Management of Suspected Bacterial Stomatitis in a Ball Python (Python regius) Based on Cytological Findings and Azithromycin Therapy: A Case Report

Rizal, Muhammad Farid; Alya, Itfa; Sudarsyah, Hilma Luthfia; Saputri, Rachma Ayu; Amien, Suseno

doi:10.22092/ari.2026.372165.4044

Management of Suspected Bacterial Stomatitis in a Ball Python (Python regius) Based on Cytological Findings and Azithromycin Therapy: A Case Report

Articles in Press

Document Type : Case Study

Authors

¹ Doctorate Student In Primatology, Primatology Program, School of Post Graduated Bogor Agricultural University

² Veterinary Study Program, Padjadjaran University, Sumedang, Indonesia

³ Urban Animal Pet Care Clinic, Bandung, Indonesia

⁴ Biotechnology Study Program, Padjadjaran University, Bandung, Indonesia

10.22092/ari.2026.372165.4044

Abstract

Background: Stomatitis is a common inflammatory condition in reptiles and represents a significant clinical concern due to its association with pain, anorexia, impaired feeding, and the potential for secondary or systemic infection. In snakes, opportunistic bacteria originating from the normal oral microflora frequently contribute to disease development when mucosal integrity is compromised by trauma, stress, or suboptimal husbandry. In clinical practice, limited access to bacterial culture and antimicrobial susceptibility testing often necessitates the use of cytology-based assessment and empirical antimicrobial therapy as an initial management approach. Case Description: A ball python (Python regius) was presented with a one-month history of anorexia and visible oral lesions consistent with stomatitis. Physical examination revealed marked oral mucosal inflammation accompanied by caseous exudate. Cytological examination of an oral swab stained with Diff-Quik demonstrated the presence of streptobacilli and Gram-positive cocci, indicating bacterial involvement. Due to the unavailability of microbiological culture and susceptibility testing, empirical antimicrobial therapy with azithromycin was initiated at a dosage of 10 mg/kg body weight. Results: Following seven days of azithromycin therapy, the snake showed marked clinical improvement. Oral inflammation and caseous exudate were substantially reduced, the mucosal surface appeared cleaner and closer to normal, and the animal exhibited increased activity and renewed interest in feeding. No adverse drug reactions or clinical deterioration were observed during the treatment period. Conclusion: Cytology-guided empirical azithromycin therapy resulted in favorable clinical improvement in a ball python with suspected bacterial stomatitis. This approach may serve as a practical and effective initial management strategy in clinical settings where advanced microbiological diagnostics are not readily available. However, bacterial culture and antimicrobial susceptibility testing remain essential for definitive diagnosis, appropriate antimicrobial stewardship, and optimization of treatment protocols whenever feasible.

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