Version One.

www.fvas.unimelb.edu.au/vetantibiotics
For more information and further resources visit

IN HORSES
ANTIMICROBIAL USE
POCKET GUIDE FOR
EVA & UNIVERSITY OF MELBOURNE

Antibiotic Pharmacokinetics & Pharmacodynamics

Bacteriostatic Bactericidal
“ECSTaTiC for bacteriostatic” “Very Proficient For Complete Cell Murder”
Erythromycin (macrolides) Vancomycin
Clindamycin Penicillin
Sulphonamides Fluoroquinolones
Trimethoprim Cephalosporins
Tetracyclines Carbapenems
Chloramphenicol Metronidazole

Time-Dependent Concentration Dependent

• Optimise killing by maximising time above MIC. • Optimise killing by maximising peak
concentration.
• More frequent administration or extended
infusion increases efficacy by extending T>MIC. • Higher doses at less frequent intervals increases
efficacy by maximising Cmax:MIC ratio.
• Goal exceed MIC by 1-5 times for 50-80% of
dosage interval. • Goal Cmax:MIC >8.
• E.g. penicillin, ceftiofur, TMS, tetracyclines • E.g. aminoglycosides, fluoroquinolones,
chloramphenicol. metronidazole.

Cmax Cmax

Intrinsic resistance Acquired resistance

All members of a bacterial genus or species have Previously susceptible bacteria acquire new genes
properties that make them naturally resistant to or a mutation occurs conferring resistance.
certain antimicrobials.
 Spectrum of Activity Against Common Bacteria
Refer to local antibiogram for susceptibility rates (if available).

Procaine Penicillin

Ampicillin

Doxycycline

Oxytetracycline

Trimethoprim sulpha

Chloramphenicol*

Gentamicin

Metronidazole

Ceftiofur

Azithromycin + rifampin
Clarithromycin or

Enrofloxacin

Amikacin
Drug

Bug

Beta-haemolytic streptococci 4 + ± ± ± + IR + + IR
Staphylococcus aureus ¥ ± ± ± ± + ± + ±
Enterococcus faecalis ¥ + 4 ± ± IR ± IR IR ± IR
Enterococcus faecium ¥ ± ± IR ± IR IR ± IR
Rhodococcus equi 4
Escherichia coli ¥ IR ± ± ± ± ± 4 + + +
Klebsiella spp. ¥ IR IR ± ± ± 4 ± ± +
Enterobacter spp. ¥ IR IR ± ± ± ± ± ± + +
Pseudomonas aeruginosa ¥ IR IR IR IR IR IR 4 IR ± +
Actinobacillus equuli ± ± 4 4 4 ± 4 + + +
Pasteurella spp. 4 + + + ± ± 4 + + +
Lawsonia intracellularis 4 4
Bacteroides spp. IR IR ± ± + IR + IR
Clostridium spp. 4 + ± ± IR + ± IR
Traffic-light system is based on ASTAG antimicrobial importance rating system.
4 Drug of choice.
+ Good susceptibility.
± Variable susceptibility.
IR Intrinsically resistant.
* Chloramphenicol is prohibited for use in animals that may enter the food chain, which includes horses in some states.
Check legislation in your jurisdiction.
¥ Susceptibility is poorly predictable, culture and susceptibility testing is strongly recommended.

EVA & UNIVERSITY OF MELBOURNE

POCKET GUIDE FOR

ANTIMICROBIAL USE
IN HORSES
For more information and further resources visit
www.fvas.unimelb.edu.au/vetantibiotics
Version One.

As part of our commitment to the implementation of the National

Antimicrobial Resistance Strategy 2015-2019, AgVic has created
Play your part in preventing
education materials about antimicrobial resistance (AMR) and
antimicrobial stewardship (AMS).
antibiotic resistant infections.
The resources aim to provide a practical guide for the prescribing For more information visit
of antimicrobials that can help start the conversation about AMR
with clients. You can order our resources by emailing agriculture.vic.gov.au/amr
[email protected]
 * Many of the recommendations in this guide represent off-label

Antibiotic Pharmacotherapy

use of antimicrobials. Compliance with the legal requirements
of your jurisdiction is your responsibility.

by Class ** Exceptional circumstances defined as use in an individual

animal based on culture and susceptiblity, where there is no
effective alternate therapy and a reasonable chance of survival.

Drug Importance Antibiotic Route Drug Dose Adverse Reactions Clinical Pearls
Class Rating

Low Procaine penicillin IM 22,000 IU/kg Diarrhoea. Procaine reaction: Drug of choice for streptococcal infections.
(22 mg/kg) q12h Inadvertent intravascular administration Excellent anaerobic activity (except
of procaine resulting in CNS excitation Bacteroides spp.). Often combined with
and frantic, uncontrollable behaviour that gentamicin for broad spectrum coverage.
generally resolves in minutes. Always draw back to check for blood before
injecting and keep penicillin refrigerated
Penicillin hypersensitivity reactions: to reduce risk of procaine reaction.
urticaria, anaphylaxis, immune mediated Long acting penicillin formulations are
haemolytic anaemia. not suitable for use in horses as they
Low Benzylpenicillin IV 22,000 IU/kg aren’t long acting and don’t reach
(13 mg/kg) q4-6h therapeutic concentrations.
Beta-lactams

IU 5 million IU for Secondary bacterial infection, fungal Uterine lavage and ecbolics are the primary
Streptococcus infection. focus of endometritis therapy. Uterine
zooepidemicus fluid/exudate may inactivate or dilute
antibiotics. Inactivated in solutions with
pH <5.5 or >8, do not mix with gentamicin,
sulphonamides or sodium bicarbonate.
Antibiotic use should be guided by culture,
cytology and ultrasound findings.

Low Ampicillin sodium IV/IM 20 mg/kg q6-8h Ampicillin trihydrate irritant when injected IM. Greater activity against gram-negative
bacteria than penicillin.

High Ceftiofur IM/IV 2.2-4.4 mg/kg iarrhoea, muscle soreness, hypersensitivity

D Reserve for multi-drug resistant infections.
q12-24h - urticaria, anaphylaxis. Does not cross BBB. Ceftiofur is rapidly
(Up to 10mg/kg metabolised to desfuroylceftiofur to which
IV q6h has most coagulase positive staphylococci are
been used in resistant (may appear susceptible in vitro
neonatal foals) but not in vivo).

Medium Gentamicin IM/IV 6.6 - 9.7 mg/kg Nephrotoxic. Muscle soreness if given IM. Generally drug of choice for suspected
q24h (adults) Hypersensitivity reactions (rare). or confirmed gram negative infections.
No anaerobic activity. Streptococci &
IM/IV 8.8 - 12 mg/kg enterococci are intrinsically resistant.
q24-36h (foals) Inactivated by purulent material. Must
penetrate bacteria to assert their effect,
IU 1-2 g buffered with Irritates endometrium or induce which is enhanced by drugs that interfere
equal volume of depigmentation of vulvar skin if not with cell wall synthesis – e.g. penicillin.
Aminoglycosides

7.5% bicarbonate buffered. Secondary bacterial infection, Not effective clinically against Salmonella
and diluted in fungal infection. spp. but may appear susceptible in vitro.
200ml saline. If kidney function is reduced, increase
inter-dosing interval.

High Amikacin IV 10mg/kg q24h Nephrotoxic. Use severely restricted in human medicine.
(adults) Not registered for use in animals and should
not be used off-label except in exceptional
circumstances**. Reserve for documented
gentamicin resistant, amikacin susceptible
IV 25 mg/kg q24h infections where no alternative. No anaerobic
(foals) activity. Streptococci & enterococci are
intrinsically resistant. Inactivated by purulent
material. Not effective clinically against
Salmonella spp. but may appear susceptible
in vitro. Can be used IA.

Low Doxycycline PO 10 mg/kg q12h Diarrhoea. Bone/tooth discolouration. xcellent broad-spectrum activity, good
E
DO NOT GIVE IV – FATAL. anaerobic coverage but variable for
Bacteroides and Clostridium spp. Drug
of choice for Lawsonia intracellularis infection.
Doxycycline bioavailability reduced by
feeding; withhold feed before and shortly
after dosing. Doxycycline can be used in
horses with renal failure. Distributes well
into pulmonary, peritoneal and synovial
Tetracyclines

fluid and concentrates in urine.

Low Oxytetracycline IV 6.6 mg/kg q12h ypotension & collapse if rapid IV

H xcellent broad-spectrum activity, good
E
administration of oxytetracycline. Renal anaerobic coverage but variable for
tubular necrosis with high doses (i.e. for Bacteroides and Clostridium spp. Drug of
neonatal foals with contracted tendons). choice for Lawsonia intracellularis infection.
Bone/tooth discolouration. Colitis. Very Distributes well into pulmonary, peritoneal
irritant if extravascular or intramuscular. and synovial fluid and concentrates in urine.
High dose oxytetracycline causes tendon
relaxation in foals with congenital contracted
tendons (not acquired) and is most efficacious
when given in the first 3 days of life (20 mg/
kg IV). Care in foals that are, or may be,
dehydrated due to renal effects; consider
administration in 1L hartmans.

Low Trimethoprim- PO/ 30 mg/kg q12h Diarrhoea. Thrombocytopaenia with Excellent broad-spectrum activity.
Sulphonamides

sulphonamide slow prolonged use. Rapid IV administration Inactivated by purulent material.

IV can cause tremors and collapse. Concurrent Undergoes urinary excretion therefore
detomidine can result in dysrhythmia, useful for urinary tract infections.
hypotension and death. Concurrent penicillin
is antagonistic to sulphonamides. Irritant if
given IU or IM.
 Low Erythromycin PO 25 mg/kg q6h Severe colitis in adults, variable diarrhoea Do not use in adults. Generally only used in
Macrolides
in foals. Altered thermoregulation in foals foals with Rhodococcus equi, in combination
Clarithromycin PO 7.5 mg/kg q12h (hyperthermia), which seems more common with rifampin. Can be used in young foals
with erythromycin. with Lawsonia intracellularis infection but
Azithromycin PO 10 mg/kg q24h not first line choice.

High Rifampin PO 5 mg/kg q12h Body fluids turn orange. Empiric use only for Rhodococcus equi, in
Antagonistic to gentamicin. combination with a macrolide. Otherwise
Ansamycin

only use in exceptional circumstances**

based on culture and susceptibility and
no effective alternative. Never use alone,
resistance can develop within hours when
used as monotherapy.

High Enrofloxacin PO/ 7.5 mg/kg q24h OCD in young horses. DO NOT USE IM, IA, IU Should be reserved for multi-drug
Nitroimidazoles Fluoroquinolones

slow or as IVRP as causes necrosis and fibrosis. resistant infections based on culture
IV Oral paste has been associated with severe and susceptibility results and no effective
oral ulceration. Colitis. Fluoroquinolone lower importance rating option. Generally
have also induced tendonitis in juveniles. avoided in horses < 4 years of age and
during pregnancy. Synergism with
beta-lactams and aminoglycosides.

Medium Metronidazole PO 25 mg/kg q12h Inappetence. Can cause neurological signs Excellent anaerobic activity. Use is generally
if underlying hepatic disease. combined with penicillin and gentamicin
for broad spectrum coverage where
anaerobes are suspected to be contributing
(pleuropneumonia, peritonitis). Indicated in
cases where Bacteroides spp. may be involved.

Low Chloramphenicol PO 50 mg/kg q12h Wear gloves and mask when crushing Broad spectrum. Prohibited for use in
tablets for horses as idiosyncratic aplastic animals that may enter the food chain
anaemia (not dose related) can develop -which includes horses in some states.
Phenicols

in people handling this drug. In horses, Check legislation in your jurisdiction.

dose-related anaemia and pancytopenia Do not give concurrently with penicillin,
may develop with prolonged treatment. gentamicin, fluoroquinolones or macrolides.
Hepatic clearance of phenytoin, phenobarbital,
phenulbutazone and xylazine is decreased.

High Polymyxin B slow 5000 U/kg Nephrotoxic. Generally only used systemically to combat
Polypeptides

IV q 8-12 hrs endotoxaemia. Care should be taken as

(anti-endotoxin endotoxic patients often have impaired
dose) renal perfusion.

High Virginiamycin PO 5g/100kg q24h High importance antimicrobial - banned Founderguard - reduces fermentative
Streptogrammins

for Equine use in UK 2014. acidosis in the hindgut and may aid in the
prevention of pasture-associated laminitis.

Low Sodium iodide IV 20-40 mg/kg Iodinism. Generally used for chronic fungal or
Other

q24h bacterial infections where antimicrobial

penetration may be poor.

Antibiotic use in Horses

Stop, Think, Choose wisely
W IMPORTA H IMPORTA
LO NC DIUM IMPORT HIG NC
ME AN
E

Ceftiofur #
E

Ampicillin *
CE

Doxycycline * Enrofloxacin * # §
Oxytetracycline
Penicillin
Gentamicin § Virginiamycin §
‡
Neomycin
Metronidazole § ‡ If no alternative, PREVENTION
FIRST, treatment as last resort.

Trimethoprim Clarithromycin or
sulphonamides Azithromycin PLUS
Rifampicin * †
§ Prohibited
if food chain
* An antibiotic
product is not
is a possible
# Use only in an
destination. individual animal
registered for use
in this species, in exceptional
check your legal circumstances, after
culture and sensitivity
obligations HIGHLY IMPORTANT †ONLY use Rifampicin testing, if there is no
before using. ANTIMICROBIALS - AVOID and macrolides in alternative.
combination as above
Amikacin Ticarcillin-clavulanate for R.equi
Imipenem Vancomycin