 30 days, the bird still had a productive cough. Therefore, nebulizer therapy with clotrimazole continued after total resolution of signs and symptoms of infection, for a total of four months (one month after the oral itraconazole was finished).

The parrot fully recovered. This case represented the pharmacy's first attempt at avian therapy, and was 100% successful. The same therapy was used later for another bird that also fully recovered from a systemic Aspergillus infection.
Enrofloxacin is highly active against most gram-negative bacteria. Doses of 15 mg/kg orally twice daily have maintained effective drug concentrations in most of the psittacine species that have been tested. Senegal parrots have required TID dosing for moderately resistant organisms. Keven Flammer, DVM, Dip ABVP, reports successful treatment of E coli, Klebsiella, and Proteus infections. He states that oral administration is well tolerated, but that IM administration should be avoided, and never used for repeated dosing, due to irritation at the site of injection. The IM formulation can be given orally but is unpalatable, even when mixed with flavoring. Dr. Flammer notes that an oral suspension can be compounded and appropriately flavored.

10th U Wisc Exotic Pet Conf Procd 04:01 The Capsule Report, Small Animal/Exotic Edition Jan 2002;20, 10: page 3
Neuropeptides, particularly dopamine, are implicated in many self-mutilating disorders. The 1993 Proceedings of the Association of Avian Veterinarians (pg. 119-120) reports the dopamine antagonist haloperidol is currently being used on cockatiels, lovebirds, ring-neck parakeets, African Greys, and several species of cockatoos and Amazon parrots. The indications for use in these birds have included severe feather plucking, mutilation of skin and muscle over the back, chest and legs, wing web mutilation, and Amazon foot necrosis syndrome. Side effects from the use of haloperidol have included depression, depressed appetite, excitability and anorexia. (In most birds, side effects disappeared after discontinuing the drug for several days and then retrying at a lower dose.) One study reported normal behavior was maintained "by administering haloperidol at approximately 0.4 mg/kg body weight/day for approximately seven months."

Journal of Small Animal Practice 1993; 34:564-566 Treatment of psychogenic feather picking in birds with a dopamine antagonist.
by Stacie Fowler, D.V.M., Texas
Signalment: "Echo", adult male Eclectus Parrot
Chief Complaint: Feather picking of 4-6 years duration

Diagnosis: Previous veterinarian had done numerous tests in 1993 to rule out medical causes of feather picking and the final diagnosis was psychological behavioral feather picking.

Feather Picking: This is a common syndrome in pet "parrot-type" birds that can have medical and/or psychological causes. It is important to rule out all medical causes of this condition before initiating psychotropic drug therapy. It is also important to institute appropriate dietary and environmental changes as well as behavioral therapy along with psychotropic drug use.

Past History and Medications: Echo first started picking at his feathers in 1991. By November of 1994 he had pulled out all his feathers except those which he could not reach on his head. In December of 1994, Echo's previous veterinarian started him on naltrexone (dose unknown) for behavioral feather picking. He failed to respond to this drug and was placed in an Elizabethan collar on 4/20/95 to prevent further plucking. The author first saw this patient on 1/10/97. He had been wearing the collar almost constantly since 4/95 and all his feathers were in place (but ragged and unkempt looking) except under the collar. Anytime the collar was removed the patient would rip his feathers out. The owners wished to try Prozac? for Echo's problem but since this author has had little success with Prozac?, we started trials on other drugs. Along with changes in diet and environment and behavioral exercises, we started Echo on Aventyl? elixir at 1/4 teaspoon per 4 ounces of drinking water to be replaced with fresh twice daily. We also initiated every other daily misting of the feathers with a dilute Aloe and Penetran? suspension. By 3/8/97, Echo was still plucking too many feathers when the collar was removed. To his Aventyl? therapy, we added naltrexone compounded to 5 mg/ml in a strawberry flavored base, 0.16 ml by mouth twice daily. By 3/20/97 he was still plucking badly when the collar was removed.

The Aventyl and naltrexone were discontinued and we did a brief trial on diazepam 2 mg per 4 ounces of drinking water. The diazepam is not meant to sedate and the owner was instructed to increase the dose to a maximum of 10 mg per 4 ounces of water if feather plucking continued but only if no sedation was noted. The diazepam produced no change in behavior and caused too much sedation for Echo. On 4/10/97 we began a trial on haloperidol 2 mg/ml at .015 ml by mouth once daily. The owners were instructed that they could increase the dose to maximum of .06cc of 2 mg/ml haloperidol twice daily. By 5/7/97, Echo's owners reported that they were giving .075 cc of 2 mg/ml haloperidol twice daily and he seemed to be responding nicely. On 5/17/97 the haloperidol was refilled and compounded to 1 mg/ml to facilitate easier measuring. As of 9/2/98, Echo is receiving haloperidol 0.15 mg by mouth twice daily. This is a higher dose than I have seen published in the literature but the owners are pleased with Echo's condition and do not wish to try a lower dose or even possibly wean him off the haloperidol. Echo is not experiencing any noticeable side effects from his haloperidol therapy. Currently, Echo never wears his Elizabethan collar and is totally feathered in except for his neck. I believe that 2 years of constant pressure from the collar has caused atrophy of the feather follicles around the neck.