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Ancillary Therapies for Equine Protozoal Myeloencephalitis (EPM) in Horses: Part 2 Treatment Guide

Updated: Aug 16, 2023

Nonsteroidal anti-inflammatory drugs (NSAIDS) such as flunixin meglumine often are given to moderately or severely affected horses with EPM during the first 3 to 7 days of antiprotozoal therapy. For horses in danger of falling down or that exhibit signs of brain involvement, the additional use of corticosteroids (.05mg/kg dexamethasone every 12 hours) and DMSO ( 1g/kg as a 10% solution IV or by nasogastric tube q12h) for the first several days may control the inflammatory response and associated clinical signs and provide time for the antiprotozoal drugs to begin to work.

Because the damaged CNS is susceptible to oxidant injury, it has become common practice to use pharmacologic doses of the antioxidant vitamin E (e.g., 20IU/kg daily PO) throughout the period in which the horses are treated for EPM. Although Vitamin E therapy may not significantly alter the course of recovery, it is considered unlikely to do any harm. Based on the assumption that horses that develop EPM may, in some respect, be immune-compromised, immunomodulators sometimes have been included in treatment of the disease. The drugs used include levamisole ( 1mg/kg PO every 12 hours for the first 2 weeks of antiprotozoal therapy and for the first week of each month thereafter), killed Propionibacterium acnes ( EqStim ) and mycobacterial wall extract ( Equimune IV ) are also used.

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