Gallium maltolate as an alternative to macrolides for treatment of presumed Rhodococcus equi pneumonia in foals.

Abstract

BACKGROUND:

Macrolide-resistant isolates of Rhodococcus equi are emerging, prompting the search for clinically effective alternative antimicrobials.

HYPOTHESIS:

The proportion of foals with ultrasonographic evidence of pneumonia presumed to be caused by R. equi that had a successful outcome when administered gallium maltolate (GaM) PO would not be more than 10% inferior (ie, lower) than that of foals receiving standard treatment.

ANIMALS:

Fifty-four foals with subclinical pulmonary abscesses among 509 foals at 6 breeding farms in Kentucky.

METHODS:

Controlled, randomized, prospective noninferiority study. Foals with ultrasonographic lesions >1 cm in diameter (n = 54) were randomly allocated to receive per os either clarithromycin combined with rifampin (CLR+R) or GaM, and followed up for 28 days by daily physical inspections and weekly (n = 1 farm) or biweekly (n = 4 farms) thoracic ultrasound examinations by individuals unaware of treatment-group assignments. Treatment success was defined as resolution of ultrasonographically identified pulmonary abscesses within 28 days of initiating treatment. Noninferiority was defined as a 90% confidence interval for the observed difference in CLR+R minus GaM that was ≤10%.

RESULTS:

The proportion of GaM-treated foals that resolved (70%; 14/20) was similar to that of foals treated with CLR+R (74%; 25/34), but we failed to demonstrate noninferiority for GaM relative to CLR+R; however, GaM was noninferior to CLR+R treatment when results from a noncompliant farm were excluded.

CONCLUSIONS AND CLINICAL IMPORTANCE:

Gallium maltolate is not inferior to macrolides for treating foals with subclinical pneumonia. Use of GaM might reduce pressure for macrolide-resistance in R. equi.

• Authors: Noah D Cohen, Nathan M Slovis, Steeve Giguère, Samantha Baker, M Keith Chaffin, Lawrence R Bernstein
• Journal: Journal of veterinary internal medicine (J Vet Intern Med) 2015 May-Jun Vol. 29 Issue 3 Pg. 932-9 ISSN: 1939-1676 [Electronic] United States
• PMID: 25868480 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2015 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

Chemical References

• Anti-Bacterial Agents
• Organometallic Compounds
• Pyrones
• gallium maltolate

Topics

• Actinomycetales Infections (drug therapy, microbiology, veterinary)
• Animals
• Anti-Bacterial Agents (therapeutic use)
• Horse Diseases (drug therapy, microbiology)
• Horses
• Organometallic Compounds (therapeutic use)
• Pneumonia, Bacterial (drug therapy, microbiology, veterinary)
• Pyrones (therapeutic use)
• Rhodococcus equi (drug effects)