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Ryan CA, McNeal CD, Credille BC. Ceftiofur use and antimicrobial stewardship in the horse. Equine Vet J 2023; 55:944-961. [PMID: 36733237 DOI: 10.1111/evj.13930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 01/26/2023] [Indexed: 02/04/2023]
Abstract
Equine practitioners require recommendations that support antimicrobial stewardship and avoid generating resistance to medically important antibiotics. This review examines current inadequacies in antimicrobial stewardship standards within the veterinary community, related to antimicrobial categorisation and prescribing practices. Resistance to cephalosporin antibiotics in horses is also described. Properties of cephalosporin antibiotics are outlined and equine-specific studies of ceftiofur, a third-generation cephalosporin antibiotic with medical importance, are detailed. Readers are provided with recommendations that encourage appropriate use of ceftiofur, citing the evidence available in horses.
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Affiliation(s)
- Clare A Ryan
- Department of Large Animal Medicine, University of Georgia, Athens, Georgia, USA
| | - Christina D McNeal
- Department of Large Animal Medicine, University of Georgia, Athens, Georgia, USA
| | - Brenton C Credille
- Department of Population Health, University of Georgia, Athens, Georgia, USA
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McNeal CD, Ryan CA, Berghaus LJ, Credille BC, Lo CP, Fajt VR. Plasma disposition of ceftazidime in healthy neonatal foals following intravenous and intramuscular administration. J Vet Pharmacol Ther 2021; 44:560-567. [PMID: 33511670 DOI: 10.1111/jvp.12947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 10/10/2020] [Accepted: 12/11/2020] [Indexed: 11/29/2022]
Abstract
Cephalosporin antimicrobials can be utilized for the treatment of sepsis in neonatal foals, particularly when an aminoglycoside is contraindicated. Some cephalosporins, however, are not utilized because of cost, sporadic availability, or uncertainty about efficacy. The plasma disposition of ceftazidime, a third-generation cephalosporin with a broad spectrum of activity against a wide variety of gram-negative bacteria and minimal renal side effects has not been reported in neonatal foals. In this study, the plasma disposition of single intravenous (IV) and intramuscular (IM) doses of ceftazidime in neonatal foals was determined. Six healthy one to two-day-old foals were given 25 mg/kg of ceftazidime by IV and IM routes in a cross-over design, with a 48-h washout period between doses. Non-compartmental analysis was used to estimate plasma pharmacokinetic parameters. Median t1/2 was 2 h and median AUC0-last was 364 µg h/ml for both IV and IM administration. Median Cmax after IM administration was 101 µg/ml, with a median Tmax of 0.7 h. Relative bioavailability of IM injection was 90%. There were no statistically significant differences between estimated IV and IM pharmacokinetic parameters. Plasma concentrations remained above the human CLSI susceptible breakpoint for Enterobacteriaceae for over 8 h following IV and IM administration.
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Affiliation(s)
- Christina D McNeal
- Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - Clare A Ryan
- Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - Londa J Berghaus
- Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - Brenton C Credille
- Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - Chih-Ping Lo
- Texas A&M Veterinary Medical Diagnostic Laboratory (TVMDL), College Station, TX, USA
| | - Virginia R Fajt
- Department of Veterinary Physiology and Pharmacology, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, TX, USA
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Zetterström S, Groover E, Lascola K, Cole R, Velloso A, Boone L. Meningitis After Tooth Extraction and Sinus Lavage in a Horse. J Equine Vet Sci 2020; 97:103323. [PMID: 33478768 DOI: 10.1016/j.jevs.2020.103323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/10/2020] [Accepted: 11/10/2020] [Indexed: 10/23/2022]
Abstract
A five-year-old Thoroughbred mare was evaluated because of chronic, malodorous, unilateral nasal discharge, and suspected maxillary cheek tooth root abscess. Skull radiographs revealed bilateral sinusitis suspected secondary to tooth root abscessation of 109 and 210. Following oral extraction of 109, bilateral conchofrontal sinus trephination and lavage; fever, tachycardia, and cervical stiffness developed. A lumbosacral cerebrospinal fluid tap was performed, and a presumptive diagnosis of bacterial meningitis was made. Targeted therapy consisted of antibiotic treatment with penicillin, enrofloxacin, and metronidazole, as well as antiinflammatory treatment with flunixin meglumine, dexamethasone, and dimethyl sulfoxide. Following the resolution of fever, tachycardia, and cervical stiffness, the second abscessed tooth, 210, was extracted. The mare was discharged receiving enrofloxacin. Twelve months later, the mare continued to do well with no residual signs of meningitis. Bacterial meningitis should be regarded as a life-threatening, although rare, the complication of dental or sinus surgery in horses. Early diagnosis and therapy may result in a successful outcome.
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Affiliation(s)
- Sandra Zetterström
- Department of Clinical Sciences, J. T. Vaughan Teaching Hospital, College of Veterinary Medicine, Auburn University, Auburn, AL
| | - Erin Groover
- Department of Clinical Sciences, J. T. Vaughan Teaching Hospital, College of Veterinary Medicine, Auburn University, Auburn, AL
| | - Kara Lascola
- Department of Clinical Sciences, J. T. Vaughan Teaching Hospital, College of Veterinary Medicine, Auburn University, Auburn, AL
| | - Robert Cole
- Department of Clinical Sciences, J. T. Vaughan Teaching Hospital, College of Veterinary Medicine, Auburn University, Auburn, AL
| | - Ana Velloso
- Department of Clinical Sciences, J. T. Vaughan Teaching Hospital, College of Veterinary Medicine, Auburn University, Auburn, AL
| | - Lindsey Boone
- Department of Clinical Sciences, J. T. Vaughan Teaching Hospital, College of Veterinary Medicine, Auburn University, Auburn, AL.
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Magdesian KG. Antimicrobial Pharmacology for the Neonatal Foal. Vet Clin North Am Equine Pract 2017; 33:47-65. [DOI: 10.1016/j.cveq.2016.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Modric S, Martinez M. Patient variation in veterinary medicine--part II--influence of physiological variables. J Vet Pharmacol Ther 2010; 34:209-23. [PMID: 21083665 DOI: 10.1111/j.1365-2885.2010.01249.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
In veterinary medicine, the characterization of a drug's pharmacokinetic properties is generally based upon data that are derived from studies that employ small groups of young healthy animals, often of a single breed. In Part I of the series, we focused on the potential influence of disease processes, stress, pregnancy and lactation on drug pharmacokinetics. In this Part II of the series, we consider other covariates, such as gender, heritable traits, age, body composition, and circadian rhythms. The impact of these factors with respect to predicting the relationship between dose and drug exposure characteristics within an animal population is illustrated through the use of Monte Carlo simulations. Ultimately, an appreciation of these potential influences will improve the prediction of situations when dose adjustments may be appropriate.
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Affiliation(s)
- S Modric
- Center for Veterinary Medicine (CVM), Office of New Animal Drug Evaluation, Food and Drug Administration (FDA), Rockville, MD 20855, USA
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Manzoni P, Esposito S, Gallo E, Gastaldo L, Farina D, Principi N. Switch therapy in full-term neonates with presumed or proven bacterial infection. J Chemother 2009; 21:68-73. [PMID: 19297276 DOI: 10.1179/joc.2009.21.1.68] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
This case-control study of full-term newborns with presumed or proven bacterial infection compared the efficacy, safety and tolerability of switch antibiotic therapy and traditional completely intravenous antibiotic administration. there were 36 newborns treated with switch therapy (i.v. ampicillin + sulbactam combined with i.v. amikacin for 3 days followed by oral cefpodoxime proxetil for 5 days); there were 72 full-term newborns with the same characteristics as controls who received i.v. ampicillin + sulbactam combined with i.v. amikacin for 3 days followed by i.v. ampicillin + sulbactam alone for a further 5 days. the results showed that full-term newborns with presumed or proven bacterial infection initially treated with intravenous antibiotics can be switched to oral antibiotics after 3 days' therapy if physical and laboratory data indicate the disappearance of infection, thus significantly reducing the length of stay in the neonatal intensive care unit and significantly increasing breastfeeding, without having any negative clinical impact.
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Cruz AM, Rubio-Martinez L, Dowling T. New antimicrobials, systemic distribution, and local methods of antimicrobial delivery in horses. Vet Clin North Am Equine Pract 2007; 22:297-322, vii-viii. [PMID: 16882477 DOI: 10.1016/j.cveq.2006.03.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
The local delivery of antimicrobials is a valuable therapeutic tool with a low morbidity, is practical to use, and is well tolerated by horses. Clinically, its use has allowed equine practitioners to achieve better results when treating musculoskeletal infections, and it represents an extremely useful tool in the practitioner's armamentarium against these types of infections. The technique is indicated to combat orthopedic infections involving bones, joints, physes, tendon sheaths, and foot tissues. Optimal treatment must include other approaches, such as systemic antimicrobial therapy and surgical debridement and lavage, and monitoring of the clinical progression of the patient can help to determine the ideal protocol for each patient.
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Affiliation(s)
- Antonio M Cruz
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada N1G 2W1.
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Pellegrini-Masini A, Livesey LC. Meningitis and Encephalomyelitis in Horses. Vet Clin North Am Equine Pract 2006; 22:553-89, x. [PMID: 16882487 DOI: 10.1016/j.cveq.2006.03.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
This article provides an overview of meningitis and encephalomyelitis in horses, including diagnostic tests, treatment developments, and preventative measures reported in the equine and human medical literature of the past few years.
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Affiliation(s)
- Alessandra Pellegrini-Masini
- Equine Section, Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL 36849, USA.
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Stewart AJ. Actinobacillus pleuritis and peritonitis in a quarter horse mare. Vet Clin North Am Equine Pract 2006; 22:e77-93. [PMID: 16627097 DOI: 10.1016/j.cveq.2005.12.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Allison J Stewart
- Department of Clinical Sciences, Auburn University, College of Veterinary Medicine, 1500 Wire Road, Auburn University, AL 36849, USA.
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Davis JL, Salmon JH, Papich MG. Pharmacokinetics and tissue fluid distribution of cephalexin in the horse after oral and i.v. administration. J Vet Pharmacol Ther 2005; 28:425-31. [PMID: 16207304 DOI: 10.1111/j.1365-2885.2005.00683.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to determine the pharmacokinetics and tissue fluid distribution of cephalexin in the adult horse following oral and i.v. administration. Cephalexin hydrate (10 mg/kg) was administered to horses i.v. and plasma samples were collected. Following a washout period, cephalexin (30 mg/kg) was administered intragastrically. Plasma, interstitial fluid (ISF) aqueous humor, and urine samples were collected. All samples were analyzed by high-pressure liquid chromatography (HPLC). Following i.v. administration, cephalexin had a plasma half-life (t(1/2)) of 2.02 h and volume of distribution [V(d(ss))] of 0.25 L/kg. Following oral administration, the average maximum plasma concentration (C(max)) was 3.47 mug/mL and an apparent half-life (t(1/2)) of 1.64 h. Bioavailability was approximately 5.0%. The AUC(ISF):AUC(plasma) ratio was 80.55% which corresponded to the percentage protein-unbound drug in the plasma (77.07%). The t(1/2) in the ISF was 2.49 h. Cephalexin was not detected in the aqueous humor. The octanol:water partition coefficient was 0.076 +/- 0.025. Cephalexin was concentrated in the urine with an average concentration of 47.59 microg/mL. No adverse events were noted during this study. This study showed that cephalexin at a dose of 30 mg/kg administered orally at 8 h dosage intervals in horses can produce plasma and interstitial fluid drug concentrations that are in a range recommended to treat susceptible gram-positive bacteria (MIC < or = 0.5 microg/mL). Because of the low oral bioavailability of cephalexin in the horse, the effect of chronic dosing on the normal intestinal bacterial flora requires further investigation.
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Affiliation(s)
- J L Davis
- Clinical Pharmacology, Research Laboratories, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606, USA.
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Abstract
Neonatal infection remains a leading cause of morbidity and mortality in the equine industry, despite advances in prevention and treatment. Many factors can influence a foal's risk for the development of sepsis in the peripartum period. This article discusses those factors, causative organisms, and therapeutic options. Factors that influence prognosis and potential preventative strategies also are addressed.
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Affiliation(s)
- L Chris Sanchez
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, PO Box 100136, 2015 S.W. 16th Avenue, Gainesville, FL 32610-0136, USA.
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