Think Globally, Treat Locally!
If you have a horse, sooner or later you have a horse with a gash somewhere on its body. Horses seem to have an uncanny ability to find the one sharp branch or protruding splinter of wood or nail in any paddock, pen or stall that no one else can ever find, no matter how hard you look. But in the end, horses, just like people, sometimes get cuts. Some cuts probably never even get noticed. Thankfully, a lot of them heal by themselves with no interference from us. In other cases, though, the cuts can get infected, and that's when you and your veterinarian need to step in and help that horse out.
Unfortunately, the "knee-jerk" reaction in many of these cases seems to be to put the horse on antibiotics. Under some circumstances I don't disagree that this may be necessary, especially if the wound may involve tendons or a joint or deeper tissues. In a lot of cases, however, this type of treatment may not be the best thing for the animal. Use of local therapy for wounds, instead of systemic (e.g. oral or injected) antibiotics, should always be carefully considered.
Local therapy for wounds can include a variety of different types of treatments, such as drainage of discharge, removal of dead tissue (debridement), flushing of the wound (lavage), topical antibiotics, antiseptics, and sometimes newer (or older) compounds like honey.
Let's compare some of the potential pros and cons of local versus systemic therapy:
- Treating what counts: Local therapy is targeted at the site of infection - the wound itself. Some antibiotics that are too toxic to be given systemically, or can't be given safely at a high enough dose to be effective, can be applied directly to the wound at a higher concentration, delivering a more effective blow to the infecting organism.
- Not treating what doesn't count: Avoiding the use of systemic antibiotics decreases exposure of the bacteria that are part of the horse's normal bacterial flora, particularly those in the intestinal tract. This helps to decrease the risk of disrupting the flora, which can otherwise result in antibiotic-associated diarrhea. It also helps decrease the risk of other bacteria in the horse's body developing resistance to the antibiotic being used.
- "Taking out the trash": Drainage, debridement and lavage help remove all the "junk" in a wound by getting rid of dirt, pus and dead tissue. Often times, these are the most important components of treatment, and likely have more of an effect on the outcome than any of the drugs that may be used. Whatever can be physically removed from the wound decreases the amount of junk and bacteria with which the horse's body needs to deal, and also eliminates material in which bacteria can hide from the immune system.
- Cost savings: Often times local therapy involves more time for cleaning and bandaging, but less drugs, because you're only treating the infected site, not the entire horse.
- It's not easy: As difficult as it sometimes can be to give a horse needles or make it swallow medication, these methods are often chosen because they are perceived as the "easy way out." Local therapy for a wound can be a lot of work - it takes time, it sometimes means getting yourself a little dirty, and some owners don't like the "ick" factor of having to deal directly with the wound itself. However, systemic antibiotics should not be used as a substitute for proper wound care.
- Every wound (and every horse) is different: Not every infected wound is amenable to local treatment. Deep wounds can be especially difficult to treat this way, because the deepest parts of the wound simply aren't accessible. Also, depending on the temperament of the horse and/or the location of the wound, the animal may not tolerate local therapy of the site without sedation, in which case it is best left to your veterinarian. It is always very important to ensure that you can safely treat your horse.
Even for wounds that do require systemic antibiotic treatment for one reason or another, local therapy should not be neglected, and can be critical to achieving a successful outcome. It's important to try to resolve infections (of any kind) as quickly and efficiently as possible in order to avoid complications associated with chronic infection, and minimize the risk of antibiotic resistance developing (if antibiotics are used). That means using all the available tools at our disposal, including simple wound care and local therapy, to treat them. But remember:
- Always wear disposable gloves if you need to clean, treat, bandage or otherwise touch a wound, and wash your hands well with soap and water afterward. This will help prevent bacteria from the wound from being transmitted to you, and bacteria from your hands from infecting the wound.
- Do not give your horse antibiotics of any kind before consulting your veterinarian.
