Elimination of guttural pouch infection and inflammation in asymptomatic carriers of Streptococcus equi.
Authors: Verheyen K, Newton J R, Talbot N C, de Brauwere M N, Chanter N
Journal: Equine veterinary journal
Summary
# Editorial Summary During investigation of three strangles outbreaks, Verheyen and colleagues identified 14 asymptomatic carriers harbouring *Streptococcus equi*, predominantly within the guttural pouches, and developed a systematic treatment protocol to eliminate both the organism and associated pathology. Their approach combined aggressive endoscopic management—including saline irrigation, suction and mechanical removal of inflammatory material and chondroids—followed by systemic and topical antimicrobial therapy, with success defined as normal pouch appearance and three consecutive negative nasopharyngeal and pouch lavage samples. Of the 15 cases treated (13 asymptomatic carriers plus 2 symptomatic horses), 14 were successfully cleared without surgery; notably, 33% of horses initially treated with potentiated sulphonamides required escalation to penicillin or ceftiofur (both systemic and topical) to achieve elimination. This work demonstrates that most carrier horses can be rendered non-infectious through combined mechanical clearance and appropriate antibiotic selection, offering a practical strategy for managing strangles outbreaks where identifying and treating carriers is critical to preventing recirculation of disease in stables and competition environments.
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Practical Takeaways
- •Asymptomatic carriers of S. equi identified during strangles outbreaks can be successfully cleared using endoscopic lavage and manipulation of guttural pouch material combined with systemic and topical antibiotics in most cases
- •Potentiated sulphonamide may be insufficient as first-line therapy; penicillin or ceftiofur should be considered if initial treatment fails
- •Aggressive endoscopic management of inflammatory material and chondroids is essential prior to antibiotic therapy to maximize treatment success
Key Findings
- •14 of 15 asymptomatic S. equi carriers (93%) were successfully treated with endoscopic removal of inflammatory material combined with antibiotic therapy without surgical intervention
- •Five carriers (33%) initially treated with potentiated sulphonamide required additional therapy with penicillin or ceftiofur administered systemically and topically for successful elimination
- •Endoscopic examination identified guttural pouch carriage in 13 of 14 asymptomatic carriers detected during outbreak investigations
- •One carrier required surgical intervention due to bilateral occlusion of guttural pouch pharyngeal openings