Responsible antimicrobial use in critically ill adult horses

Abstract

Due to increasing microbial resistance, pressure on veterinarians is mounting to adhere to responsible use of antimicrobial drugs. Antimicrobials are frequently included in the treatment of systemically ill horses due to the strong likelihood of an infection and the innate difficulties in differentiating systemic inflammation secondary to non-infectious from infectious causes. In light of increasing antimicrobial drug resistance and the potential negative impact of antimicrobials on equine patients, every attempt should be made to identify non-infectious disease, choose first line antimicrobials and discontinue treatment as soon as possible. In most cases, a short duration of antimicrobial therapy ranging from a single dose (for example pre-operatively) to 24-72h might be sufficient with long-term treatment being rarely required. The article aims to provide practical guidelines for antimicrobial drug usage in critically ill adult horses by describing ancillary diagnostic aids that can help establishing whether or not an infection is present, discussing commonly encountered pathogens and their typical antimicrobial drug sensitivity patterns and providing some guidance how to safely shorten the duration of antimicrobial therapy.

The Effects of Antimicrobial Protocols and Other Perioperative Factors on Postoperative Complications in Horses Undergoing Celiotomy: A Retrospective Analysis, 2008–2021

“…Furthermore, antimicrobial drug resistance is not only a concern in the human medical field, but reports in equine veterinary medicine exist describing multidrug resistant infections with Staphylococcus, Escherichia coli, and Enterococci, as well as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococci, and rifampin-and macrolide-resistant Rhodococcus equi [28][29][30][31][32][33][34][35][36][37][38]. The impact of antimicrobial resistance on equine practice specifically, challenges to appropriate use, and the opportunity to improve clinical outcomes through responsible antimicrobial use, including in critical patients, has been emphasized in several pertinent recent review articles [25,[39][40][41][42][43][44][45]. Factors contributing to appropriate antimicrobial use, such as indication for administration, selection, dosing, timing, route, duration, modification, and therapy have been reviewed recently by Hardefeldt et al [46].…”

Room for improvement? The use of antimicrobials in equine respiratory disease

“…Any insult that alters the innate airway defence mechanisms theoretically has the potential to result in secondary bacterial infection but assessing this risk can be difficult. If the decision is taken to prescribe prophylactic or metaphylactic antimicrobials, practitioners should be ready to de‐escalate treatment if it becomes apparent that a bacterial infection is not present, rather than continuation of a set course of antimicrobials, which is now considered obsolete (Dunkel, 2020; Isgren, 2022). The host immune response should also be considered.…”