Gentamicin in a Leopard Gecko with Gout

Samurai Drifter

New member
Hello! Sorry in advance for the long post. If anyone does happen to read it, and is able to weigh in, I'd be very appreciative.

My roughly 15-year-old leopard gecko Merlin was recently diagnosed with early stage gout, which the vet believed was due to age-related decline in kidney function. He's got mild swelling in his front legs and back knee. At the vet's advice, I began administering .05 mg of allopurinol per day (extremely easy, I just drip it onto one of his crickets). I've also been giving him warm baths with a little bit of cherry extract, which I've read as an effective treatment for gout in both humans and reptiles.

Shortly after I got him back from the vet, he shed again, and while he did not have any immediately apparent retained shed this time, he started keeping his left eye closed after shedding. He usually opens it up after I get him out and start handling him, and I can see when he opens it that the eye appears to be red and mildly cloudy.

Rather than stress my gecko out by bringing him into the vet again in our cold weather climate (I live in Minnesota and it's in the 30s-40s right now), especially because it's been raining almost non-stop for a week, I called and described what I was seeing to him over the phone. He prescribed gentamicin eyedrops to treat a possible infection, and basically said that it wouldn't hurt anything if it wasn't an eye infection. So I went and picked up the eyedrops.

The only problem is, having heard of negative side-effects certain antibiotics can have on the kidneys in the past, I did some research and found a number of articles citing the nephrotoxic side-effects of gentamicin, which are apparently particularly notable. Even if it's only used topically, he's definitely going to be licking his eyes, which will result in the oral consumption of the medication. If his kidneys are already compromised, the last thing they need is more damage from antibiotics. However, at the same time, I can't let an infection run rampant.

As of right now, I'm washing it out with basic, sterile eye-wash from the drugstore until I figure out what to do. It is worth noting that the eye appears less clouded today than yesterday.

So, the vet has already been seen- the clinic came recommended by the University of Minnesota as the best clinic for reptiles, and the vet I saw is the reptile specialist. The question is whether I trust his prescription, given what I've read about gentamicin. People make mistakes, and it was something he prescribed at a moment's notice. This is also a pretty specific, unusual problem he may not have even had occasion to deal with before, though he did specifically say that the eyedrops would not interact negatively with the allopurinol.

Basically, I was just wondering if any of you had any experience using gentamicin to treat eye infections, or had used it on any reptiles that had gout and/or impaired kidney function? Also, I'd just be interested to hear your more experienced opinions. Even though I've had Merlin around for over 15 years now, and know a little about caring for leopard geckos, he is the first one I've had and I'm not an expert on their health problems. So any advice would be appreciated. Should I administer the eyedrops and trust the vet, despite what I've read? Should I continue washing out his eye a little bit longer to see if it shows further improvement on its own, and consider antibiotics a last resort? Should I consult with another reptile vet?

Merlin's gout has been so under control since it was diagnosed that I would hate to have a medical mishap reverse his situation and send him downhill. Besides his mildly swollen joints, you'd never know he had gout. He's active and has as good of an appetite as he's ever had (and has for the month and a half since the swelling was noted- hasn't obviously increased since then) so my hopes are relatively high that he has the opportunity to continue living a happy life for some time.

TLDR: Is it okay to give an old leopard gecko Gentamicin drops for an eye infection if he already has early stage gout?

Basic Information
Species of lizard: Leopard Gecko
Gecko's name: Merlin
Morph: Unknown
Gender: Male
Age: ~15 years old
Weight: 50 grams

Enclosure dimensions (length x width x height): 20 gallon long
Substrate provided: Reptile carpet

What type and brand of thermometer (digital with probe, temperature gun, LCD strip, analog (circle), combo digital thermometer/hygrometer, stainless steel aquarium type, other): Analog thermometer is used to monitor ground and air temperatures
What is the ground temperature right on the substrate under the warm dry hide: 90 degrees
What is the air temperature on the warm end about 4 inches up from the ground: ~80 degrees
What is the air temperature on the cool end about 4 inches up from the ground: 70s
What device(s) are used to maintain the temperature (Under Tank Heater, heat light, Ceramic Heat Emitter, Flexwatt heat tape, hot rock, other): Under Tank Heater and red basking light. UVB light for short periods every day as a source of D3.

Insects and worms, list type: Crickets, mealworms, hornworms
Regular diet fed to the insects: Zoo Med Adult Bearded Dragon food & Flukers Cricket Quencher (calcium-fortified).
Regular diet fed to the worms: Have not typically gut-loaded my worms. Hornworms I feed as quickly as possible after picking them up from the pet store to avoid them growing too much. Mealworms I keep around in case I run out of crickets, and pretty much just keep them in the fridge in their original packaging.

How often do you feed your gecko? Daily since his gout diagnosis (I use a cricket to administer allopurinol, and I want to make sure he's getting as much nutrition as possible), before that, several times a week.
Please list any supplements (with brand names) used. How are they given and how often? Crickets are dusted with pure calcium. There's also a pure calcium (no D3) dish in his enclosure. D3 is obtained via limited usage of a UVB light.

If your gecko is sick, please describe the signs and how long your gecko has been showing these signs: Swollen legs/back leg joint for approximately 1 1/2 months. Within the past several days, squinty left eye, cloudy and red when open.


Additional Information

General
Gecko's total length:
Length of your reptile when you first acquired it: He was tiny, and I got him when I was 12 years old, so I'm having difficulty remembering.
Source (pet store, breeder, previous owner): Probably a large chain pet store (PetCo, PetSmart, etc).
Captive bred or wild caught: Unknown, but probably captive bred.

Vivarium
Number of hides: 3
Location of hides: One on cool side, two on warm side.
Is there a humidity hide? location? Yes, one on the warm side.
Please describe any other furnishings: There's a decorative animal "skull" and a desert log.
List recent changes in the environment, if any:

Lighting
Artificial lighting
Incandescent ("screw-in type bulbs): wattages: 75w red basking bulb. UVB light, which is on for approx. 2-3 hours per day.
Fluorescent (tube bulbs):
Access to ambient daylight from a distant window: Yes, during the day I keep the blinds slightly open to allow a small amount of sunlight into the room he's in.

Heating
Ventilation space for your UTH by elevating the tank above the shelf (some UTHs come with sticky feet for the tank corners): Yes
Are you using a thermostat(s)? Yes
Which hide does she/he spend most of her time? Splits time between warm humid and cool dry hides. Seems to prefer the humid hide a bit lately.
Is the temperature decreased at night? by how much?

Humidity
Is the humidity measured? Yes
Humidity range:

Diet
Are the insects and worms formally “gutloaded” 1-2 days prior to feeding off to your gecko? If so with? The crickets are gutloaded with bearded dragon food.
What calcium brand are you using? with D3, without or both? Both, depending on how much time he has spent under the UV Lamp
Is the calcium in the tank with D3 or without? Without.
Multivitamins (include brand name)? No.
Please list any recent additions/changes in the diet: Added the occasional Horn worm.

General Health
Is your gecko’s general activity level normal, decreased, or increased? About a month ago we got him a bigger cage that includes a hide that is kept constantly moist. He also is getting Allopurinol for gout. For the last few weeks he has been more energetic.
Is your gecko’s appetite normal, decreased, or increased? Increased since improving his environmentand introducing Allopurinol.
Have you noticed any of the following?
Weight (loss or gain): No
Discharge from the eyes or nose: YES. Once, had what looked like a tear drop with a little bit of red color in it immediately after eating crickets. This came out of the problem eye.
Increased breathing rate or effort: No
Change in the droppings: Slightly more frequent, but it looks healthy and does not happen more than 2x perweek.
Urates
---white or yellowish: They had been yellowish a couple of weeks ago, but they have gotten less yellow and the one from yesterday did not look yellow.
---size of urates as compared to size of feces: Previously 1:1, now 1:3
Abnormal skin color or shedding: Has had shedding problems in the recent past.
Parasites on the skin or in the feces: No
Weakness: No
Regurgitation: No

Previous problems and/or illnesses: Gout, shedding problems

Other Critters in Same Cage or in Household: Cat in the household, but is kept out of the room.
List other animals that are kept in the same cage: None
Recent acquisitions (new pets within the past 6 months): None
Are any of your other pets ill? No
 

Elizabeth Freer

Well-known member
I called and described what I was seeing to him over the phone. He prescribed gentamicin eyedrops to treat a possible infection, and basically said that it wouldn't hurt anything if it wasn't an eye infection. So I went and picked up the eyedrops

TLDR: Is it okay to give an old leopard gecko Gentamicin drops for an eye infection if he already has early stage gout?

If your gecko is sick, please describe the signs and how long your gecko has been showing these signs: Swollen legs/back leg joint for approximately 1 1/2 months. Within the past several days, squinty left eye, cloudy and red when open.

Discharge from the eyes or nose: YES. Once, had what looked like a tear drop with a little bit of red color in it immediately after eating crickets. This came out of the problem eye.
How long ago did that red tear drop occur?

I don't know whether giving Gentamicin eye drops is OK when early stage gout has been diagnosed.
  • Was this the same vet who diagnosed the gout?
  • Do normal saline flushes help?
  • Does Merlin open his left eye at night when the red basking light and the UVB are off?
  • How often are you dusting his feeders with plain calcium?
  • What type and brand of D3 calcium? How often used?
  • How come no MVs? just now or never?
 
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Enzyme_Zoo

New member
Thanks very much for your reply! I am Merlin's secondary caretaker.

[*]How long ago did that red tear drop occur? Day before yesterday

[*]Was this the same vet who diagnosed the gout? Yes

[*]Does Merlin open his left eye at night when the red basking light and the UVB are off? Yes. He sometimes opens his bad eye at night when his red light is on. It's also open when we handle him for baths and when he's hunting.

[/LIST]

I'm not sure about the other answers. I'll ask Samurai Drifter when he gets home from work. We can also post pictures.
 

Samurai Drifter

New member
How long ago did that red tear drop occur?

Day before yesterday.

I don't know whether giving Gentamicin eye drops is OK when early stage gout has been diagnosed.
That's alright, I honestly don't know if anyone has a clear-cut answer. I found one scientific paper describing gentamicin-induced gout in snakes, but the sample size was extraordinarily small (2 individuals), it was being administered internally, and the dosages were not necessarily comparable. So, to an extent, it seems to be uncharted territory.

  • Was this the same vet who diagnosed the gout? Yes
  • Do normal saline flushes help? Not 100% sure. His eye does look less cloudy today, but it's still quite red. My uneducated guess would be that it's improving, but I'm not certain enough to risk his health, so I started him on the gentamicin tonight.
  • Does Merlin open his left eye at night when the red basking light and the UVB are off? Not always open, but he definitely opens it more frequently. He also opens it when I handle him.
  • How often are you dusting his feeders with plain calcium? Almost every feeding. Maybe 6/7 times in a week.
  • What type and brand of D3 calcium? How often used? Since starting with the UVB light I have not dusted with D3-fortified calcium, as I've heard that can lead to an overdose of D3. However, before utilizing the UVB, like 1-2 times per week. I've used multiple brands; currently I have National Geographic Calcium with D3 and ExoTerra pure calcium.
  • How come no MVs? just now or never? I assume MVs means multivitamins, which was mentioned in the questionnaire. I have not given Merlin multivitamins (outside of calcium with D3) and had honestly not heard of doing so. I believed the purpose of gutloading was to ensure sufficient intake of other nutrients like vitamin A, and have tried to ensure that I gutload with vitamin-rich foods like Bearded Dragon food. If additional supplementation is needed I can definitely order some.

So basically, weighing the options and examining his eye tonight, I decided that the immediate issue of the potential eye infection outweighed the more long-term issue of gout, especially given the eye medication has been prescribed for a relatively short 10-day run. So I started him on the eye medication and will document the outcome in this thread to hopefully add to the knowledge base.
 
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Elizabeth Freer

Well-known member
Does Merlin open his left eye at night when the red basking light and the UVB are off? Not always open, but he definitely opens it more frequently. He also opens it when I handle him. Is he in total darkness at night to do his thing?

How often are you dusting his feeders with plain calcium? Almost every feeding. Maybe 6/7 times in a week. Are his jaws firm? No MBD? Even lightly dusting plain calcium carbonate 6-7 times per week is too frequent.

What type and brand of D3 calcium? How often used? Since starting with the UVB light I have not dusted with D3-fortified calcium, as I've heard that can lead to an overdose of D3. However, before utilizing the UVB, like 1-2 times per week. I've used multiple brands; currently I have National Geographic Calcium with D3 and ExoTerra pure calcium.

How come no MVs? just now or never? I assume MVs means multivitamins, which was mentioned in the questionnaire. I have not given Merlin multivitamins (outside of calcium with D3) and had honestly not heard of doing so. I believed the purpose of gutloading was to ensure sufficient intake of other nutrients like vitamin A, and have tried to ensure that I gutload with vitamin-rich foods like Bearded Dragon food. If additional supplementation is needed I can definitely order some.
In addition to the best dry diet + veggies that one can afford, it's a very good idea to lightly dust with multivitamins to cover all bases. Check out the Reptile Supply Company in California for excellent prices on reptile supplies. The RSC sells Cricket Crack too!

How long have you been feeding insects/worms Zoo Med's Natural Adult Bearded Dragon Food?

How long has he been under UVB?

I like and use Zoo Med's supplements. I'd order some Zoo Med Reptivite multivitamins without D3 and use according to the following schedule.


#126---Monthly Feeding & Supplement Schedule for leopard geckos 18 months old +
Adapted for 15 yo Merlin who has UVB

Feed an adult leopard gecko crickets or dubia 2x per week and mealworms 1x per week:
Crickets or dubia>Monday
Crickets or dubia>Thursday
Mealworms>Saturday

  • Use plain (no D3) Zoo Med ReptiVite multivitamins lightly dusted on crickets or dubia 1x per week. Maybe only half of them.
  • Use some plain precipitated calcium carbonate (purer than oyster shell calcium). The NOW brand sold in health foods stores is ideal.
Feed finely ground Zoo Med's Natural Adult Bearded Dragon Food (or an equivalent high quality dry diet) 24/7 to the insects and worms to cover the basics. Add high calcium, low phosphorus veggies like collard greens, mustard greens, turnip greens, and pesticide-free dandelion flowers/greens in a dish off to the side for extra calcium and for moisture! Vary your leopard gecko's diet. Crickets, Blaptica dubia, hornworms, Phoenix worms, and silkworms are all good.

Nutritional Comparisons of Insects & Worms

Monthly Schedule for Leos 18 months old +
Week 1:
Crickets or dubia>Monday- Zoo Med Reptivite multivitamins without D3
Crickets or dubia>Thursday- plain calcium carbonate
Mealworms>Saturday

Week 2:
Crickets or dubia>Monday- Zoo Med Reptivite multivitamins without D3
Crickets or dubia>Thursday- plain calcium carbonate
Mealworms>Saturday

Week 3:
Crickets or dubia>Monday- Zoo Med Reptivite multivitamins without D3
Crickets or dubia>Thursday- plain calcium carbonate
Mealworms>Saturday

Week 4:
Crickets or dubia>Monday- Zoo Med Reptivite multivitamins without D3
Crickets or dubia>Thursday- plain calcium carbonate
Mealworms>Saturday

Week 5:
Repeat.....
 

Samurai Drifter

New member
Retroactive and long overdue "thank you" for your supplementation schedule, Elizabeth! I have adapted his schedule to match this more closely.

As an update, I did finish the course of antibiotics, and it does not seem to have made Merlin worse. I should have just trusted the vet from the beginning, I guess. It didn't totally fix his eye (still closed/squinty all the time), but the cloudiness did go away.

I also figured it would be a good idea to include a general status report, just for the benefit of anyone else attempting to research what they can expect out of caring for a Leo with gout, and community knowledge.

Time since diagnosis: approximately 2 months.

Medication/Treatment: 0.5 mg allopurinol daily. Most days receives a bath in a 3:1 water to pedialyte mixture, occasionally mixing in cherry extract (have heard this is good for gout on other reptile forums. Vet said he wasn't aware of studies showing its effectiveness, but that it wouldn't hurt).

General Status: Active with a good appetite (almost bit my finger when I was dropping in his cricket earlier). Weight is normal. Feces are normal.

Signs/Symptoms: Definitely consuming more water than normal, which is likely related to the decline in kidney function. The swelling of his limbs has not progressed very noticeably, but there does seem to be greater opacity in certain areas on his underside, such as where the forelegs meet the body. There is decreased mobility of joints. Spends the vast majority of his time on the warm side of his tank, though that may also be due to the fact that it's winter here and I live in a very cold environment, so it sometimes gets cold in my room.
 
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Elizabeth Freer

Well-known member
You're so welcome, Samurai Drifter! I'm happy Merlin's gout has stabilized.

Your post is awesome. I, too, hope others can benefit from these details. :)

I've PMed you.
 

Samurai Drifter

New member
Final update- Merlin passed away this morning at the age of 15 1/2. Even though he hadn't been moving much over the past few days, he crawled into his cave sometime last night and laid on his comfy moss bed. I saw him move a little this morning, but by the time I lifted his cave, he was gone.

He was my friend and companion for over 15 years, since he was a tiny baby gecko. I'll never forget him.
 

Elizabeth Freer

Well-known member
I'm very sorry to hear of Merlin's passing. Thanks for sharing. Treasure him always; focus on the good times. 15.5 years is a pretty long life for a leo.

Here's a rose to ease your pain: @}--;- -
 
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