Antibiotic Pharmacokinetics & Pharmacodynamics: Bacteriostatic Bactericidal
Antibiotic Pharmacokinetics & Pharmacodynamics: Bacteriostatic Bactericidal
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IN HORSES
ANTIMICROBIAL USE
POCKET GUIDE FOR
EVA & UNIVERSITY OF MELBOURNE
Cmax Cmax
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.
Antibiotic Pharmacotherapy
use of antimicrobials. Compliance with the legal requirements
of your jurisdiction is your responsibility.
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.
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
Low Trimethoprim- PO/ 30 mg/kg q12h Diarrhoea. Thrombocytopaenia with Excellent broad-spectrum activity.
Sulphonamides
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
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
High Polymyxin B slow 5000 U/kg Nephrotoxic. Generally only used systemically to combat
Polypeptides
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
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