Efficacy of Tulathromycin for the Treatment of Foals with Mild to Moderate Bronchopneumonia

Rutenberg, D.; Venner, Monica; Giguère, Steeve

doi:10.1111/jvim.14717

Cited by 21 publications

(43 citation statements)

References 29 publications

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“…Its elimination is extremely slow with half-lives of 4-6 days , Gáler et al 2004. Results of a recent study reconfirmed that TUL is as effective as standard treatment with RIF/AZM (Rutenberg et al 2017). The only observed side effect in a recent study were 12 minor (< 5 cm) swellings developed at the injection site after a total of 279 injections of TUL (Venner et al 2007).…”

Section: Introductionmentioning

confidence: 98%

Efficacy of treatment and survival rate of foals with pneumonia: Retrospective comparison of rifampin/azithromycin and rifampin/tulathromycin

Arnold-Lehna¹,

Venner²,

Berghaus³

et al. 2019

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Rhodococcus equi (R. equi), a Gram-positive facultative intracellular pathogen is one of the most common causes of pneumonia in foals. The retrospective study compares the efficacy of rifampin/azithromycin versus rifampin/tulathromycin for the treatment of R. equi pneumonia in foals. Weekly medical data of foals born in the seasons 2012 to 2016 (i.e. five foaling seasons) that developed pneumonia were collected and analysed. Foals 21 days of age or older with a pulmonary consolidation of more than 1 cm (abscess score ≥ 1 cm) were enrolled for participation in the study. All foals meeting the criteria for inclusion were listed in a spreadsheet and 330 foals affected with pneumonia each year were randomly selected by an online research randomizer. Foals with incorrect or missing data and those that were included in previous treatment studies were excluded from the analysis, resulting in a total enrolment of 1544 foals with pneumonia. The farm established a screening program in 2003 in order to detect foals in the early course of pneumonia, so all foals were examined once weekly starting at the age of two weeks until four and a half months of age. A physical examination of the respiratory tract, body temperature, haematology and an ultrasonographic examination of the lungs were included. Sonography areas with visible consolidation were measured and added to calculate an "abscess score" which represents the extent of pulmonary damage. Weekly medical data were analysed retrospectively. The risk of therapy failure, which means either death or worsening of pneumonia requiring that the foal be switched to another therapy, showed in a univariate comparison of the two treatments, that there was a higher incidence of treatment failure in foals treated with RIF/AZM (32/353, 9.1 %) than in foals that were treated with RIF/TUL (19/406, 4.7 %; Pearson's χ 2 , P = 0.016). In a Kaplan-Meier analysis, there was also a significant difference between the two treatments with respect to their survival functions (Log-rank test, P = 0.045; Figure 1). The incidence of mortality due to R. equi pneumonia was higher in foals that were treated with RIF/AZM (8/353, 2.3 %) than in those that were treated with RIF/TUL (0/406, 0.0 %; Fisher's exact test, P = 0.002). After adjusting for year, age of foals at the beginning of treatment, and abscess score at the beginning of treatment, the risk of treatment failure was not significantly lower for foals that were treated with RIF/TUL compared to those that were treated with RIF/AZM [Hazard Ratio (95 % CI) = 0.75 (0.38, 1.5)]. Age of foals was negatively associated with treatment failure, with the risk of failure decreasing by 30 % for every one-month increase in age at the beginning of treatment [HR (95 % CI) = 0.70 (0.54, 0.91)]. Abscess score was positively associated with treatment failure, with the risk of failure increasing by 4 % for every one cm increase in score [HR (95 % CI) = 1.04 (1.01, 1.07)]. Year was also associated with the risk of treatment failure but it did not meet the proportiona...

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Section: Introductionmentioning

confidence: 98%

Efficacy of treatment and survival rate of foals with pneumonia: Retrospective comparison of rifampin/azithromycin and rifampin/tulathromycin

Arnold-Lehna¹,

Venner²,

Berghaus³

et al. 2019

PHK

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“…; Rutenberg et al . ). Additional studies at multiple other endemic farms will be required to determine whether this approach should be widely recommended.…”

Section: Treatment Of Foals With Subclinical Pulmonary Lesionsmentioning

confidence: 97%

“…Monotherapy with tulathromycin also was more effective than a placebo, but not as effective as the combination of a macrolide with rifampin (Rutenberg et al . ). Despite a statistically significant difference between macrolide monotherapy and the control group in these studies, however, it is important to note that up to 78% of the foals receiving the placebo recovered without the need for antimicrobial treatment (Hildebrand et al .…”

Section: Should the Combination Of A Macrolide And Rifampin Remain Thmentioning

confidence: 97%

“…By being more selective and treating only foals with larger lesion scores (e.g. >10 cm) and weekly or twice weekly clinical and ultrasonographic monitoring of the foals, one farm was able to decrease antimicrobial drug use by approximately 80% without an increase in mortality (Hildebrand et al 2015;Rutenberg et al 2017). Additional studies at multiple other endemic farms will be required to determine whether this approach should be widely recommended.…”

Section: Treatment Of Foals With Subclinical Pulmonary Lesionsmentioning

confidence: 99%

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Controversies in therapy of infections caused by Rhodococcus equi in foals

Giguère

Cohen

2017

Equine Veterinary Education

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Summary Pneumonia caused by Rhodococcus equi is one of the most important causes of disease and death in foals. R. equi can also be cultured from a large variety of extrapulmonary sites of infection. In the absence of an effective vaccine, ultrasonographic screening for early detection of pulmonary lesions has become routine practice at many farms endemic for pneumonia caused by R. equi. Consequently, the most frequently recognised form of R. equi infection at such farms is a subclinical form in which foals develop sonographic evidence of peripheral pulmonary consolidation or abscessation without necessarily manifesting clinical signs. Evidence exists that not all foals with ultrasonographic lesions will progress to develop clinical signs, and treating a large proportion of foals based on subclinical ultrasonographic findings has been linked to emergence of macrolide‐ and rifampin‐resistant R. equi at a horse farm. Selectively treating only those foals with larger lesion scores and monitoring foals with daily physical inspections and weekly thoracic ultrasonography offers an approach that could decrease antimicrobial drug use without significantly increasing mortality. Current evidence continues to support the combination of rifampin with a macrolide (azithromycin, clarithromycin or erythromycin) for treating clinical infections caused by R. equi despite recently described pharmacological interactions between these drugs. When infection with a macrolide‐resistant isolate is confirmed, limited effective alternatives exist.

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“…This study by D. Rutenberg and colleagues in Germany and the USA investigated the efficacy of tulathromycin as a treatment of foals with mild to moderate bronchopneumonia .…”

Section: Tulathromycin Treatment For Bronchopneumoniamentioning

confidence: 99%

Highlights of recent clinically relevant papers

Wright¹

2017

Equine Veterinary Education

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Efficacy of Tulathromycin for the Treatment of Foals with Mild to Moderate Bronchopneumonia

Cited by 21 publications

References 29 publications

Efficacy of treatment and survival rate of foals with pneumonia: Retrospective comparison of rifampin/azithromycin and rifampin/tulathromycin

Efficacy of treatment and survival rate of foals with pneumonia: Retrospective comparison of rifampin/azithromycin and rifampin/tulathromycin

Controversies in therapy of infections caused by Rhodococcus equi in foals

Highlights of recent clinically relevant papers

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