Management

	Septic arthritis requires prompt treatment to avoid irreparable damage.  Systemic 
broad- spectrum antibiotics are indicated. In this case, the joint was found to have a pure 
infection of Klebsiella that is sensitive to amikacin.  Amikacin and potassium penicillin 
are used most commonly in foals given at a dose of 20,000IU/kg intramuscularly twice a 
day.  This treatment should be continued for at least two weeks up to 4-6 weeks 
depending on the foalÕs response.  Treatment will be costly so client education is 
important.
	
	The joint will be lavaged initially to remove the products of inflammation that lead 
to cartilage destruction, and to remove the purulent material to improve antibiotic 
efficacy. Since this is a foal not used to restraint, general anesthesia will be performed 
before joint lavage takes place and lidocaine will be added to initial flush.  Arthroscopy is 
the best choice in this case to allow visualization and a biopsy of synovial membrane can 
be taken if needed.  This method of joint lavage uses a large bore cannula allowing the 
removal of particulate material  more effectively than other methods of joint lavage.

	Systemic antibiotic treatment will be combined with intra-articular antibiotics to 
achieve more effective sterilization of the joint. This should be done over a period of 24-
48 hours.  Aminogylcosides such as amikacin or gentamicin ceftofur are commonly used 
at the conclusion of joint lavage.

	Adjunctive treatment with nonsteroidal anti-inflammatory drugs such as 
phenylbutazone will also be used to improve patient comfort and limit the inflammatory 
response.  
	
	Once the acute inflammatory reaction has lessened, hyaluronan will be used to 
limit inflammation and help return the synovial fluid to normal.  Once we are certain the 
infection has resolved we can use a PSGAG such as Adequan to prolong joint protection.  
Prolonged rest for this foal is very important to allow healing of the joint and the soft 
tissues surrounding it.  Stall rest is recommended for at least two weeks.  The joint should 
not be immobilized because passive motion is beneficial for the rehabilitation process.  

	Subsequent joint fluid analysis and frequent physical examinations will be done to 
assure proper healing.

Prognosis

	Prognosis is usually guarded for joint sepsis, however, this foal has a better chance 
for recovery because the infection only involves one joint, and the infection was treated 
early.