In Adult Horses With Septic Peritonitis, Does Peritoneal Lavage Combined With Antibiotic Therapy Compared to Antibiotic Therapy Alone Improve Survival Rates?

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Appraisal, application and reflection

Only low-quality evidence is available comparing the use of antibiotics with the combined use of antibiotics and peritoneal lavage to treat horses with peritonitis. There are many likely confounding factors in the case series reported which are inherent to use of case series. This includes unblinded treatment selection; it is likely that more severely affected cases or those where the abdomen is contaminated with gastrointestinal or uterine contents are treated with peritoneal lavage and antibiotics whereas those thought to be less severely affected are treated with antibiotics alone. There is also significant variation in the treatments used between cases within studies and between studies, including the use of treatment protocols which are now outdated, in particular, aminoglycoside choice, dose and frequency, (Golland et al., 1994, Hawkins et al., 1993). There is variation in the class of antibiotics, doses and frequency used and duration of treatment for cases within and between studies. A single study (Nieto et al., 1993) included patients in which abdominal lavage was performed using povidone-iodine solution, which has been shown to cause peritoneal inflammation (Schneider et al., 1988) and several studies do not describe the fluid used for lavage the abdomen (Hawkins et al., 1993, Henderson et al., 2008, Javsicas et al., 2010, Matthews et al., 2001). Financial constraints may have influenced the choice of treatment and the survival of patients reported. Patients in all the case series studies described received additional treatments including intravenous fluid therapy, non-steroidal anti-inflammatory medication, gastroprotectants, anti-endotoxic medication and prokinetics. The impact of these treatments was not analysed in most studies and is not described in this summary.

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