Antimicrobial use in critically ill horses

Area of Science:

• Veterinary Medicine
• Equine Infectious Diseases
• Antimicrobial Stewardship

Background:

• Antimicrobial resistance is a growing concern in veterinary medicine, influencing treatment protocols for critically ill horses.
• Veterinary practices often lack high-level evidence to guide antimicrobial use, leading to common dilemmas.

Purpose of the Study:

• To discuss controversies and provide insights into antimicrobial use in critically ill horses.
• To highlight challenges in antimicrobial selection and duration of treatment.

Main Methods:

• Comprehensive PubMed literature searches from 1970 to the present.
• Keywords included "horse," "foal," "antimicrobial," "prophylaxis," "infection," "surgery," "sepsis," and "antimicrobial resistance."

Main Results:

• Increasing antimicrobial resistance necessitates changes in first-line drug choices and shorter treatment durations.
• Reserved antimicrobials pose dilemmas, and differentiating infectious from non-infectious diseases is challenging.
• Evidence for antimicrobial use in neonatal sepsis, colic surgery, and colitis is limited, with shorter durations potentially being effective.

Conclusions:

• Evidence-based recommendations for antimicrobial use in horses are scarce.
• Antimicrobial treatment is crucial for neonatal sepsis but should be shortened post-recovery.
• Prophylactic antimicrobial use beyond three days for colic surgery and for adult horses with diarrhea is likely unnecessary.