Equine Health Update EHU Vol 20 Issue 03 - Page 38

EQUINE | CPD Article Treatment Rapid and aggressive therapy is required once a diagnosis of pleuropneumonia is made 7 as treatment costs, duration of therapy and positive outcome or return to athletic function are directly influenced by delay 5 16 . As most horses will need to be transported to a facility where pleural drainage and lavage, intravenous fluid administration and monitoring for complications can be done 17 , broad spectrum antibiotics should be administered prior to referral (in consultation with the referral center), regardless if a pleural effusion sample has been obtained or not. Antimicrobial drugs to be considered initially 3 6 9 are B-lactam penicillins: 44000 IU/kg IV q4-6hr [broad spectrum; anaerobes], aminoglycosides: gentamicin: 6.6mg/kg IV q24hr [aerobes, gram negative] and metronidazole: 20mg/kg IV q8hr, or 35mg/kg per rectum q12hr 3 [anaerobes]. Cephalosporins: ceftiofur : 2.2 -4.4mg/kg IM q12hr 3 may also be considered. Once the culture and sensitivity results are received, antimicrobial therapy should be re-evaluated and adjusted accordingly 2. Haematology and biochemistry may reveal an inflammatory leucogram – neutrophilic leucocytosis, hyperfibrinogenaemia and hyper gammaglobuline- mia 3 10 11 . The patient should remain on parental antimicrobial administration for at least 7 – 14 days 3 9 11 , and should exhibit good clinical improvement3 before switching to oral medication 9 11 . Oral antimicrobial therapies to consider are enrofloxacin, erthyromycin, rifampicin and chloramphenicol (with the consideration of human health risk ) 11 . Trimethoprim sulphonamides are seldom effective given the type of organisms implicated 3 . Drug cost, availability, route and owner compliance 3 must also be considered 11 as the horse may require medication long term; in some cases for at least 2 -4 months 11 . Arterial blood gas values may indicate the extent of the respiratory compromise and hypoxemia 10 . The patient’s hydration status is very important and must be assessed before the administration of Images of a chest drain in the right hemithorax draining a haemorrhagic effusion 38 • Equine Health Update •