Management Plan

	Septic arthritis and osteomyelitis is an emergency for this foal, and needs to be 
treated immediately.  We are going to treat the foal aggressively with systemic 
antibiotics.  Our choice is an amikacin/potassium penicillin combination.  The Klebsiella 
pneumoniae that was cultured is sensitive to the amikacin, and penicillin is a good broad 
spectrum antibiotic for gram positive organisms.  Even though the Klebsiella was 
cultured, it may have been a contaminant, so the penicillin will help cover the bases.  The 
filly may need long-term treatment (4-6 weeks), and she will be on the antibiotic for at 
least 2 weeks.   We will also lavage the joint with Normasol.  The procedure will be tried 
with sedation and local anesthesia first.  The joint will be infiltrated with the solution via 
needle, and also drained by needle.  Local perfusion with antibiotics (amikacin) in the 
fetlock region of the right hind will be performed. We will use a tourniquet to occlude 
blood flow and inject the antibiotic into a local vessel, for example, the plantar metatarsal 
artery or vein.  This procedure will be performed every other day while the filly is in the 
hospital.  The filly will also receive phenylbutazone to decrease inflammation and relieve 
pain.  After these procedures, the leg will be wrapped to give the filly some support and 
to help prevent further infection.  In consideration for the finances or our client, this is 
our first plan of action.
	The filly needs stall rest or restriction from exercise (a small paddock) for several 
weeks to months.  This will give her tissues time to rest and respond to treatment.  After 
she has begun to recover, her joint should be passively flexed at least once a day to 
maintain range of motion and help rehabilitate the joint.
	If the filly does not respond, there are other courses of action available if the 
client wishes to pursue them.  Surgery to open the joint, curettage the affected bone, and 
flush the joint may help the filly.  Antibiotics could also be administered via the 
intramedullary cavity through a hole drilled in the bone.  This option would be an 
alternative to the regional perfusion.