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Rhodococcus Equi Pneumonia: Treatment Strategies
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Rhodococcus equi (R. equi) pneumonia causes sporadically or endemically high losses in foals and consequently economic losses in breeding farms because of high morbidity and mortality. R. equi is a gram positive bacterium (Actinomycetales, group of mycolata, genus Rhodococcus) with a lipid-rich cell envelope. This cell envelope forms a permeability barrier to hydrophilic compounds and influences the resistance against many antibiotics. The mucolique acid-rich cell envelope provides furthermore the ability to survive and proliferate in the macrophages of foals.
The gross lesions induced by R. equi in the lung of foals are multiple firm nodules that can merge in later course of disease. In some foals miliary pyogranulomatous lesions are observed (Martens et al. 1982).
When the diagnosis of R. equi pneumonia is made the antimicrobial treatment should be started as soon as possible. The choice of appropriate drugs is restricted to those showing the ability to penetrate into the lipid-rich membrane of pulmonary abscesses and into the macrophages. So although many antimicrobial agents reduce the growth of R. equi in vitro, this does not correlate to an efficacy in vivo. Consequently only lipophilic antimicrobials should be used to treat affected foals. A combination of Rifampin twice daily (10 mg/kg p.o.) with a macrolid antibiotic is the most effective treatment and has reduced the losses of foals dramatically. In the past, erythromycin was used but the adverse effects (colitis in foal and mare) are frequent and occasionally life-threatening (Stratton-Phelbs et al. 2000). […]
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