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Redpath A, Hallowell GD, Bowen IM. Use of aminoglycoside antibiotics in equine clinical practice; a questionnaire-based study of current use. Vet Med Sci 2020; 7:279-288. [PMID: 33099884 PMCID: PMC8025607 DOI: 10.1002/vms3.382] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 10/03/2020] [Accepted: 10/05/2020] [Indexed: 01/10/2023] Open
Abstract
Veterinary use of the aminoglycoside antibiotics is under increasing scrutiny. This questionnaire-based study aimed to document the use of aminoglycosides with a particular focus on gentamicin. An online questionnaire was delivered to generalist equine veterinary surgeons and specialists in internal medicine to determine the perceived importance, frequency of use and routes of administration of the aminoglycoside antibiotics. A series of hypothetical scenarios were also evaluated regarding gentamicin. Data were compared to evaluate the impact of the level of specialisation on prescribing practices for different antibiotics using Chi-squared and Fischer's exact tests. Data were analysed from 111 responses. Gentamicin was commonly used empirically without culture and susceptibility testing. Generalists were more likely to use gentamicin only after susceptibility testing than specialists in a variety of clinical presentations including respiratory diseases, septic peritonitis, acute febrile diarrhoea, cellulitis and contaminated limb wounds (p < 0.01). Intravenous administration of gentamicin was most common, although inhaled and regional administration of gentamicin and amikacin were also described. Amikacin was most commonly used by intra-articular administration. Gentamicin was more likely to be used in high-risk procedures or contaminated surgeries (86% and 74%, respectively) compared with clean surgery (32%; p < 0.0001). Gentamicin was often used perioperatively in horses undergoing exploratory celiotomy and more commonly used in horses undergoing an enterotomy (90%) than without and enterotomy (79%; p = 0.04). Most respondents (86%) used gentamicin at a dose of 6.6 mg/kg in adults, with few changing their dosing strategies based on the presence of sepsis, although higher doses were more reported in foals (7-15 mg/kg) irrespective of the presence of sepsis. Aminoglycosides are widely used in equine practice and use outside current EU marketing authorisations is common. Stewardship of the aminoglycoside antibiotics could be enhanced in both generalists and specialists through the more frequent use of susceptibility testing, regional administration and dose adjustment, especially in foals.
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Affiliation(s)
- Adam Redpath
- Oakham Veterinary HospitalSchool of Veterinary Medicine and ScienceUniversity of NottinghamLoughboroughUK
| | - Gayle D. Hallowell
- School of Veterinary Medicine and ScienceUniversity of NottinghamLoughboroughUK
| | - Ian Mark Bowen
- Oakham Veterinary HospitalSchool of Veterinary Medicine and ScienceUniversity of NottinghamLoughboroughUK
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Gustafsson K, Tatz AJ, Dahan R, Britzi M, Soback S, Sutton GA, Kelmer G. Time to Peak Concentration of Amikacin in the Antebrachiocarpal Joint Following Cephalic Intravenous Regional Limb Perfusion in Standing Horses. Vet Comp Orthop Traumatol 2020; 33:327-332. [PMID: 32799312 DOI: 10.1055/s-0040-1714418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to determine the time (Tmax) to the maximum concentration (Cmax) of amikacin sulphate in synovial fluid of the radiocarpal joint (RCJ) following cephalic intravenous regional limb perfusion (IVRLP) using 2 g of amikacin sulphate. METHODS Cephalic IVRLP was performed with 2 g of amikacin sulphate diluted in 0.9% NaCl to a total volume of 100 mL in six healthy adult mixed breed mares. An Esmarch's rubber tourniquet was applied for 30 minutes and the antibiotic solution was infused through a 23-gauge butterfly catheter. Synovial fluid was collected from the RCJ prior to the infusion and at 5, 10, 15, 20, 25 and 30 minutes after completion of IVRLP. The tourniquet was removed after the last arthrocentesis. Synovial fluid amikacin sulphate concentrations were determined by liquid chromatography/tandem mass spectrometry. RESULTS The calculated mean Tmax occurred at 15 minutes (range: 10-20 minutes) post-perfusion. The highest synovial fluid amikacin sulphate concentration was noted at 10 minutes in 2 horses, 15 minutes in 2 horses and 20 minutes in 2 horses. The highest mean concentration was 1023 µg/mL and was noted at 20 minutes. Synovial mean concentrations were significantly different between 15 and 30 minutes. CLINICAL SIGNIFICANCE In this study no Tmax occurred after 20 minutes; thus, 30 minutes of tourniquet application time appear to be excessive. The 20 minutes duration of tourniquet application appears sufficient for the treatment of the RCJ in cephalic IVRLP using 2 g amikacin sulphate in a total volume of 100 mL.
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Affiliation(s)
- Kajsa Gustafsson
- Department of Large Animal Medicine and Surgery, Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Food and Environment, the Hebrew University of Jerusalem, Rehovot, Israel
| | - Amos J Tatz
- Department of Large Animal Medicine and Surgery, Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Food and Environment, the Hebrew University of Jerusalem, Rehovot, Israel
| | - Roee Dahan
- Department of Large Animal Medicine and Surgery, Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Food and Environment, the Hebrew University of Jerusalem, Rehovot, Israel
| | - Malka Britzi
- National Residue Control Laboratory, Kimron Veterinary Institute, Beit Dagan, Israel
| | - Stefan Soback
- National Residue Control Laboratory, Kimron Veterinary Institute, Beit Dagan, Israel
| | - Gila A Sutton
- Department of Large Animal Medicine and Surgery, Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Food and Environment, the Hebrew University of Jerusalem, Rehovot, Israel
| | - Gal Kelmer
- Department of Large Animal Medicine and Surgery, Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Food and Environment, the Hebrew University of Jerusalem, Rehovot, Israel
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Biasutti SA, Cox E, Jeffcott LB, Dart AJ. A review of regional limb perfusion for distal limb infections in the horse. EQUINE VET EDUC 2020. [DOI: 10.1111/eve.13243] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- S. A. Biasutti
- Research and Clinical Training Unit University Veterinary Teaching Hospital Camden University of Sydney New South Wales Australia
| | - E. Cox
- Research and Clinical Training Unit University Veterinary Teaching Hospital Camden University of Sydney New South Wales Australia
| | - L. B. Jeffcott
- Research and Clinical Training Unit University Veterinary Teaching Hospital Camden University of Sydney New South Wales Australia
| | - A. J. Dart
- Research and Clinical Training Unit University Veterinary Teaching Hospital Camden University of Sydney New South Wales Australia
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Johns I. Antimicrobial stewardship in the treatment of equine bacterial infections. Vet J 2017; 219:4-5. [DOI: 10.1016/j.tvjl.2016.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 11/16/2016] [Indexed: 11/16/2022]
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Lovallo J, Helming J, Jafari SM, Owusu-Forfie A, Donovan S, Minnock C, Adib F. Intraoperative intra-articular injection of gentamicin: will it decrease the risk of infection in total shoulder arthroplasty? J Shoulder Elbow Surg 2014; 23:1272-6. [PMID: 24613181 DOI: 10.1016/j.jse.2013.12.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 12/13/2013] [Accepted: 12/16/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Deep infection is a debilitating complication after shoulder arthroplasty. Intra-articular injection of antibiotic can give a higher concentration compared with intravenous administration. We hypothesized that a group of patients given an intra-articular, intraoperative injection of gentamicin would report a lower infection rate than a group without local antibiotics. METHODS Between 2005 and 2011, the senior author performed 507 shoulder arthroplasties. We retrospectively reviewed all of those cases. All patients were administered systemic prophylactic antibiotics. Beginning in June 2007, patients were also injected with 160 mg of gentamicin in the glenohumeral joint at the end of their surgery. Patient records were examined for preexisting medical conditions, type of surgery, and presence of infection. Patients receiving surgery before 2007 were compared with those after to determine the effect of prophylactic gentamicin administration in preventing deep infection associated with surgery. All patients were observed for a minimum of 1 year. RESULTS Of the 507 surgeries, 164 were performed before 2007 (without intra-articular injection of gentamicin; group A) and 343 were performed with addition of gentamicin (group B). In group A, 5 patients presented with infection (3.0%) compared with 1 in group B (0.29%). The gender, mean age, mean body mass index, and prevalence of comorbidities were similar between the groups. CONCLUSIONS The data from this study support the conclusion that intra-articular intraoperative gentamicin administration may reduce postoperative infection.
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Affiliation(s)
- Jeffrey Lovallo
- Anderson Orthopedic Clinic, Alexandria, VA, USA; Department of Medicine, Georgetown University, Washington, DC, USA; INOVA Hospital, Alexandria, VA, USA
| | | | | | | | - Skye Donovan
- Nirschl Orthopedic Center, Arlington, VA, USA; Department of Physical Therapy, Marymount University, Arlington, VA, USA.
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Bohannon LK, Owens SD, Walker NJ, Carrade DD, Galuppo LD, Borjesson DL. The effects of therapeutic concentrations of gentamicin, amikacin and hyaluronic acid on cultured bone marrow-derived equine mesenchymal stem cells. Equine Vet J 2013; 45:732-6. [DOI: 10.1111/evj.12045] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 12/30/2012] [Indexed: 11/29/2022]
Affiliation(s)
- L. K. Bohannon
- Department of Surgical and Radiological Sciences; School of Veterinary Medicine; University of California-Davis; USA
| | - S. D. Owens
- Department of Pathology, Microbiology, and Immunology; School of Veterinary Medicine; University of California-Davis; USA
| | - N. J. Walker
- Department of Pathology, Microbiology, and Immunology; School of Veterinary Medicine; University of California-Davis; USA
| | - D. D. Carrade
- Department of Pathology, Microbiology, and Immunology; School of Veterinary Medicine; University of California-Davis; USA
| | - L. D. Galuppo
- Department of Surgical and Radiological Sciences; School of Veterinary Medicine; University of California-Davis; USA
| | - D. L. Borjesson
- Department of Pathology, Microbiology, and Immunology; School of Veterinary Medicine; University of California-Davis; USA
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Mal P, Dutta S, Bandyopadhyay D, Dutta K, Basu A, Bishayi B. Gentamicin in combination with ascorbic acid regulates the severity of Staphylococcus aureus infection-induced septic arthritis in mice. Scand J Immunol 2013; 76:528-40. [PMID: 22924656 DOI: 10.1111/j.1365-3083.2012.02766.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
To study the effects of gentamicin in combination with ascorbic acid on septic arthritis, mice were infected with Staphylococcus aureus (S. aureus) and treated with gentamicin, which was given at 5 mg/kg after 24 h of infection, followed by ascorbic acid, given at 20 mg/kg body weight after 2 h of gentamicin treatment. Mice were sacrificed at 3, 9, 15 days post-infection (dpi). Combined treatment of infected mice with gentamicin and ascorbic acid eradicated the bacteria from the blood, spleen and synovial tissue and showed a significant gross reduction in arthritis, reduced serum levels of tumour necrosis factor alpha (TNF-α) and interferon gamma (IFN-γ). S. aureus-infected mice have demonstrated the disturbed antioxidant status measured in terms of cellular antioxidants like reduced glutathione and antioxidant enzymes such as superoxide dismutase (SOD) and catalase. The same were ameliorated when the animals were co-treated with gentamicin along with ascorbic acid.
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Affiliation(s)
- P Mal
- Department of Physiology, Immunology Laboratory, University of Calcutta, University Colleges of Science and Technology, Calcutta, West Bengal, India
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Edwards SHR. Intra-articular drug delivery: the challenge to extend drug residence time within the joint. Vet J 2010; 190:15-21. [PMID: 20947396 DOI: 10.1016/j.tvjl.2010.09.019] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Revised: 09/20/2010] [Accepted: 09/22/2010] [Indexed: 02/02/2023]
Abstract
The rationale behind developing sustained release microsphere formulations of non-steroidal anti-inflammatory drugs (NSAIDs) administered via the intra-articular (IA) route is to minimise the systemic bioavailability and attendant side-effects associated with oral drug administration. Overall dose is reduced whilst therapeutic benefit within the joint is maintained. The potential benefits of IA therapy for osteoarthritis (OA) are not achieved using currently available medications and delivery vehicles due to the rapid clearance of therapeutic substances from the synovial space. There is a need for sustained release delivery systems if the potential of IA drug administration is to be realised. Rationally designed microspheres taken up by synovial macrophages offer a strategy to sustain drug delivery within the joint, and to deliver NSAIDs directly to pivotal inflammatory cells. The efficacy of microsphere candidates may be evaluated in large animal models of OA. The principles of IA microsphere drug delivery may also be applicable to other classes of drugs.
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Affiliation(s)
- Scott H R Edwards
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia.
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Garcìa-Lòpez JM, Jenei T, Chope K, Bubeck KA. Diagnosis and management of cranial and caudal nuchal bursitis in four horses. J Am Vet Med Assoc 2010; 237:823-9. [DOI: 10.2460/javma.237.7.823] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Stewart AA, Goodrich LR, Byron CR, Evans RB, Stewart MC. Antimicrobial delivery by intrasynovial catheterisation with systemic administration for equine synovial trauma and sepsis. Aust Vet J 2010; 88:115-23. [PMID: 20402698 DOI: 10.1111/j.1751-0813.2010.00553.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To present the technique for intra-articular catheter placement and report the clinical outcomes of 38 cases of equine synovial trauma and/or infection treated with broad-spectrum antimicrobials administered via an intrasynovial catheter (ISC). DESIGN Retrospective study. PROCEDURE Medical records of 38 horses treated for synovial trauma and sepsis with frequent antimicrobial administration through an ISC from 1995 to 2008 were reviewed. Follow-up information was obtained via clinical re-evaluation or telephone contact with the owners. RESULTS The majority of horses (84%) received amikacin and Timentin(R) four times daily. In addition, synovial lavage through the ISC was carried out in 27 horses (71%). Only radiological evidence of osteolysis had a significant negative impact on both lameness at the time of hospital discharge and the long-term outcome. In total, 92% of horses treated with frequent antimicrobial administration through an ISC had clinical resolution of infection. Catheter obstruction occurred in three cases, necessitating replacement or removal, and two synovial fistulae developed at sites of open drainage. The majority of horses treated had a favourable outcome, with 86% being at least pasture sound and 43% returned to riding. CONCLUSION Septic synovial structures treated with frequent antimicrobial administration through an ISC had a good prognosis for survival and 43% returned to riding, which is consistent with the results of other studies. The use of a simple ISC should be considered when broad-spectrum intrasynovial antimicrobial administration and lavage of a septic synovial structure are indicated.
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Affiliation(s)
- A A Stewart
- Department of Veterinary Clinical Medicine, University of Illinois, Urbana-Champaign, Illinois, USA.
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CRIBB NICOLAC, BOURÉ LUDOVICP, BRAD HANNA WJ, AKENS MARGARETEK, MATTSON SHAWNE, MONTEITH GABRIELLEJ, WEESE JSCOTT. In Vitro and In Vivo Evaluation of Ferric-Hyaluronate Implants for Delivery of Amikacin Sulfate to the Tarsocrural Joint of Horses. Vet Surg 2009; 38:498-505. [DOI: 10.1111/j.1532-950x.2009.00518.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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