Current Antimicrobial Use in Horses Undergoing Exploratory Celiotomy: A Survey of Board-Certified Equine Specialists.
Authors: Rockow Meagan, Griffenhagen Gregg, Landolt Gabriele, Hendrickson Dean, Pezzanite Lynn
Journal: Animals : an open access journal from MDPI
Summary
# Editorial Summary: Antimicrobial Protocols in Equine Abdominal Surgery Exploratory celiotomy remains one of equine surgery's most critical procedures, yet substantial variation exists in how practitioners manage perioperative antimicrobial prophylaxis and treatment—a concern amplified by rising antimicrobial resistance in equine medicine. This 2023 survey of 113 board-certified equine surgeons and internal medicine specialists revealed that whilst most clinicians administer two-drug combinations (95.5%), typically gentamicin and penicillin, their dosing protocols often diverge from evidence-based guidelines: 63% give preoperative cover 30–60 minutes before incision, but 78.6% fail to re-dose intraoperatively despite prolonged procedures, and postoperative durations vary considerably depending on intraoperative findings (1–3 days for non-strangulating lesions; 3–5 days for strangulating pathology). Beyond standard IV protocols, localised antimicrobial delivery—perioperative irrigation or intra-abdominal infusions—was employed by fewer than one quarter of respondents, suggesting underutilisation of adjunctive strategies. For equine practitioners, these findings underscore the need for evidence-based surgical antimicrobial protocols that balance effective infection prevention against stewardship principles, particularly as resistance patterns evolve and guidelines become increasingly stringent on duration and re-dosing intervals during prolonged procedures.
Read the full abstract on PubMed
Practical Takeaways
- •Review your perioperative antimicrobial protocol for exploratory celiotomy against current evidence-based guidelines, as this survey reveals significant variation among specialists that may not reflect best practices
- •Consider whether intraoperative re-dosing of gentamicin is appropriate for your cases, particularly for prolonged procedures, as most respondents did not re-dose despite pharmacokinetic support for doing so
- •Evaluate your postoperative treatment duration decisions against documented complications (fever, resection, incisional issues) rather than relying solely on diagnosis, as these factors significantly influenced practitioners' choices
Key Findings
- •Gentamicin (98.2%) and potassium penicillin (74.3%) were the most commonly used antimicrobials for equine celiotomy, with two classes typically administered together (95.5%)
- •Most practitioners (63.1%) administered antimicrobials 30-60 minutes preoperatively, but 78.6% did not re-dose intraoperatively despite evidence supporting re-dosing
- •Postoperative antimicrobial duration varied by diagnosis: 1-3 days for non-strangulating lesions (54.4%) and 3-5 days for strangulating lesions (63.7%), influenced by complications like fever (85.0%) and resection (81.4%)
- •Antimicrobial usage patterns among board-certified equine specialists were highly variable and frequently inconsistent with current literature recommendations