Intra‐articular administration of antibiotics in horses: Justifications, risks, reconsideration of use and outcomes

Abstract

Intra-articular (IA) antibiotics have been used by equine practitioners for decades when injecting joints in osteoarthritis or to treat septic arthritis. More recently, IA antibiotic usage has gained attention in human orthopaedic clinical practice with the goal of achieving high local drug concentrations in septic arthritis, particularly those associated with orthopaedic implants such as after arthroplasty. In horses, the inability to deliver antibiotics systemically for longer durations without risk of severe side effects (eg gastrointestinal and renal toxicity) has been the impetus to emphasise local vs systemic administration to treat joint infections. Furthermore, the development of biofilms or floating biofilm aggregates in synovial structures may require higher antibiotic doses to penetrate and therefore effectively treat the infection. Finally, antibiotics that would be prohibitively expensive at systemic doses may be administered intra-articularly based on sensitivity results. More rapid resolution of infection through a combination of antibiotic routes of administration (eg systemic, regional limb perfusion and intra-articularly) may also improve owner compliance and convenience in treatment, potentially decreasing cost and complications and improving prognosis with faster resolution of clinical signs compared with long-term administration of oral medications.However, as the IA route of administration is "off-label," appropriate doses have not been defined. Furthermore, the increasing

Diagnosis and unsuccessful management of iatrogenic fungal septic arthritis caused by Wickerhamomyces anomalous (formerly Candida pelliculosa) and concurrent osteochondral lesion

“…This re-enforces the need for responsible antimicrobial use especially given the evidence suggests that concurrent antimicrobial administration with corticosteroids does not significantly reduce the risk of iatrogenic synovial sepsis (Braid 2019) and could increase the risk of fungal septic arthritis (Fang et al 2019, Riaz et al2020. The incidence of septic arthritis following intra-articular injection is reported to be <0.1% following injection of more than 300,000 joints (Pezzanite et al 2022).…”

Arthroscopic debridement and lavage of a fetlock joint in a British blue calf

“…Intra‐articular use of aminoglycosides is common in equine medicine 31 . Until recently, gentamicin use in food‐producing animals was banned in the United Kingdom, but this ban appears to have recently expired 32 .…”

“…Intra-articular use of aminoglycosides is common in equine medicine. 31 Until recently, gentamicin use in food-producing animals was banned in the United Kingdom, but this ban appears to have recently expired. 32 Use of this antimicrobial may still be illegal in other countries and may complicate later export of the animal.…”

Review of glucocorticoid therapy in horses: Intra‐articular corticosteroids

“…The significant emotional, financial and clinical consequences to the horse, client and veterinarian following the development of synovial sepsis after IA injection have resulted in justified interest in prevention strategies (Pezzanite et al, 2022). Concurrent prophylactic administration of an antibiotic theoretically reduces the risk of synovial sepsis by eliminating any iatrogenically inoculated bacteria through locally established MIC.…”