Drug therapy in the neonatal foal

The neonatal period in foals refers to the first 7 days of postnatal life. The effects of drugs (pharmacologic agents) may be different in neonatal foals, particularly during the first 3 days of postnatal life, from those in older foals and adult horses. The changed drug effects decrease as the physiologic processes that affect absorption, distribution, and elimination (metabolism and excretion) of drugs mature. Dosage regimens should take into account the altered pharmacokinetic profiles of drugs, and because of wide individual variation, the response to therapy should be closely monitored for signs of toxicity. In conjunction with the prudent use of drugs, good nursing care and the provision of supportive therapy are critical in the management of neonatal foal diseases. Over-crowding imposes stress upon young foals and predisposes them to an increased incidence of bacterial and parasitic infections. The collection of specimens for precise microbiologic diagnosis and correction of deficits in serum immunoglobulins should precede antimicrobial therapy. Although E. coli is by far the most common cause of bacterial infections in neonatal foals, other bacterial pathogens of unpredictable susceptibility often cause infection. The selection of an antimicrobial drug for specific therapy should be based on both the microbiologic (quantitative susceptibility) and pharmacologic (pharmacokinetic) properties of the drug. The use of an antimicrobial drug or combination of drugs that will produce a bactericidal effect is highly desirable. Whenever possible, a parenteral preparation that can be administered intravenously should be chosen. The bioavailability and selectivity of action of pharmacologic agents are influenced by the dosage form and route of administration. Diazepam is the sedative drug of choice for neonatal foals. Cimetidine, an H2-receptor antagonist, may be indicated in foals diagnosed to have gastric ulcers; hepatic microsomal oxidative metabolism of drugs administered concurrently with cimetidine is decreased. Nonsteroidal anti-inflammatory drugs (flunixin, phenylbutazone) have a higher incidence of toxicity in foals and, when indicated, should be used at lower dosage than in adult horses. Even though it is highly important to maintain hydration status and electrolyte balance, intravenous infusion should always be performed slowly. Immature renal function decreases the ability of the neonatal animal to excrete excess fluid. The use of drugs in neonatal foals requires greater precision in dosage, more attention to the route and rate of administration, and close monitoring of pharmacologic effects.