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Home / Equine Research Bank / Equine Vet J / Efficacy of the combination of doxycycline and azithromycin ...
Equine veterinary journal2020; 52(4); 613-619; doi: 10.1111/evj.13211

Efficacy of the combination of doxycycline and azithromycin for the treatment of foals with mild to moderate bronchopneumonia.

Abstract: Given the importance of rifampin in treatment protocols for tuberculosis in people, its use in veterinary medicine is under increasing scrutiny in some countries and alternatives might be needed in the near future. Objective: This study was set up to evaluate whether azithromycin combined with doxycycline is effective for the treatment of bronchopneumonia in foals and noninferior to the combination of azithromycin and rifampin. Methods: This is a controlled, randomised and double-blinded clinical trial. Two hundred and forty foals on a farm endemic for infections caused by Rhodococcus equi were involved. Methods: Foals with ultrasonographic pulmonary lesions (lesion score 10-15 cm) were allocated to 3 groups: azithromycin-doxycycline orally (n = 81); azithromycin-rifampin orally (n = 81); or untreated controls (n = 78). Physical examination and thoracic ultrasonography were performed by individuals unaware of treatment group assignment. Foals that worsened were considered treatment failures and removed from the study. Results: The proportion of foals that recovered was significantly higher for foals treated with azithromycin-doxycycline (80 of 81) or azithromycin-rifampin (81 of 81) compared with that of control foals (57 of 78). The difference in the percentage of efficacy of azithromycin-rifampin vs azithromycin-doxycycline was 1.2% (90% CI = -0.78% to 3.5%) which did not cross the predetermined noninferiority limit of 10%. Therefore, azithromycin-doxycycline was noninferior to azithromycin-rifampin within the predetermined noninferiority limit. Conclusions: The study was performed on a single farm, and recovery rates may differ in other locations. Conclusions: Azithromycin-doxycycline was noninferior to azithromycin-rifampin for the treatment of bronchopneumonia in this farm.
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Publication Date: 2020-02-17 PubMed ID: 31769897DOI: 10.1111/evj.13211Google Scholar: Lookup
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  • Journal Article
  • Randomized Controlled Trial
  • Veterinary

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

This study investigates whether the combination of azithromycin and doxycycline can effectively treat bronchopneumonia in foals, and if it is a viable alternative to the use of azithromycin and rifampin in the treatment of the same condition.

Objective and Background

  • The main aim of the research was to explore the effectiveness of azithromycin combined with doxycycline in treating bronchopneumonia in foals and to check if its efficiency is not inferior to the commonly used combination of azithromycin and rifampin.
  • The focus on alternative treatment options stems from the increasing scrutiny of rifampin use in veterinary medicine due to its critical role in treating tuberculosis in humans.

Methodology

  • The researchers conducted a controlled, randomized, and double-blinded clinical trial using 240 foals with symptoms of bronchopneumonia.
  • The animals with ultrasonographic pulmonary lesions of a certain size were randomly divided into three groups. Two groups received different treatments: the first group was given azithromycin and doxycycline orally, while the other treated with azithromycin and rifampin orally. The third group served as untreated controls.
  • Physical examinations and thoracic ultrasonography were performed by individuals who did not know which treatment each foal had received.
  • If a foal’s condition worsened, it was considered a treatment failure and removed from the study.

Results and Conclusions

  • The study found that the recovery rate was significantly higher in the groups treated with azithromycin-doxycycline or azithromycin-rifampin than in the control group.
  • In terms of the treatment efficacy difference between the utilized drug combinations, the study concludes that the combination of azithromycin-doxycycline was noninferior to azithromycin-rifampin, considering the pre-set noninferiority limit of 10%.
  • Despite the encouraging findings, the research acknowledges the study’s limitations. The research was performed on a single farm, suggesting that recovery rates might differ in other environments.

In conclusion, the research suggests that the combination of azithromycin and doxycycline could serve as an effective treatment for bronchopneumonia in foals and a potential alternative to the use of azithromycin and rifampin.

Cite This Article

APA
Wetzig M, Venner M, Giguère S. (2020). Efficacy of the combination of doxycycline and azithromycin for the treatment of foals with mild to moderate bronchopneumonia. Equine Vet J, 52(4), 613-619. https://doi.org/10.1111/evj.13211

Publication

Equine veterinary journal
ISSN: 2042-3306
NlmUniqueID: 0173320
Country: United States
Language: English
Volume: 52
Issue: 4
Pages: 613-619

Researcher Affiliations

Wetzig, Maria
  • Equine Clinic, School of Veterinary Medicine, Hanover, Germany.
Venner, Monica
  • Veterinary Clinic, Destedt, Germany.
Giguère, Steeve
  • Veterinary Medical Center, University of Georgia, Athens, GA, USA.

MeSH Terms

  • Actinomycetales Infections / veterinary
  • Animals
  • Anti-Bacterial Agents / therapeutic use
  • Azithromycin
  • Bronchopneumonia / drug therapy
  • Bronchopneumonia / veterinary
  • Doxycycline
  • Horse Diseases / drug therapy
  • Horses
  • Rhodococcus equi

Grant Funding

  • PS
  • Pferdehaltung
  • GmbH
  • Lewitz
  • Stud.

References

This article includes 33 references
  1. Cohen ND. Causes of and farm management factors associated with disease and death in foals.. J Am Vet Med Assoc 1994;204:1644-51.
  2. Hoffman AM, Viel L, Prescott JF, Rosendal S, Thorsen J. Association of microbiologic flora with clinical, endoscopic, and pulmonary cytologic findings in foals with distal respiratory tract infection.. Am J Vet Res 1993;54:1615-22.
  3. Giguère S, Gaskin JM, Miller C, Bowman JL. Evaluation of a commercially available hyperimmune plasma product for prevention of naturally acquired pneumonia caused by Rhodococcus equi in foals.. J Am Vet Med Assoc 2002;220:59-63.
  4. Slovis NM, McCracken JL, Mundy G. How to use thoracic ultrasound to screen foals for Rhodococcus equi at affected farms.. Proc Am Assoc Equine Pract 2005;51:274-8.
  5. McCracken JL, Slovis NM. Use of thoracic ultrasound for the prevention of Rhodococcus equi pneumonia on endemic farms.. Proc Am Assoc Equine Pract 2009;55:38-44.
  6. Venner M, Kerth R, Klug E. Evaluation of tulathromycin in the treatment of pulmonary abscesses in foals.. Vet J 2007;174:418-21.
  7. Giguère S, Cohen ND, Chaffin MK, Slovis NM, Hondalus MK, Hines SA. Diagnosis, treatment, control, and prevention of infections caused by Rhodococcus equi in foals.. J Vet Intern Med 2011;25:1209-20.
  8. Nahid P, Dorman SE, Alipanah N, Barry PM, Brozek JL, Cattamanchi A. Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: treatment of drug-susceptible tuberculosis.. Clin Infect Dis 2016;63:e147-e195.
  9. Womble A, Giguère S, Lee EA. Pharmacokinetics of oral doxycycline and concentrations in body fluids and bronchoalveolar cells of foals.. J Vet Pharmacol Ther 2007;30:187-93.
  10. Jacks S, Giguère S, Gronwall RR, Brown MP, Merritt KA. Disposition of oral clarithromycin in foals.. J Vet Pharmacol Ther 2002;25:359-62.
  11. Giguère S, Lee EA, Guldbech KM, Berghaus LJ. In vitro synergy, pharmacodynamics, and postantibiotic effect of 11 antimicrobial agents against Rhodococcus equi.. Vet Microbiol 2012;160:207-13.
  12. Kilian K. Comparative studies of the detection of Rhodococcus equi in the breath, tracheobronchial fluids and in faeces of foals [Thesis].. Germany: Veterinary School of Hanover, Foundation; 2008; p. 1-128.
  13. Lammer M. Detection of Rhodococcus equi in faeces and tracheobronchial secretions of foals on a farm with endemic rhodococcosis: comparison of healthy foals and foals with pulmonary abscesses.. Germany: Veterinary School of Hanover, Foundation; 2010; p. 1-116.
  14. Venner M, Heyers P, Strutzberg-Minder K, Lorenz N, Verspohl J, Klug E. Detection of rhodococcus equi by microbiological culture and by polymerase chain reaction in samples of tracheobronchial secretions of foals.. Berl Munch Tierarztl Wochenschr 2007;120:126-33.
  15. Venner M, Meyer-Hamme B, Verspohl J, Hatori F, Shimizu N, Sasaki Y. Genotypic characterization of VapA positive Rhodococcus equi in foals with pulmonary affection and their soil environment on a warmblood horse breeding farm in Germany.. Res Vet Sci 2007;83:311-7.
  16. Hagist C. Genotypisierung von Rhodococcus equi Stämmen aus Deutschland, isoliert bei Fohlen und anderen Tierarten.. Thesis, Veterinary School of Hanover, Foundation, 2016;1-134.
  17. Weimar BM. Lung abscesses in foals: evaluation of clinical, ultrasonic, endoscopical, pathomorphological and microbiological findings.. Thesis, Veterinary School of Hannover, Foundation, 2006;1-157.
  18. Giguère S, Hernandez J, Gaskin JM, Miller C, Bowman JL. Evaluation of WBC concentration, plasma fibrinogen concentration, and an agar gel immunodiffusion test for early identification of foals with Rhodococcus equi pneumonia.. J Am Vet Med Assoc 2003;222:775-81.
  19. Venner M, Reinhold B, Beyerbach M, Feige K. Efficacy of azithromycin in preventing pulmonary abscesses in foals.. Vet J 2009;179:301-3.
  20. Jacks S, Giguère S, Nguyen A. In vitro susceptibilities of Rhodococcus equi and other common equine pathogens to azithromycin, clarithromycin and 20 other antimicrobials.. Antimicrob Agents Chemother 2003;47:1742-5.
  21. Riesenberg A, Fessler AT, Erol E, Prenger-Berninghoff E, Stamm I, Böse R. MICs of 32 antimicrobial agents for Rhodococcus equi isolates of animal origin.. J Antimicrob Chemother 2014;69:1045-9.
  22. Venner M, Rodiger A, Laemmer M, Giguère S. Failure of antimicrobial therapy to accelerate spontaneous healing of subclinical pulmonary abscesses on a farm with endemic infections caused by Rhodococcus equi.. Vet J 2012;192:293-8.
  23. Venner M, Astheimer K, Lämmer M, Giguère S. Efficacy of mass antimicrobial treatment of foals with subclinical pulmonary abscesses associated with Rhodococcus equi.. J Vet Intern Med 2013;27:171-6.
  24. Venner M, Credner N, Lämmer M, Giguère S. Comparison of tulathromycin, azithromycin and azithromycin-rifampin for the treatment of mild pneumonia associated with Rhodococcus equi.. Vet Rec 2013;173:397.
  25. Worthington RJ, Melander C. Combination approaches to combat multidrug-resistant bacteria.. Trends Biotechnol 2013;31:177-84.
  26. Nordmann P, Ronco E. In-vitro antimicrobial susceptibility of Rhodococcus equi.. J Antimicrob Chemother 1992;29:383-93.
  27. Prescott JF, Nicholson VM. The effects of combinations of selected antibiotics on the growth of Corynebacterium equi.. J Vet Pharmacol Ther 1984;7:61-4.
  28. Berghaus LJ, Giguère S, Guldbech K. Mutant prevention concentration and mutant selection window for 10 antimicrobial agents against Rhodococcus equi.. Vet Microbiol 2013;166:670-5.
  29. Giguère S, Lee E, Williams E, Cohen ND, Chaffin MK, Halbert N. Determination of the prevalence of antimicrobial resistance to macrolide antimicrobials or rifampin in Rhodococcus equi isolates and treatment outcome in foals infected with antimicrobial-resistant isolates of R equi.. J Am Vet Med Assoc 2010;237:74-81.
  30. Burton AJ, Giguère S, Sturgill TL, Berghaus LJ, Slovis NM, Whitman JL. Macrolide- and rifampin-resistant Rhodococcus equi on horse breeding farm, Kentucky, USA.. Emerg Infect Dis 2013;19:282-5.
  31. Olayianka ET, Ore A. Influence of Azithromycin treatment on hepatic lipid peroxidation and antioxidant defence systems of rats.. Br J Pharmaceut Res 2014;4:240-56.
  32. Giguère S, Jacks S, Roberts GD, Hernandez J, Long MT, Ellis C. Retrospective comparison of azithromycin, clarithromycin, and erythromycin for the treatment of foals with Rhodococcus equi pneumonia.. J Vet Intern Med 2004;18:568-73.
  33. Stratton-Phelps M, Wilson WD, Gardner IA. Risk of adverse effects in pneumonic foals treated with erythromycin versus other antibiotics: 143 cases (1986-1996).. J Am Vet Med Assoc 2000;217:68-73.

Citations

This article has been cited 7 times.
  1. Rakowska A, Marciniak-Karcz A, Bereznowski A, Cywińska A, Żychska M, Witkowski L. Less Typical Courses of Rhodococcus equi Infections in Foals.. Vet Sci 2022 Oct 31;9(11).
    doi: 10.3390/vetsci9110605pubmed: 36356082google scholar: lookup
  2. Wu C, Zha D, Gao H. Prediction of Bronchopneumonia Inpatients' Total Hospitalization Expenses Based on BP Neural Network and Support Vector Machine Models.. Comput Math Methods Med 2022;2022:9275801.
    doi: 10.1155/2022/9275801pubmed: 35633928google scholar: lookup
  3. Ang L, Vinderola G, Endo A, Kantanen J, Jingfeng C, Binetti A, Burns P, Qingmiao S, Suying D, Zujiang Y, Rios-Covian D, Mantziari A, Beasley S, Gomez-Gallego C, Gueimonde M, Salminen S. Gut Microbiome Characteristics in feral and domesticated horses from different geographic locations.. Commun Biol 2022 Feb 25;5(1):172.
    doi: 10.1038/s42003-022-03116-2pubmed: 35217713google scholar: lookup
  4. Nielsen SS, Bicout DJ, Calistri P, Canali E, Drewe JA, Garin-Bastuji B, Gonzales Rojas JL, Gortázar C, Herskin M, Michel V, Miranda Chueca MÁ, Padalino B, Pasquali P, Roberts HC, Spoolder H, Ståhl K, Velarde A, Viltrop A, Winckler C, Baldinelli F, Broglia A, Kohnle L, Alvarez J. Assessment of listing and categorisation of animal diseases within the framework of the Animal Health Law (Regulation (EU) No 2016/429): antimicrobial-resistant Rhodococcus equi in horses.. EFSA J 2022 Feb;20(2):e07081.
    doi: 10.2903/j.efsa.2022.7081pubmed: 35136423google scholar: lookup
  5. Erol E, Scortti M, Fortner J, Patel M, Vázquez-Boland JA. Antimicrobial Resistance Spectrum Conferred by pRErm46 of Emerging Macrolide (Multidrug)-Resistant Rhodococcus equi.. J Clin Microbiol 2021 Sep 20;59(10):e0114921.
    doi: 10.1128/JCM.01149-21pubmed: 34319806google scholar: lookup
  6. Álvarez-Narváez S, Huber L, Giguère S, Hart KA, Berghaus RD, Sanchez S, Cohen ND. Epidemiology and Molecular Basis of Multidrug Resistance in Rhodococcus equi.. Microbiol Mol Biol Rev 2021 May 19;85(2).
    doi: 10.1128/MMBR.00011-21pubmed: 33853933google scholar: lookup
  7. Rakowska A, Cywinska A, Witkowski L. Current Trends in Understanding and Managing Equine Rhodococcosis.. Animals (Basel) 2020 Oct 18;10(10).
    doi: 10.3390/ani10101910pubmed: 33081047google scholar: lookup
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