Does intra-articular injection of antimicrobials alongside corticosteroids or other medications reduce the risk of synovial sepsis?

  • Helen R Braid University of Liverpool Leahurst Campus Chester High Road Neston Wirral CH64 7TE



Open Access Logo



PICO question

In horses, does treatment with intra-articular antimicrobials concurrently with intra-articular corticosteroids reduce the risk of iatrogenic synovial sepsis compared to intra-articular corticosteroids alone?

Clinical bottom line

From the current literature, there is no evidence showing that intra-articular injection of antibiotics in conjunction with corticosteroids reduces the risk of synovial sepsis. However, the intra-articular injection of polysulphated glycosaminoglycans (PSGAGs) in combination with corticosteroids was noted as a risk factor for developing iatrogenic synovial sepsis and therefore concurrent antibiotic injection when administering PSGAGs may be warranted. The reported frequency of infection following intra-articular injections was very low (0.02–0.08%).  An overall prevalence of iatrogenic synovial sepsis following all intra-articular injections based on data from all included studies was calculated as 0.02% (CI 0.02–0.03%). However, due to the paucity of literature on the topic, further studies are required in this field to determine more accurate clinical recommendations.

Open Access Peer Reviewed

Author Biography

Helen R Braid, University of Liverpool Leahurst Campus Chester High Road Neston Wirral CH64 7TE

Lecturer in Equine Practice and Equine Practice Vet at the University of Liverpool.


Arlt, S.P., & Heuwieser, W. (2016). ‘The Staircase of Evidence–a New Metaphor Displaying the Core Principles of Evidence-based Veterinary Medicine’. Veterinary Evidence, 1(1). DOI:

Ausvet Pty Ltd. (2019). ‘Epitools epidemiological calculators’.

Bohlin, A.M., Kristoffersen, M., & Toft, N. (2014). ‘Infectious arthritis following intra-articular injection in horses not receiving prophylactic antibiotics: a retrospective cohort study of 2833 medical records’. In Proceedings of the 60th Annual Convention of the American Association of Equine Practitioners, Salt Lake City, Utah, USA, December 6-10 2014 (pp. 255–256). American Association of Equine Practitioners (AAEP).

Gillespie, C.C., Adams, S.B., & Moore, G.E. (2016). ‘Methods and Variables Associated with the Risk of Septic Arthritis Following Intraâ€Articular Injections in Horses: A Survey of Veterinarians’. Veterinary Surgery, 45(8), pp. 1071–1076. DOI:

Gustafson, S.B., McIlwraith, C.W., Jones, R.L., & Dixon-White, H.E. (1989). ‘Further investigations into the potentiation of infection by intra-articular injection of polysulfated glycosaminoglycan and the effect of filtration and intra-articular injection of amikacin’. American journal of veterinary research, 50(12), pp. 2018–2022.

Murad, M.H., Asi, N., Alsawas, M., & Alahdab, F. (2016). ‘New evidence pyramid’. BMJ Evidence-Based Medicine, 21(4), pp. 125–127. DOI:

Peduzzi, P., Concato, J., Kemper, E., Holford, T.R., & Feinstein, A.R. (1996). ‘A simulation study of the number of events per variable in logistic regression analysis’. Journal of clinical epidemiology, 49(12), pp. 1373–1379. DOI:

Smith, L., Palmer, L., Shepherd, M., Steven, W.N., Dallas, R., Baldwin, G., Sommerville, G., Hawthorne, T. and Ramzan, P. (2013). ‘Risks of Synovial Sepsis Following Intra-synovial Medication in Ambulatory Practice, 2006–2011: 9456 Intra-synovial Injections’. In: Clinical Research Abstracts of the British Equine Veterinary Association Congress 2013, Equine Veterinary Journal, 45, pp. 6–6. DOI:

Smith, L.C.R., Wylie, C.E., Palmer, L., & Ramzan, P.H.L. (2018). ‘Synovial sepsis is rare following intra-synovial medication in equine ambulatory practice’. Equine veterinary journal. DOI:

Steel, C.M., Pannirselvam, R.R., & Anderson, G A. (2013). ‘Risk of septic arthritis after intraâ€articular medication: a study of 16,624 injections in Thoroughbred racehorses’. Australian veterinary journal, 91(7), pp. 268–273. DOI:

Vol. 4 No. 4 (2019): The fourth issue of 2019

Section: Knowledge Summaries

Categories :  Small Animal  /  Dogs  /  Cats  /  Rabbits  /  Production Animal  /  Cattle  /  Sheep  /  Pig  /  Equine  / 

Themes by