Antimicrobial selection and dosing in the treatment of wounds in the United Kingdom.
Authors: Ross S E, Duz M, Rendle D I
Journal: Equine veterinary journal
Summary
# Antimicrobial Selection and Dosing in Equine Wound Treatment Between 2014 and 2016, Ross and colleagues examined retrospective records of 113 horses referred to a tertiary centre for limb wound management, assessing whether first-opinion practitioners had selected appropriate antimicrobial classes and calculated doses correctly according to British Equine Veterinary Association guidelines. Systemic antimicrobials were prescribed pre-referral in 83% of cases, yet 8.5% received protected agents (third/fourth-generation cephalosporins or fluoroquinolones) despite evidence suggesting these should be reserved for resistant or serious infections—a concerning finding given the profession's commitment to antimicrobial stewardship. More troublingly, over half the horses with complete dosing records (55.2%) received sub-optimal doses at ≤90% of recommendations, with heavier animals disproportionately under-dosed, suggesting bodyweight estimation may have been inaccurate or omitted entirely. Postgraduate qualifications and equine-only practice status did not predict more judicious prescribing, though more experienced practitioners were paradoxically less likely to use protected antimicrobials—a relationship the authors cautiously interpret given small numbers. For practitioners treating limb wounds, this research underscores the critical importance of accurate bodyweight measurement before dispensing any systemic medication, careful consideration of whether protected antimicrobials are genuinely indicated, and verification of dose calculations against current guidelines to minimise resistance development and therapeutic failure.
Read the full abstract on PubMed
Practical Takeaways
- •Verify horse bodyweight using validated objective techniques before administering systemic medications, as heavier horses are at higher risk of under-dosing
- •Review your antimicrobial selection against BEVA guidelines for limb wounds—protected antimicrobials are being used in cases where first-line alternatives are appropriate
- •Check your dosing calculations carefully; over half of cases reviewed showed doses at or below 90% of recommendations, which may compromise treatment efficacy
Key Findings
- •83.2% of horses (94/113) received systemic antimicrobials prior to referral, with 8.5% receiving protected third or fourth generation cephalosporins or fluoroquinolones
- •55.2% of horses (48/87) with complete dosing data received antimicrobials at ≤90% of recommended dose rates
- •More experienced veterinary surgeons were significantly less likely to use protected antimicrobials (P<0.001)
- •Heavier horses were significantly more likely to be under-dosed (P<0.002)