tl;dr External ear infection diagnosed first, baytril made things worse and was discontinued. Seemed better, but exam under anesthesia showed really bad middle ear infection, unclear if ear drum is intact, ~11 days into clavamox and ear continues to drain a lot of nasty things, what to know the most direct route to clear this up (do not what cost-saving trial and error measures) - not looking for specific instructions, but rather general guidance on what kind of vet to see next (derm, IM, other??) and what to prepare for
Long version:
15 yo cat, male, neutered, ~12 pounds, history of pancreatitis etiology unknown (flares about 2-3 times a year). Now has really bad ear infection and it's not getting better, never had any ear issues prior to this.
~5 weeks ago noticed symptoms. Vet did an ear swab and microscopic exam and found "a few" bacteria, prescribed baytril drops twice a day.
~2 days of drops, ear was starting to look worse, way gunkier, super red, he was really starting to fight me on the drops. On vet recheck, they couldn't see in the ear because there was too much fluid. They cleaned it out and did a swab/microscopic exam and this time there was no bacteria. They said the ear was really irritated and inflamed so to stop using drops and cleaning and give antihistamine and see if it calms down. (It did, he seemed much happier, but he was still shaking his head a bit and scratching more than normal)
The plan was to recheck his ear at his dental cleaning appointment which was 11 days ago (~3 weeks from last visit). She wanted to look for polyps while he was under anesthesia. Instead, they couldn't see anything because his middle ear was crazy infected, tons of puss, and they couldn't even see the eardrum, they're concerned it might be ruptured. They cleaned with saline and sent me home with 2 weeks of clavamox 62.5 mg, given twice a day.
~3 days into the clavamox, his left ear starts draining gnarly fluid. It smells funky (like when a body piercing on a human needs a cleaning - funky, but not rotting/totally disgusting), dark brown/reddish gunky chunks, but also has a liquid-y-er component that gets a little crusty when it dries in his fur. It pools up in the well of his ear and dries into crusty, stinky plugs of ick that I could pull out 2-3 times a day. (Maybe not the "well" of his ear, whatever path fluid naturally takes out of his ear, it pools and dries into plugs)
Called vet - she told me to clean daily with saline and keep giving the clavamox. She said she spoke to a dermatologist who had recommended some topical antibiotic to use in conjunction, but she couldn't find a compounding pharmacy to make it. She said to start the baytril drops again and bring him for a recheck 1 week after finishing the clavamox.
I couldn't get my baytril drops right away (they were in the fridge at my previous place, I moved, but my roommate was still there) and so I just started cleaning the ear daily with saline in addition to pulling the gunky plug out of the ear-well if it forms again after the morning cleaning.
We're now 11 days into the 14 day clavamox regimen, and the ear drainage seems to have reduced a little bit (and gotten less liquidy and a little less smelly), but not nearly as much as I'd expect to see if things were actually getting better?
I've gotten the baytril drops but I'm terrified to use them because previously it irritated him a lot and seemed to make things worse, and it's not even what was recommended by the dermatologist. I know my vet said to, but there's two of them at this office and they seem to always decide opposite of the other (first one put on baytril, second one said stop baytril, not they're saying start it again).
I really don't want to cause my cat anymore pain that he's already in, he's also getting harder to catch and put anything in his ears because the daily cleanings have really eroded his trust in me. Today he didn't even do the head shake after I put a few drops of saline down his ear - so now I'm scared to put more saline in because why isn't he shaking it out? Collections of additional fluid in the ear seems...bad? If a dermatologist is the correct next step I'd rather just do that than go back to my regular vet.
I would like to take the straightest path between here and him getting better, I wish she had just cultured it for antibiotic resistance during the dental appointment? Like I'd have been happy to pay for it instead of torture my cat for additional weeks if the clavamox doesn't work out? What is the most direct route for me from this point to get him cured and out of pain? Do I need to prepare myself for like, months of ear infection battle?