AUSTRALIAN EQUINE VETERINARIAN Vol.

22 (2) Winter 2003

Clinical Paper Abstracts

4. ANTIBIOTIC ASSOCIATED COLITIS IN A THOROUGHBRED COLT

Winner of the inaugural Plasvacc Prize for Undergraduate Veterinary
Students kindly donated by Plasvacc Pty Ltd

Claire S. Hawkes
Final Year Veterinary Science Student.
The University of Queensland. Brisbane, QLD 4072, Australia.

Introduction
The ileum, caecum and colon of the horse have a dynamic and intricately balanced bacterial flora. The
use of antibiotics can alter the innate colonisation resistance, allowing proliferation of potentially
pathogenic bacteria. Antibiotic associated colitis, although uncommon relative to antimicrobial usage, is
a serious and life threatening disease in horses. Numerous reports in the literature implicate a wide
range of antibiotics in potentially causing equine colitis and diarrhoea. Administration of ceftiofur under
experimental conditions (10 and 25 times recommended dose rate of 2.2mg/kg IM q24h) changed the
bacterial flora, led to inflammation of the large intestine and was associated with diarrhoea, dehydration
and colic. Horses with colitis are at risk of development of equally serious secondary complications such
as laminitis, thrombophlebitis, renal failure and DIC. Laminitis is the most common secondary
complication of colitis. In this case, cryotherapy, a novel approach to the prevention of laminitis was
instituted.

Case History
A 2-year-old thoroughbred colt developed profuse, watery, non-haemorrhagic diarrhoea, two days after
completing a 10-day course of 2.2mg/kg ceftiofur sodium (Excenel) IV q24h for a respiratory infection. On
presentation, the colt was depressed, tachycardic, tachypnoeic and pyrexic. Peripheral pulses were poor,
oral mucous membranes a congested brick red to purple colour and capillary refill prolonged. Haematology
and biochemical analysis results were indicative of a protein losing enteropathy, with an underlying acute
inflammatory process. The colt was moderately dehydrated and severely hypoproteinaemic.

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 AUSTRALIAN EQUINE VETERINARIAN Vol. 22 (2) Winter 2003

Clinical Paper Abstracts

There was a marked leukopenia with neutropenia, and in a later sample the presence of toxic
(activated) neutrophils. The colt was hyponatraemic, hypochloraemic and azotaemic. Total bilirubin,
ALP, AST and CK were all elevated. A mild hyperglycaemia was also observed Treatment for colitis and
endotoxaemia was initiated on admission. Immediate aggressive fluid therapy was administered to
improve the cardiovascular status of the colt. Antimicrobial therapy consisted of metronidazole in
combination with enrofloxacin (later replaced with cephalothin sodium). The colt received anti-endotoxic
doses of flunixin meglumine, in addition to activated charcoal and mineral oil drenches. Due to a severe
hypoproteinaemia and endotoxaemia, fresh frozen hyperimmune plasma was administered to the colt.
Ice bath cryotherapy was instituted on admission of the colt and maintained for approximately 90 hours.
Faecal culture was negative for both Salmonella and Campylobacter.

Clinical Outcome
With the use of targeted and aggressive therapy, the clinical signs of colitis were resolved. Cryotherapy
was well-tolerated and no clinical signs of laminitis developed during, or in the 8 weeks post, treatment.
A 6-12 months paddock rest is recommended before returning to athletic pursuits.

Relevance to clinical equine practice

This case highlights the sensitivity of essential microflora of the equine hindgut to ceftiofur, and the
need for judicious use, and clinical vigilance when ceftiofur is used. Therapeutic strategies for colitis and
endotoxaemia should be instituted in addition to preventative measures against the common secondary
complications. This case is a good example of how modern, knowledge-based medicine can succeed
for a horse with an otherwise grave prognosis. In this case, aggressive fluid therapy and antimicrobials
in combination with agents to reduce the effect of endotoxin (hyperimmune plasma, activated charcoal,
mineral oil and flunixin) proved to be successful in the management and treatment of colitis. The use of
an ice bath to prevent laminitis is novel and its efficacy in this case suggests that its widespread use in
equine hospitals is justifiable.

Acknowledgements
I would like to acknowledge the primary responsibility of case treatment to Eagle Farm Equine
Veterinary Hospital

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