Management Plan Optimal Therapy includes: Early initiation of systemic antibiotic therapy. Ideally this should be guided by culture and sensitivity. Klebsiella is often susceptible to Amikacin. Often combinations of Amikacin and cephalothin are good initial therapy or penicillin and gentamicin. Intraarticular antibiotic therapy could be considered with similar antibiotics (amikacine and cepatholthin often used. Synovial infusion of antibiotics is risky as you can introduce bacteria to the joint if not done with proper sterile technique; and, in this particular case, since the infection appear to be confined to the area of the growth plate, injection of antibiotics into the synovial fluid may not be warranted. Klebsiella was found on the synovial fluid analysis, though, so we may want to consider this as preventative. Before joint infusion with antibiotics the joint should be lavaged to remove products of inflammation that lead to cartilage destruction, remove purulent material to improve antibiotic efficacy. The addition of chemicals, though, can cause chemical synovitis. Antibiotic therapy should be continued for 2 weeks after resolution of clinical signs. . We would also like to further inspect the other joints. Often they can be affected without showing clinical signs at this point. Since we suspect that this is a form of neonatal septicemia ( due to possibly due to pneumonia since the organism was Klebsiella pneumoniae ) as opposed to due to trauma, we want to make sure other joints are not affected. Supportive care should be done as follows: Stall rest and maintenance of modified Robert Jones ( to allow healing of damages soft tissues and articular cartilageÉaccording to our notes, we should not immobilize the joint but other books did mention a modified Robert Jones.) Hand walking and passive joint flexion may improve joint function. ( this allows rehabilitation and maintenance of range of motion of recovering joint0 NSAIDÕs are indicated to relieve pain and inflammation. While on these may want to put on antiulcer medication. Gastric ulceration is common with septic arthritis. Administration of hyaluronan ( used to normalize the synovial fluid and for its activity in limiting the inflammatory response) or polysulfated glycosaminoglycans may be worthwhile once acute inflammation is controlled (PSGAG inhibits complement activation) If within 48 hours, there is no repsonse to 1-2 lavages in conjunction with systemic antibiotics, or foals first seen after lameness lasting several days may need surgical debridement of the affected joint due to the extensive lesions.