EQUINE | CPD Article
Differential diagnosis
• Lameness, especially of multiple legs.
• Anaplasmosis.
• EPM.
• EHV-1.
Treatment
Initial symptomatic treatment
• NSAIDs may be given initially to control the
inflammatory reaction and pain.
Standard treatment
Antibiotics
• No definitive treatment protocol is known and has
been extrapolated from humans.
• The two most common drugs used are:
Either IV oxytetracycline (6.6 mg/kg SID) used for
7-30 days. Alternatively, this may be given for 1
week, followed by doxycycline for 4 weeks.
OR Oral doxycycline (10 mg/kg PO BID).
• This protocol has shown the most success for
acute cases. For more typical cases of Lyme disease
with chronic stiffness, lameness, hyperesthesia,
doxycycline alone works well.
• Therapy may have to be extended if resolution is
not seen in 4 weeks.
• Standard therapeutic doses of oxytetracycline,
ampicillin or procaine penicillin have been used
successfully in the horse.
• Clinical signs resolved within 7 days in some
suspected cases.
• A 7-14 day initial course is recommended.
• For refractory cases cephalosporins and
metronidazole have been used in humans. An
appropriate approach to antibiotic stewardship
should be used.
NSAIDs
• Some clinicians recommend not to use initially as
they mask the signs and response to the antibiotics
as part of the diagnostic criteria. However,
tetracyclines also have potent anti-inflammatory
properties and therefore some of the response to
treatment may be due to this factor, rather than
due to an underlying Borreliosis infection.
• Phenylbutazone or other NSAIDs are useful in
controlling the inflammatory reaction and pain.
Supportive therapy
• Non-specific supportive therapy:
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Bandage legs.
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Cold therapy.
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Nursing care.
Other therapies
• Treat other less common syndromes:
○○
Anterior uveitis.
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Cardiovascular disease.
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Neurologic disease.
Monitoring
• Clinical signs.
• Synovial fluid analysis.
• Paired titers often not useful as already
seroconverted and reductions in titers are rarely
seen until >6 m beyond treatment. Therefore,
antibiotic therapy cessation should not be based
on antibody titers, rather clinical equipment.
Subsequent management
Treatment
• Persistent signs or relapse require prolonged or
additional therapy.
42 • Equine Health Update •