Treatment
1. Initiate systemic Antibiotics
The joint tap indicated that the bacteria in the joint were susceptible to amikacin, 
gentamicin, ceftofur, chloramphemicol, and enrofloxacin.  We would choose this 
antibiotic based owner compliance and available funds.  It is recommended that the 
foal be treated with amikacin, the cost of that is $220 per day.  The foal may need 
long term treatment for 4 to 6 weeks.
--Intra-articular antibiotic Infusion could also be used.  This allows for locally high 
concentrations of antibiotics.  The antibiotic of choice would be gentamicin.  Intra-
articular antibiotic administration is commonly used following joint lavage.
--Regional Perfusion of antibioticsÑrequires general anesthesia but achieves high 
concentration of antibiotic to the joint
--Antibiotic Impregnated polymethylmethacrylate beads could be placed in the joint 
through athrotomy, they need to be removed prior to healing.

2. Joint Lavage
The process of joint lavage allows us to remove products of inflammation that lead to 
cartilage destruction, and removal of purulent material, which would improve the 
efficacy of the antibiotic. This process should be performed under general anesthesia. 
There are various ways to perform this procedure.

3.  Adequan (PSGAG)Ñused after the infection has resolved will allow for a 
      ÒChondroprotectiveÓ effect

4.  Administer NSAIDSÑused to improve patient comfort and to limit the inflammatory           
     response that could cause further damage.

5.  Hyaluronan is also used after the infection is resolved, the will normalize the 
synovial fluid.

6.  Prolonged rest from exercise will allow healing, but do not immobilize the joint.

7.  Passive motion is important in rehabilitation and maintaining the range of motion 


Specific Treatment for this Foal
In this case money is no object and the client can spend as much as needed, we will use 
this protocol:
1. Systemic amikacin for 4-6 weeks with joint aspirates done routinely to assure the 
Klebseilla infection has resolved.
2. Joint lavage through arthroscopy with infusion of gentamicin into the joint
3. NSAIDS
4. PSGAG
5. Hyaluronan
6. Rest
7. Passive motion exercise