IN-DEPTH INTERACTIVE: REPRODUCTIVE DISORDERS – PATHOLOGY TO TREATMENT


Table 3. Common Therapies Used for Treating Mares With Placentitis Drug


Dosage


Potassium penicillin 22,000 U/kg, IV,q6h Procaine penicillin Gentamicin sulfate


22,000 U/kg, IM, q 12 h 6.6 mg/kg, IV or IM, q 24 h


Trimethoprim sulfa 15–30 mg/kg, PO, q 12 h Flunixin meglumine 1.1 mg/kg, IV or PO, q 12–24 h Phenylbutazone Firocoxib


2.2–4.4 mg/kg, PO, q 12–24 h


Pentoxifylline Altrenogest


Acetylsalicylic acid 50 mg/kg, PO, q 12 h IM, intramuscularly; IV, intravenously; PO, orally.


rum amyloid A (SAA) and haptoglobin (indicators of inflammation) have been examined in normal and abnormal equine pregnancies. Using enzyme- linked immunosorbent technology, da Silva et al.81 measured SAA in normal pregnant mares and in mares with experimentally induced placentitis. SAA concentrations were shown to increase dramat- ically in the last 36 hours of normal pregnancy. Mares with placentitis demonstrated a premature rise in SAA. When SAA concentrations were mon- itored in mares that were treated for placentitis, concentrations were shown to decline in some mares, presumably as a response to treatment. In a similar study,82 SAA, haptoglobin, fibrinogen, and white blood cell (WBC) counts were monitored in mares with normal pregnancies and in those with experimentally induced placentitis. Similar to the previous study, SAA and haptoglobin increased rap- idly after experimental infection and stayed ele- vated until abortion. However, in contrast to the previous study, SAA (and haptoglobin) did not rise prior to foaling in normal, pregnant mares. Fibrin- ogen andWBCcounts were not affected by infection. Data from these studies demonstrate the usefulness of SAA as a screening tool for mares with placentitis. Serial measurements that can reveal trends in SAA concentrations as a result of infection, or in response to treatment, will likely yield the most useful infor- mation. As with previously validated tests for pla-


Table 4. Drug Distribution After Administration to Pregnant Pony Mares Drug


Mare Plasma


Penicillin Gentamicin


Ceftiofur crystalline free acid Pentoxifylline


Flunixin meglumine Firocoxib


Present Present


Trimethoprim Sulfamethoxazole Present Ceftiofur sodium


Foal Plasma


Antimicrobial Antimicrobial Antimicrobial Antimicrobial


Anti-inflammatory/antiprostaglandin (mixed Cox-1 and 2) Anti-inflammatory


Administered on a per body weight basis Cox-2 selective anti-inflammatory 8.5 mg/kg, PO, q 12 h 0.088 mg/kg, PO, q 24 h


Anti-cytokine/anti-inflammatory Antiprostaglandin/tocolytic Anti-inflammatory/antiplatelet


Mechanism of Action


centitis, changes in SAA concentrations are best used as an adjunct to ultrasonography and clinical signs.


Treatment Strategies


Therapies for treating mares with placentitis should be selected for efficacy, known pharmacokinetics of drugs in pregnant mares, and client compliance for administration. Although bacterial infection is thought to initiate placentitis, secondary inflamma- tion and prostaglandin production are likely culprits in the premature delivery of foals. Treatment strategies are aimed at addressing infection, inflam- mation, and uterine contractility. Several drugs that are commonly used in mares with placentitis are listed in Table 3. Some therapeutic agents that are used clinically


have been tested for placental passage and improved foal viability in normal pregnant and mares affected with placentitis. Drugs tested in pregnant mares for placental passage (with and without placentitis) are compiled in Table 4. Penicillin and trim- ethoprim sulfamethoxazole (TMS) achieved mini- mum inhibitory concentrations against S. equi subsp. zooepidemicus in the allantoic fluid of mares with induced placentitis, whereas gentamicin was detectable at concentrations effective to treat E. coli and K. pneumoniae (also implicated in placenti- tis).83,84 Pentoxifylline was detected in allantoic


Allantoic Fluid


Present Present Present


Present Present ND Present Present ND Present Present


Present Present


ND ND


Present ND


Present


Open cells indicate areas that were not examined for presence of drug. ND, not detected.


288 2015  Vol. 61  AAEP PROCEEDINGS Present Present


Amniotic Fluid


Fetal Colostrum Placenta Tissues Present Present


Present ND Present ND


ND


Present Present Present Present


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