Treatment approaches to horses with acute diarrhea admitted to referral institutions: A multicenter retrospective study.
Authors: Gomez Diego E, Kopper Jamie J, Byrne David P, Renaud David L, Schoster Angelika, Dunkel Bettina, Arroyo Luis G, Mykkanen Anna, Gilsenan William F, Pihl Tina H, Lopez-Navarro Gabriela, Tennent-Brown Brett S, Hostnik Laura D, Mora-Pereira Mariano, Marques Fernando, Gold Jenifer R, DeNotta Sally L, Desjardins Isabelle, Stewart Allison J, Kuroda Taisuke, Schaefer Emily, Oliver-Espinosa Olimpo J, Agne Gustavo Ferlini, Uberti Benjamin, Veiras Pablo, Delph Miller Katie M, Gialleti Rodolfo, John Emily, Toribio Ramiro E
Journal: PloS one
Summary
# Editorial Summary: Treatment Approaches to Acute Equine Diarrhoea Acute diarrhoea remains a significant clinical challenge in referral practice, yet considerable variation exists in how clinicians manage this condition across different regions. This multicentre retrospective analysis of 1,438 horses from 26 hospitals across five continents examined treatment protocols implemented during the first 24 hours of admission, documenting fluid therapy, antimicrobial use, anti-inflammatory agents, gastroprotectants, digital cryotherapy, and adjunctive therapies. Fluid boluses were administered to 65% of horses on admission, whilst antimicrobial therapy was used in 55%, predominantly as penicillin–gentamicin combinations; importantly, horses presenting with leukopenia or systemic inflammatory response syndrome criteria were significantly more likely to receive antimicrobial treatment (odds ratios 2.26 and 2.54 respectively), suggesting clinicians were identifying sicker patients. Additional interventions showed considerable heterogeneity: gastroprotectants were used in 44% of cases, digital cryotherapy in 34%, polymyxin B in 13%, and probiotics in only 15%, with notable geographic variation in all treatment categories. Whilst this study provides a snapshot of current clinical practice and identifies which factors trigger antimicrobial escalation, the retrospective design prevents evaluation of treatment efficacy or survival outcomes—a significant gap that prospective clinical trials must address to establish evidence-based protocols and potentially reduce the wide variation observed across institutions.
Read the full abstract on PubMed
Practical Takeaways
- •Acute diarrhea management at referral centers shows high variability in treatment choices between institutions and regions—this suggests lack of consensus guidelines; consider evidence-based protocols tailored to your patient population
- •Leukopenia and SIRS criteria appear to drive antimicrobial decisions in clinical practice; these may serve as useful clinical decision-making flags in your own caseload
- •Only 15% of horses received probiotics despite common use claims—prospective trials are needed to determine which supportive therapies (cryotherapy, gastroprotection, toxin-binders) actually improve survival in your cases
Key Findings
- •65% of horses with acute diarrhea received fluid bolus on admission across 26 referral hospitals
- •55% received antimicrobials within 24 hours, with penicillin-gentamicin being the most common combination (25%)
- •Horses with leukopenia (OR: 2.26) or SIRS (OR: 2.54) were significantly more likely to receive antimicrobial therapy
- •Treatment protocols varied substantially between geographic regions, with probiotics (15%), cryotherapy (34%), and gastroprotectants (44%) showing inconsistent adoption