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The combination of erythromycin and rifampin has been the treatment of choice for Rhodococcus equiinfections in foals for many years. Erythromycin is a macrolide antibiotic. It works by inhibiting the production of protein by susceptible bacteria. At the usual therapeutic concentrations, erythromycin is bacteriostatic and has a relatively narrow spectrum (including R. Equi).
Rifampin is an antibiotic that is used in combination with erythromycin. Rifampin penetrates abscesses and most body-tissues including bone and CNS. This property makes rifampin particularly useful to treat R. equi because one of the major problems associated with these infections is abscess formation. Rifampin always should be used in combination with another antibiotic because when rifampin is used alone, the bacteria are rapidly able to develop resistance. Rifampin can be either bactericidal or bacteriostatic depending on the specific organism and the concentration of the drug.
Infection due to R. equi generally is thought to be the most-severe bacterial pneumonia in foals. In addition to respiratory disease, R. equi can cause gastrointestinal disease and, less commonly, infections of the growth plate. R. equi infections can be both difficult to diagnose and to treat. The disease can progress sub-clinically until the foal presents as a life-threatening emergency due to overwhelming infection and widespread abscessation. Fatalities can occur even with prompt diagnosis and treatment.
Dr. Barbara Forney is a veterinary practitioner in Chester County, Pennsylvania. She has a master's degree in animal science from the University of Delaware and graduated from the University of Pennsylvania School of Veterinary Medicine in 1982.
She began to develop her interest in client education and medical writing in 1997. Recent publications include portions of The Pill Book Guide to Medication for Your Dog and Cat, and most recently Understanding Equine Medications published by the Bloodhorse.
Dr. Forney is an FEI veterinarian and an active member of the AAEP, AVMA, and AMWA.
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