Management & Prognosis

	Although a systemic infection is not apparent this foal should be placed on long term treatment with systemic broad spectrum antibiotics.  The culture and sensitivity from the joint analysis only identified Klebsiella pneumonia.  It also showed it to be sensitive to gentamicin and amikacin.  Because it s a foal we would put it on amikacin and potassium penicillin for approximately five weeks.   We would also administer intra-articular antibiotics to the right rear fetlock but only after we have lavaged the joint.  Again we would use gentamincin or amikacin as the antibiotic of choice for intra-articular administration for 24-48 hours.  To remove inflammatory products we would lavage the joint.  We would do this on the initial visit and then several days later we would do another joint fluid analysis to determine if it would be necessary to do another joint lavage.  The joint lavage should be done under general anesthesia and should initially contain lidocaine.  To limit the inflammatory response an NSAID, most likely phenylbutazone, would be given.  After the infectious arthritis and the acute inflammatory reaction have resolved we would also put the foal on polysulfated glycosaminoglycans and hyaluronan.  Finally, to allow the soft tissue to heal we would prescribe prolonged rest from exercise but passive motion is important in the rehabilitation process.
	The Prognosis is guarded for joint sepsis but it is a little better for this foal because it is early, localized to a single joint, and possibly no bone involvement.