Page 525 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

500 CHAPTER 2

VetBooks.ir Table 2.2 Drugs and their doses used in treatment of uterine infections

DRUG DOSE COMMENT
Amikacin sulphate 1–2 g Gram-negative organisms
Ampicillin 1–3 g Not good against anaerobes
Carbenicillin 2–6 g Broad spectrum including Pseudomonas spp.
Ceftiofur 1 g Very broad spectrum
Gentamicin sulphate 0.5–2 g Gram-negative organisms. Requires buffering
Neomycin sulphate 3–4 g Gram-negative organisms. Often used with penicillins
Oxytetracyclines 1–5 g Gram-positive organisms, especially streptococci
Penicillin (Na or K salt) 5,000,000 IU Gram-positive organisms, especially streptococci
Penicillin G 3–6,000,000 IU Gram-positive organisms, especially streptococci
Ticarcillin 1–6 g Broad spectrum, but poor against Klebsiella spp.
Combinations
Neomycin + penicillin G 2 g/3,000,000 IU
Gentamicin sulphate + penicillin G 0.5–2 g/3–6,000,000 IU
Oral
Enrofloxacin 8 mg/kg Accumulates and concentrates in endometrium
Antimycotics
Nystatin 250,000–1,000,000 IU Dissolve in 0.9% saline solution
Clotrimazole 300–600 mg Daily or every 2–3 days for 12 days
Vinegar 2% solution 20 ml wine vinegar in 1 litre saline
Povidone–iodine 1–2% solution Individual mares may be very sensitive to povidone–
iodine, causing uterine pathology. Use with caution!
Others
Saline Infuse 1 litre at a time Infuse until recovery becomes clear
EDTA-Tris 250–500 ml Lavage 24 hours later with saline/lactated Ringer’s
solution. Biofilm reduction
Hydrogen peroxide 60 ml of a 1% solution Lavage 24 hours later. Treatment of fungal endometritis
and biofilm reduction
Acetylcysteine 6 g in 150 ml sterile saline Mucolytic and treatment of uterine infection
DMSO 50–200 ml in 1 litre of saline Follow with saline lavage. Mucolytic and biofilm reduction

Adapted from Perkins NR (1999) Equine reproductive pharmacology. Vet Clin North Am Equine Pract 15(3):687–704.

breaking down the ‘biofilm’ layer of mucus Systemic treatment with antibiotics is rarely indi-
that can coat the endometrium in cases of cated because in most cases the infecting organism is
fungal endometritis. in the uterine lumen rather than the endometrium.
Oral ketaconazole (2 g q24 h for 10 days) concur-
Indwelling uterine infusers can facilitate the rently with povidone–iodine flushing has improved
treatment of mares with CUI. The infuser is held in the chance of successful resolution of fungal endo-
position in the uterus by an intrauterine device and metritis in some cases.
at the vulva by sutures. It can be left in position for Follow-up examination including smears/swabs
up to a month but can cause irritation and result in should be made 3–4 weeks after the end of any
local infections. course of treatment.