I do not wish to be the bearer of bad news, but part of the reason that his lungs are clear is because of the lasix. I have trouble conveying this to the owners of my small animal patients who are in congestive heart failure. I am keeping my fingers crossed for you that this was just a very severe case of pneumonia but if you cut back on his diuretic please do so under the guidance of your vet so you can make sure he doesn't develop pulmonary edema again. If it is heart failure, the more times we allow the edema to develop, the harder it is to get things managed again.
I honestly am not trying to be a pill and I REALLY hope things go well with him, but with how rapid his response was to the meds I fear the worst. Pneumonia does not generally respond to antibiotics so quickly so I am worried it was the edema responding to the lasix. I will keep my fingers crossed that he does well as you back off on the diuretics.
Are you a vet? If so that's AWESOME! :)
The only thing that makes me wonder about how he improved so quickly on naxcel, enalapril and lasix... We gave a very high dose of naxcel (20ml) IM twice daily, and started the enalapril at the same time. I didn't have the lasix on hand and she had to call it in, so we didn't actually start the lasix until the following day, and he had already shown significant improvement by the time I got the lasix home. Yes I understand that's a very quick response for pneumonia... AND I've read that enalapril's gastric absorption in equines is dubious at best.... So.... I dunno. I'm not a vet. But by the time I got the lasix home his cough was 1/4 of what it had been - and believe me, it was BAD. He was pitiful and I thought he was going to die.
I can't help but wonder about how he has responded to bactrim and naxcel. He did seem to improve ~slowly~ the 3 times he was on bactrim, BUT the cough and malaise came back after a few weeks. Then he was given high doses of naxcel and he showed improvement, but when switched over to bactrim again he started to decline... So I guess there must be some bacteria that are susceptible to bactrim, but MORE susceptible to naxcel. That's about all I can think of that would explain it.
I'm not trying to discount his heart condition. I give him his medicine faithfully and we go for walks now instead of rides... I don't stress him in any way. But I do feel very encouraged to that he's galloping through the pasture now when it's time for his triple crown senior! Man that stuff is like crack for horses! :) And he seems to tolerate galloping now. Before he couldn't even walk with me without gasping for breath. :(
So, do you have any thoughts about the antibiotic issue? And what do you think about excede (extended release naxcel) maintaining a high enough serum concentration for the duration of treatment?