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Background  Adverse effects of, and bacterial resistance to, macrolides used to treat  Rhodococcus equi  infections have prompted search for clinically effective alternative antimicrobials. Liposomal gentamicin ( LG ) is effective against  R. equi  in vitro and decreases tissue concentrations of  R. equi  in experimentally infected mice. Effectiveness of  LG  treatment of foals with  R. equi  pneumonia, however, has not been described.    Hypothesis  Liposomal gentamicin is safe and effective for treating foals with  R. equi  pneumonia.    Animals  Ten foals with experimentally induced  R. equi  pneumonia.    Methods  Pilot treatment trial. Foals with pneumonia induced by intrabronchial instillation of  R. equi  were randomly allocated to receive either clarithromycin combined with rifampin ( CLR  +  RIF )  PO  or  LG IV , and followed by daily physical examinations and weekly thoracic ultrasonography and serum creatinine concentration determinations until the resolution of clinical signs. Treatment success was defined as the resolution of clinical signs and ultrasonographically identified pulmonary abscesses.    Results  All 10 foals were successfully treated. Two of 5 foals treated with  LG  developed azotemia within 1 week;  LG  was discontinued and treatment switched to  CLR  +  RIF  for these foals. None of the  CLR  +  RIF  treated foals developed azotemia.    Conclusions and Clinical Importance  Liposomal gentamicin  IV  can be effective for treatment of  R. equi  pneumonia, but nephrotoxicity indicates that an alternative dosing interval or route (such as nebulization) will be needed before  LG  is adequately safe for clinical use. Larger comparative trials will be needed to evaluate the relative efficacy of a safer  LG  dosage regimen.

Use of Liposomal Gentamicin for Treatment of 5 Foals with Experimentally Induced Rhodococcus equi Pneumonia