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LYDIKSEN ET AL.
TABLE 2 p -values for association between antibiotics and success compared to the categorical values breed, duration, tooth, prior antibiotics, extraction method and antibiotics.
Breed
Duration Tooth
Prior antibiotics
Extraction method Antibiotics
p -values (AB) 0.87
0.56 0.57 0.59 1
–
Note : Significance, including not significant is shown in the table. Abbreviation : NS, not significant.
TABLE 3 Logistic regression analysis for association between antibiotics and probability of success.
Estimated effect
Intercept Antibiotics: No 0.51 −0.11 Abbreviation : CIs, confidence intervals.
hypothesis of this study could not be rejected. These findings sug- gest that the perioperative administration of AB may be an irrelevant adjunct to dental extraction, when treating cases of dental sinusitis. This is in agreement with a recent study which concluded that the administration of perioperative AB was not associated with the risk of complications in horses subjected to standard oral extraction of cheek teeth in horses (Christiansen et al., 2023 ). In the present study, AB-treated horses received either Procaine Benzylpenicillin or TMP- sulfa, both known to be effective against Gram-positive as well as anaerobic bacteria, with TMP-sulfa also covering a wider spectrum of Gram-negative bacteria (Haggett & Wilson, 2008 ). A recent study found anaerobes to be present in 57.7% (15/26) and enterobacte- riaceae in 46.2% (12/26) of cases with dental sinusitis compared to 0% (0/45) and 17.8% (8/45) in healthy sinuses respectively (Gergeleit et al., 2018 ). Based on these findings, it is reasonable to assume that the AB used in the present study would have some effect in terms of treating sinusitis. However, taking both the degree of AB pene- tration to the inflamed sinuses, antibiotic resistance and bacteria ' s own defence mechanisms, for example, biofilm formation, into con- sideration, it is still relevant to question the actual efficacy of the administered AB (Brook, 2005 ; Gergeleit et al., 2018 ). An adequate concentration of AB within the sinuses is a prerequisite for a relevant effect. In a study by Bienert-Zeit et al. ( 2015 ), only 5 of 10 healthy horses showed Trimethoprim (5 mg/kg) combined with Sulfadimidine (25 mg/kg) intravenous administration resulting in concentrations exceeding the minimal inhibitory concentration in the equine para- nasal sinuses. However, in horses with dental sinusitis, the penetra- tion of antibiotics to the sinuses may potentially be further reduced due to an increased thickness of the sinus mucosa observed in cases of chronic sinusitis in horses and humans (Block & Dastoury, 2014 ;
95% - CIs of effect
−0.32;1.34 −1.17;0.96
p -value 0.23
0.85
Henninger et al., 2003 ; Tremaine et al., 1999 ). A study in humans reported that if dental sources of the infection in odontogenic cases of sinusitis are removed, the mucosal swelling of the sinuses will be significantly reduced and thereby improving the natural drain- age through the nasomaxillary aperture (Block & Dastoury, 2014 ). If this effect applies to horses as well, removal of the primary cause together with the anti-inflammatory effect of a non-steroidal anti- inflammatory drug (NSAID) potentially creates optimal conditions for the body to clear the infection/inflammation, without the addi- tional use of AB. This hypothesis is supported by the results of the present study, where 60% (21/35) of horses that did not receive perioperative AB became successful solely by use of dental extrac- tion and NSAID compared to 62.5% (15/24) of the horses that ad- ditionally received perioperative AB. To the authors ' knowledge, no other study has investigated the efficacy of treating dental sinusitis by dental extraction without the use of AB. Moreover, it is worth noticing the minimally invasive extraction methods used in this study with 55/59 horses having a standing oral extraction and the remaining four horses having MTE. One study by Dixon et al. ( 2005 ) found that 84.6% (11/13) horses with dental sinusitis became suc- cessful following standing oral extraction combined with repeated sinus lavages and AB administration for 5–7 days. In another study by Dixon et al. ( 2012a ) where standing oral extraction was initially attempted in horses with dental sinusitis, 70% (28/40) had a single treatment. However, the exact details of each of these treatments remain unclear and it is, therefore, difficult to make a direct com- parison. Despite the discrepancy in rates of success following ini- tial treatment in the comparison with previous studies, the results of the present study, where 88.1% were eventually cured, compare very well with the results of the other mentioned studies. The big difference being that approximately two-thirds of the horses in the present study became successful without any other treatment than extraction and NSAID therapy.
Further treatment
In the present study, a total of 39% (23/59) horses required fur- ther treatment after being unresponsive to initial treatment.
In
Significance level (AB) NS
NS NS NS NS –
p -values (success) 0.59
1
0.31 1
0.64 1
Significance level (success)
NS NS NS NS NS NS
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