Pros and Cons of Equine Joint Antibiotic Injections – Horse Racing News

Because of the finesse with which equine veterinarians inject drugs into the joints, the procedure may seem simple. Although injecting antibiotics into the joints can help clear up infections, the procedure is not without its risks. Veterinarians should therefore consider a number of important factors before going ahead with intra-articular antibiotic therapies.

Manage osteoarthritis

Medicate the joints with corticosteroidspolysulfated glycosaminoglycans, or hyaluronic acid is commonplace in equine sports medicine. Intra-articular injection is often used in conjunction with other modalities, including oral joint health supplements. Oral products decrease inflammation and improve mobility, improving overall joint health. Examples of suitable products include high quality supplements which contain exclusive combinations of glucosamine hydrochloride, chondroitin sulfate, MSM and hyaluronic acid.

According to a recent study on the use of intra-articular antibiotics, 78% of veterinarians use intra-articular antibiotics in combination with other medications.* By adding an antibiotic, often amikacin, to a corticosteroid or polysulfated glycosaminoglycan, veterinarians hope to prevent the development of a septic joint.

Given the low risk of infection following joint injections, the question then becomes whether or not veterinarians should use prophylactic antibiotics. Additionally, since intra-articular antibiotics are used “off-label”, there are no documented guidelines for appropriate intra-articular use.

Prophylactic intra-articular antibiotic therapy therefore has two major ramifications:

  1. Veterinarians may administer an excessively high dose. “There is some evidence that antibiotics like amikacin have toxic effects on cartilage cells and other joint tissues,” said Peter Huntington, BVSc., MACVSc., director of nutrition at Kentucky Equine Research.
  2. Unnecessary use of antibiotics contributes to antibiotic resistance. “With few new antibiotics in development and increasing multidrug resistance to currently available drugs, there may be merit in revisiting the practice of prophylactic antibiotic use in horses,” Huntington added.

These concerns associated with intra-articular administration of antibiotics alternative strategies to maintain joint health.

Management of septic joints

Intra-articular antibiotics are essential in the face of septic seal since direct administration into the joint can achieve high local drug concentrations. If, on the other hand, antibiotics are offered orally, high doses would be needed for longer durations to achieve the same result as an intra-articular injection.

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“Systemic antibiotics, however, can be associated with significant and life-threatening side effects such as gastrointestinal disorders that disrupt the microbiome. In the face of microbiome disorder, pathogenic bacteria can proliferate, impairing immunity and increasing the risk of diarrhea or laminitis,” Huntington explained. When systemic antibiotics must be given, gastrointestinal support in the form of research-proven supplements should be considered.

Local administration of antibiotics directly into a joint can also:

  • Improve owner compliance, as injections are not dependent on the owner administering the entire oral antibiotic treatment;
  • Make treatment more affordable, as a systemic antibiotic can be prohibitively expensive for an owner;
  • Shorten treatment time and improve results; and
  • This results in high concentrations at the site of infection that can be particularly useful in combating “floating biofilm,” which is an accumulation of microbes embedded in a self-produced extracellular matrix that helps protect bacteria from antibiotics.

*Pezzanite, LM, DA Hendrickson, S. Dow, L. Chow, D. Krause, and L. Goodrich. 2021. Intra-articular administration of antibiotics in horses: justifications, risks, reconsideration of use and results. Equine Veterinary Journal: 13502.

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Reprinted by kind permission of Kentucky Equine Research. To visit for the latest in equine nutrition and management, and subscribe to Equinews to receive these articles directly.