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Ratliff C, Clarke L, Knych HK, Morello SL, Mans C. Plasma and Tissue Amikacin Concentrations Following Regional Limb Perfusion of Chickens ( Gallus gallus domesticus). J Avian Med Surg 2024; 38:91-97. [PMID: 38980818 DOI: 10.1647/avianms-d-23-00025] [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] [Indexed: 07/11/2024]
Abstract
Intravenous regional limb perfusion (IVRLP) has been used in the treatment of pododermatitis and distal limb infections, which are significant causes of morbidity in avian species. This intravenous drug administration technique is designed to achieve high drug tissue concentrations while minimizing systemic toxic effects. Amikacin is commonly used for IVRLP in veterinary medicine, but dosing guidelines have not been established for its use in birds. The current study aimed to determine the tissue concentration of amikacin after a single IVRLP administration in healthy, euhydrated leghorn hen chickens (Gallus gallus domesticus). Chickens received a single IVRLP dose of 10 mg/kg amikacin and were euthanatized posttreatment at 1 hour (n = 6), 12 hours (n = 6), and 24 hours (n = 6) to assess tissue and synovial fluid concentrations of amikacin in the injected leg. Mean tissue concentrations were highest 1 hour post-IVRLP (synovial fluid = 153.0 µg/mL, metatarsal pad tissue = 26.05 µg/mL) before declining at the 12- and 24-hour time points. This indicates that administration of amikacin via IVRLP can reach minimum inhibitory concentrations of common bacterial isolates in tissues after a single treatment with 10 mg/kg amikacin. Regional limb perfusion every 24 hours is recommended, although the minimum days of treatment may be case dependent and vary based on response to therapy.
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Affiliation(s)
- Cameron Ratliff
- Departments of Surgical Science, School of Veterinary Medicine, University of Wisconsin, Madison, WI 53706, USA
| | - Lorelei Clarke
- Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI 53706, USA,
| | - Heather K Knych
- KL Maddy Equine Analytical Pharmacology Laboratory, School of Veterinary Medicine, University of California, Davis, CA 95616, USA
| | - Samantha L Morello
- Department of Clinical Sciences, Center for Veterinary Business and Entrepreneurship, Cornell University College of Veterinary Medicine, Ithaca, NY 14853, USA
| | - Christoph Mans
- Departments of Surgical Science, School of Veterinary Medicine, University of Wisconsin, Madison, WI 53706, USA
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Kilcoyne I, Nieto J, Nottle BF, Flynn H, Knych HK. Morphine synovial fluid concentrations after intravenous regional limb perfusion in horses during standing sedation. Equine Vet J 2024. [PMID: 38887833 DOI: 10.1111/evj.14114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 05/16/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Addition of morphine to the perfusate while performing intravenous regional limb perfusion (IVRLP) may be helpful in treating painful infectious orthopaedic conditions of the distal limb. OBJECTIVES The main objective of this study was to determine synovial morphine concentrations following IVRLP with morphine alone or in combination with amikacin. STUDY DESIGN Randomised cross-over in vivo experiment. METHODS Six horses underwent IVRLP with 0.1 mg/kg morphine sulphate diluted to 60 mL using 0.9% NaCl (M group) or combined with 2 g amikacin and 0.9% NaCl (MA group) with a 2-week washout period between treatments. Synovial fluid was collected from the radiocarpal joint (RCJ) at 10, 20, 30, 120, 240, 480, 720 and 1440 min after IVRLP. The tourniquet was removed after the 30-min sample was collected. Synovial concentrations of morphine and major metabolites were measured using liquid chromatography-tandem mass spectrometry. Amikacin concentrations were quantified by a fluorescence polarisation immunoassay. RESULTS Measurable concentrations of morphine were apparent in the RCJ of all horses. Median CMAX of morphine in the M group was 4753.1 (2115.7-14 934.5) ng/mL and 4477 (3434.3-7363) ng/mL in the MA group (p = 0.5). Median CMAX of synovial amikacin was 322.6 (157.5-1371.6 μg/mL). MAIN LIMITATIONS Limitations include small sample size. Investigators were not blinded to the treatments and a third treatment group where amikacin alone was administered via IVRLP to the study population was not included. CONCLUSIONS IVRLP using morphine is a feasible technique and synovial morphine concentrations were measurable following IVRLP and were not affected when used concurrently with amikacin. Administration of morphine via IVRLP may be beneficial as an analgesic technique for orthopaedic conditions of the distal limb while limiting potential serious systemic side-effects.
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Affiliation(s)
- Isabelle Kilcoyne
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
| | - Jorge Nieto
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
| | - Bridget F Nottle
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Harriet Flynn
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
| | - Heather K Knych
- K.L. Maddy Equine Analytical Chemistry Laboratory, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
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3
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Dowling K, Wells K, Hoppes S, Thielen L. SURGICAL MANAGEMENT OF A TARSAL LUXATION IN A RED KANGAROO ( OSPHRANTER RUFUS). J Zoo Wildl Med 2024; 55:285-289. [PMID: 38453513 DOI: 10.1638/2022-0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2023] [Indexed: 03/09/2024] Open
Abstract
Joint luxations commonly occur in animals secondary to traumatic injury. Because of the unique hind-limb anatomy of macropods, surgical stabilization of orthopedic injuries is considered challenging, and reports of successful management are limited. A 4-yr-old male neutered red kangaroo (Osphranter rufus) presented with a dorsolateral luxation of the left tibiotarsal joint. Surgical reduction and tarsal arthrodesis were performed. Although the full range of motion of the tarsal joint was limited, this kangaroo was still able to ambulate normally at slow speeds following surgery and recovery. The aim of this report was to describe the surgical and postoperative management of a tibiotarsal luxation in a kangaroo. There were significant postoperative complications in this kangaroo, and antibiotic regional limb perfusion was used to treat wound and implant infection.
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Kilcoyne I, Nieto J, Magdesian KG, Nottle BF. Effects of a 10% dimethyl sulfoxide solution on radiocarpal joint amikacin pharmacokinetics during intravenous regional limb perfusion in standing sedated horses. Vet Surg 2023; 52:1171-1179. [PMID: 37280731 DOI: 10.1111/vsu.13973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 04/28/2023] [Accepted: 05/08/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To determine the effect of a 10% dimethyl sulfoxide (DMSO) solution on the peak concentration (CMAX ) of amikacin in the radiocarpal joint (RCJ) during intravenous regional limb perfusion (IVRLP) compared with 0.9% NaCl. STUDY DESIGN Randomized crossover study. ANIMALS Seven healthy adult horses. METHODS The horses underwent IVRLP with 2 g of amikacin sulfate diluted to 60 mL using a 10% DMSO or 0.9% NaCl solution. Synovial fluid was collected from the RCJ at 5, 10, 15, 20, 25, and 30 minutes after IVRLP. The wide rubber tourniquet placed on the antebrachium was removed after the 30 min sample. Amikacin concentrations were quantified by a fluorescence polarization immunoassay. The mean CMAX and time to peak concentration (TMAX ) of amikacin within the RCJ were determined. A one-sided paired t-test was used to determine the differences between treatments. The significance level was p < .05. RESULTS The mean ± SD CMAX in the DMSO group was 1361.8 ± 593 μg/mL and in the 0.9% NaCl group it was 860 ± 481.6 μg/mL (p = .058). Mean TMAX using the 10% DMSO solution was 23 and 18 min using the 0.9% NaCl perfusate (p = .161). No adverse effects were associated with use of the 10% DMSO solution. CONCLUSION Although there were higher mean peak synovial concentrations using the 10% DMSO solution no difference in synovial amikacin CMAX between perfusate type was detected (p = .058). CLINICAL SIGNIFICANCE Use of a 10% DMSO solution in conjunction with amikacin during IVRLP is a feasible technique and does not negatively affect the synovial amikacin levels achieved. Further research is warranted to determine other effects of using DMSO during IVRLP.
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Affiliation(s)
- Isabelle Kilcoyne
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Los Angeles, California, USA
| | - Jorge Nieto
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Los Angeles, California, USA
| | - K Gary Magdesian
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Los Angeles, California, USA
| | - Bridget F Nottle
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
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Crosby CE, Redding LE, Ortved KF. Current treatment and prevention of orthopaedic infections in the horse. EQUINE VET EDUC 2023. [DOI: 10.1111/eve.13770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Corinne E. Crosby
- Department of Clinical Studies University of Pennsylvania, New Bolton Center Kennett Square Pennsylvania USA
| | - Laurel E. Redding
- Department of Clinical Studies University of Pennsylvania, New Bolton Center Kennett Square Pennsylvania USA
| | - Kyla F. Ortved
- Department of Clinical Studies University of Pennsylvania, New Bolton Center Kennett Square Pennsylvania USA
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Clarke LL, Ratliff C, Mans C. Clinicopathologic Findings in Chickens (Gallus gallus domesticus) Administered Amikacin Through Intravenous Regional Limb Perfusion. J Avian Med Surg 2022; 36:187-191. [DOI: 10.1647/21-00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Redding LE, Elzer EJ, Ortved KF. Effects of regional limb perfusion technique on concentrations of antibiotic achieved at the target site: A meta-analysis. PLoS One 2022; 17:e0265971. [PMID: 35363825 PMCID: PMC8974993 DOI: 10.1371/journal.pone.0265971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/10/2022] [Indexed: 11/28/2022] Open
Abstract
Intravenous regional limb perfusions (RLP) are widely used in equine medicine to treat distal limb infections, including synovial sepsis. RLPs are generally deemed successful if the peak antibiotic concentration (Cmax) in the sampled synovial structure is at least 8-10 times the minimum inhibitory concentration (MIC) for the bacteria of interest. Despite extensive experimentation and widespread clinical use, the optimal technique for performing a successful perfusion remains unclear. The objective of this meta-analysis was to examine the effect of technique on synovial concentrations of antibiotic and to assess under which conditions Cmax:MIC ≥ 10. A literature search including the terms "horse", "equine", and "regional limb perfusion" between 1990 and 2021 was performed. Cmax (μg/ml) and measures of dispersion were extracted from studies and Cmax:MIC was calculated for sensitive and resistant bacteria. Variables included in the analysis included synovial structure sampled, antibiotic dose, tourniquet location, tourniquet duration, general anesthesia versus standing sedation, perfusate volume, tourniquet type, and the concurrent use of local analgesia. Mixed effects meta-regression was performed, and variables significantly associated with the outcome on univariable analysis were added to a multivariable meta-regression model in a step-wise manner. Sensitivity analyses were performed to assess the robustness of our findings. Thirty-six studies with 123 arms (permutations of dose, route, location and timing) were included. Cmax:MIC ranged from 1 to 348 for sensitive bacteria and 0.25 to 87 for resistant bacteria, with mean (SD) time to peak concentration (Tmax) of 29.0 (8.8) minutes. Meta-analyses generated summary values (θ) of 42.8 x MIC and 10.7 x MIC for susceptible and resistant bacteria, respectively, though because of high heterogeneity among studies (I2 = 98.8), these summary variables were not considered reliable. Meta-regression showed that the only variables for which there were statistically significant differences in outcome were the type of tourniquet and the concurrent use of local analgesia: perfusions performed with a wide rubber tourniquet and perfusions performed with the addition of local analgesia achieved significantly greater concentrations of antibiotic. The majority of arms achieved Cmax:MIC ≥ 10 for sensitive bacteria but not resistant bacteria. Our results suggest that wide rubber tourniquets and concurrent local analgesia should be strongly considered for use in RLP and that adequate therapeutic concentrations (Cmax:MIC ≥ 10) are often achieved across a variety of techniques for susceptible but not resistant pathogens.
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Affiliation(s)
- Laurel E. Redding
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, Pennsylvania
| | - Elizabeth J. Elzer
- Rood and Riddle Equine Hospital, Saratoga Springs, New York, United States of America
| | - Kyla F. Ortved
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, Pennsylvania
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Gustafsson K, Tatz AJ, Britzi M, Dahan R, Sutton GA, Kelmer G. Concentration of amikacin sulphate in synovial fluid when given in combination with dexamethasone phosphate in intravenous regional limb perfusion in standing horses. J Vet Pharmacol Ther 2022; 45:409-414. [DOI: 10.1111/jvp.13053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/06/2022] [Accepted: 03/07/2022] [Indexed: 11/29/2022]
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
| | - Malka Britzi
- National Residue Control Laboratory Kimron Veterinary Institute Beit Dagan 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
| | - 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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Jurek KA, Schoonover MJ, Williams MR, Rudra P. Effect of perfusate volume on amikacin concentrations after saphenous intravenous regional limb perfusion in standing, sedated horses. Vet Surg 2022; 51:665-673. [PMID: 35234300 DOI: 10.1111/vsu.13789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/31/2022] [Accepted: 02/06/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the influence of perfusate volume on synovial fluid amikacin concentrations in the joints of the hind limb after standing saphenous intravenous regional limb perfusion (IVRLP). STUDY DESIGN Randomized crossover design. ANIMALS Six adult horses. METHODS Saphenous IVRLP was performed in 6 standing horses with 1 g of amikacin diluted with 0.9% NaCl to volumes of 10 ml, 60 ml, and 120 ml. Samples of synovial fluid from the tarsocrural, metatarsophalangeal, and hind limb distal interphalangeal joints were collected at 15 and 30 min after perfusate administration. Concentrations of 40 μg/ml and 160 μg/ml were considered therapeutic for susceptible and resistant pathogens, respectively. RESULTS No difference in synovial fluid amikacin concentrations was detected between volumes in any joint (P = .4). All synovial fluid amikacin concentrations were higher at 30 min compared to 15 min (P = .003). All median synovial fluid amikacin concentrations at 30 min were > 40 μg/ml using the 60 ml and 120 ml volumes. Synovial fluid amikacin concentrations >40 μg/ml were only reached in the hind limb distal interphalangeal joint when the 10 ml volume was used. All median synovial fluid amikacin concentrations observed were < 160 μg/ml. CONCLUSIONS Target concentrations for pathogens that were considered susceptible were consistently reached with perfusate volumes of 60 ml and 120 ml. However, median synovial fluid amikacin concentrations did not reach target levels for resistant pathogens. CLINICAL SIGNIFICANCE Perfusate volumes of 60 ml or 120 ml are recommended to treat infections due to susceptible pathogens in the joints of the distal hind limb. These results justify investigation of saphenous IVRLP with different perfusate volumes using higher doses of amikacin.
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Affiliation(s)
- Kelsey A Jurek
- Department of Veterinary Clinical Sciences, Oklahoma State University, College of Veterinary Medicine, Stillwater, Oklahoma, USA
| | - Mike J Schoonover
- Department of Veterinary Clinical Sciences, Oklahoma State University, College of Veterinary Medicine, Stillwater, Oklahoma, USA
| | - Megan R Williams
- Department of Veterinary Clinical Sciences, Oklahoma State University, College of Veterinary Medicine, Stillwater, Oklahoma, USA
| | - Pratyaydipta Rudra
- Department of Statistics, Oklahoma State University, College of Arts and Sciences, Stillwater, Oklahoma, USA
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Bergstrom TC, Kilcoyne I, Magdesian KG, Nieto JE. Increasing tourniquet number has no effect on amikacin concentration within the radiocarpal joint in horses undergoing intravenous regional limb perfusion. Am J Vet Res 2022; 83:364-370. [PMID: 35113796 DOI: 10.2460/ajvr.21.08.0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether IV regional limb perfusion (IVRLP) performed in the cephalic vein with a wide rubber tourniquet (WRT) applied proximal and distal to the carpus results in a higher peak concentration (Cmax) of amikacin in the radiocarpal joint (RCJ), compared with the Cmax for IVRLP using a single WRT proximal to the carpus. Animals 7 healthy adult horses. Procedures Horses underwent IVRLP using standing sedation with 2 g of amikacin sulfate diluted to 60 mL by use of saline (0.9% NaCl) solution in the cephalic vein with 2 different tourniquet techniques; proximal WRT (P) and proximal and distal WRT (PD). Synovial fluid was collected from the RCJ at 5, 10, 15, 20, 25, and 30 minutes after IVRLP. Tourniquets were removed after the 30-minute sample was collected. Blood samples from the jugular vein were collected at 5, 10, 15, 20, 25, 29, and 31 minutes after IVRLP. Amikacin concentration was quantified by a fluorescence polarization immunoassay. Median peak concentration (Cmax) of amikacin and time to maximum drug concentration (Tmax) within the RCJ were determined. Results Median peak concentration in the RCJ was 1331.4 μg/mL with technique P and 683.1 μg/mL with technique PD. Median Tmax occurred at 30 minutes with technique P and 25 minutes with technique PD. No significant (Cmax, P = 0.18; Tmax, P = 0.6) difference in amikacin Cmax or Tmax between techniques was detected. Clinical Relevance Placement of 2 WRTs offers no advantage to a single proximal WRT when performing IVRLP to deliver maximal amikacin concentrations to the RCJ using IVRLP.
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Affiliation(s)
- Thomas C Bergstrom
- William R. Prichard Veterinary Medical Teaching Hospital, University of California-Davis, Davis, CA
| | - Isabelle Kilcoyne
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA
| | - K Gary Magdesian
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, CA
| | - Jorge E Nieto
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA
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Kilcoyne I, Nieto JE. Orthopedic Infections-Clinical Applications of Intravenous Regional Limb Perfusion in the Field. Vet Clin North Am Equine Pract 2021; 37:275-291. [PMID: 34243876 DOI: 10.1016/j.cveq.2021.04.003] [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] [Indexed: 11/18/2022] Open
Abstract
For the equine veterinarian, orthopedic emergencies are a common occurrence in clinical practice, with traumatic wounds of the distal limb and penetrating injuries of the hoof being some of the most common medical conditions to affect horses. Intravenous regional limb perfusion is a technique widely used for the treatment of orthopedic infections in horses. The objectives of this review are to discuss some of the clinical applications for this treatment modality in the field and to review the technique for the practitioner.
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Affiliation(s)
- Isabelle Kilcoyne
- Department of Surgical and Radiological Sciences, UC Davis School of Veterinary Medicine, One Shields Avenue, Davis, CA 95616, USA.
| | - Jorge E Nieto
- Department of Surgical and Radiological Sciences, UC Davis School of Veterinary Medicine, One Shields Avenue, Davis, CA 95616, USA
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Cooper HE, Davidson EJ, Slack J, Ortved KF. Treatment and outcome of eight horses with limb cellulitis and septic tendonitis or desmitis. Vet Surg 2021; 50:1542-1552. [PMID: 34270112 DOI: 10.1111/vsu.13691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 06/02/2021] [Accepted: 07/08/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To report the clinical features, treatment, and outcome in horses with cellulitis and concurrent septic tendonitis and/or desmitis. STUDY DESIGN Short case series. METHODS Medical records from 2000 to 2019 were reviewed, identifying horses with cellulitis and concurrent septic tendonitis and/or desmitis based on sonographic examination and positive bacterial culture. Signalment, ultrasonographic results, bacterial culture, treatment, duration of hospitalization, and complications were recorded. Long-term outcome data were obtained from follow-up examinations and/or telephone interviews. Successful outcome was defined as return to intended use. RESULTS Eight horses met the inclusion criteria. All infections occurred in hindlimbs, with septic suspensory ligament in six of eight horses, and septic superficial digital flexor tendon in one of eight horses. Surgical debridement was performed in six of eight horses. All horses were treated with systemic and regional intravenous antimicrobials and were discharged from the hospital. Long-term follow-up was available in seven of eight horses. Of these, four horses returned to their intended athletic function, two horses returned to their intended function as a broodmare or pasture pet, and one horse is still rehabilitating. CONCLUSION Septic tendonitis or desmitis is a rare but possible sequela of limb cellulitis. Based on the findings in this study, prognosis for return to athletic function is fair to good for horses diagnosed with cellulitis and concurrent septic tendonitis or desmitis.
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Affiliation(s)
- Hannah E Cooper
- New Bolton Center, University of Pennsylvania, Kennett Square, Pennsylvania, USA
| | - Elizabeth J Davidson
- New Bolton Center, University of Pennsylvania, Kennett Square, Pennsylvania, USA
| | - Joann Slack
- New Bolton Center, University of Pennsylvania, Kennett Square, Pennsylvania, USA
| | - Kyla F Ortved
- New Bolton Center, University of Pennsylvania, Kennett Square, Pennsylvania, USA
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Cummings CO, Tully TN. Pilot assessment of a single, intraosseous, regional limb perfusion of amikacin in the wing of domestic chickens (Gallus gallus). J Exot Pet Med 2021. [DOI: 10.1053/j.jepm.2021.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Gustafsson K, Tatz AJ, Dahan R, Britzi M, Soback S, Ahmad WA, Prince H, Kelmer G. The Concentration of Metronidazole in the Distal Interphalangeal Joint following Intravenous Regional Limb Perfusion via the Cephalic Vein in Standing Horses. Vet Comp Orthop Traumatol 2021; 34:287-293. [PMID: 33979876 DOI: 10.1055/s-0041-1726083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of this study was to determine the concentration of metronidazole in the distal interphalangeal joint (DIPJ) of the thoracic limb after administering metronidazole to standing horses by intravenous regional limb perfusion (IVRLP). METHODS Eleven healthy horses had a wide rubber tourniquet applied to the proximal aspect of the antebrachium for 0.5 hours and 500 mg of metronidazole diluted in physiologic saline solution to a total volume of 108 mL was administered by cephalic IVRLP. Synovial fluid samples were collected from the DIPJ before perfusion and at 0.25, 0.5, 2, 12 and 24 hours. Blood samples were obtained at the same time points for serum analysis. Concentrations of metronidazole were determined by liquid chromatography/tandem mass spectrometry. RESULTS Four horses were excluded due to low synovial fluid concentrations and not completing the full tourniquet application time. The C max in the synovial fluid was 327 ± 208 µg/mL, and the t max was 26 ± 7 minutes. Only the concentrations of metronidazole at time points 0.25 and 0.5 hours were significantly different (p < 0.001) from synovial concentration before perfusion. The serum C max was 1.78 ± 0.93 µg/mL, and the t max was 76 ± 52min. CONCLUSION Metronidazole administered by IVRLP reached high concentrations in the synovial fluid at 0.5 hours. However, the concentrations rapidly decreased below the minimum inhibitory concentration of potential target pathogens. Effectiveness of metronidazole administered by IVRLP as a sole therapy against anaerobic infections of synovial structures of the distal limb cannot be determined by a pharmacokinetic study. However, the present study serves as the basis for future carefully planned clinical trials.
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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
| | - Wiessam Abu Ahmad
- Braun School of Public Health and Community Medicine, Hebrew University-Hadassah Braun School of Public Health and Community Medicine, Jerusalem, Israel
| | - Hagar Prince
- 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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Knych HK, Magdesian KG. Equine antimicrobial therapy: Current and past issues facing practitioners. J Vet Pharmacol Ther 2021; 44:270-279. [PMID: 33650183 DOI: 10.1111/jvp.12964] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 02/06/2023]
Abstract
Equine antimicrobial therapy has advanced over time with the availability of increasing pharmacokinetic and pharmacodynamic studies in horses, allowing for greater evidence-based clinical decision-making. However, many challenges to optimal antimicrobial therapy remain and further research is needed to address these areas. There are a limited number of approved antimicrobials for use in horses, which creates a need for compounded preparations for clinicians. Extra-label drug use is commonplace in equine practice, which warrants continual education of veterinarians about policies and updates. Performance and competitive horses have their own unique concerns when it comes to antimicrobial use and drug testing. In keeping with the use of a broader range of antimicrobials over time, antimicrobial resistance is emerging as an important issue facing veterinary medicine, including equine practice. Another challenge is that of drug interactions and adverse drug events for which there are little scientific data available for horses, especially for critically important diseases such as Rhodococcus equi infection. Finally, much progress has been made in the availability of equine-specific antimicrobial susceptibility break points. These aid clinicians in interpreting culture and susceptibility results and antimicrobial selection. Even with these advances, continuing education and further research are needed in this area.
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Affiliation(s)
- Heather K Knych
- Kenneth L. Maddy Equine Analytical Pharmacology Laboratory and Department of Molecular Biosciences, School of Veterinary Medicine, University of California, Davis, California, USA
| | - K Gary Magdesian
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, California, USA
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Kilcoyne I, Nieto JE, Galuppo LD, Dechant JE. Time required to achieve maximum amikacin concentration in the synovial fluid of the tarsocrural joint following administration of the drug by intravenous regional limb perfusion in horses. Am J Vet Res 2021; 82:99-104. [PMID: 33480277 DOI: 10.2460/ajvr.82.2.99] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the median time to maximum concentration (tmax) of amikacin in the synovial fluid of the tarsocrural joint following IV regional limb perfusion (IVRLP) of the drug in a saphenous vein of horses. ANIMALS 7 healthy adult horses. PROCEDURES With each horse sedated and restrained in a standing position, a 10-cm-wide Esmarch tourniquet was applied to a randomly selected hind limb 10 cm proximal to the point of the tarsus. Amikacin sulfate (2 g diluted with saline [0.9% NaCl] solution to a volume of 60 mL) was instilled in the saphenous vein over 3 minutes with a peristaltic pump. Tarsocrural synovial fluid samples were collected at 5, 10, 15, 20, 25, and 30 minutes after completion of IVRLP. The tourniquet was removed after collection of the last sample. Amikacin concentration was quantified by a fluorescence polarization immunoassay. Median maximum amikacin concentration and tmax were determined. RESULTS 1 horse was excluded from analysis because an insufficient volume of synovial fluid for evaluation was obtained at multiple times. The median maximum synovial fluid amikacin concentration was 450.5 μg/mL (range, 304.7 to 930.7 μg/mL), and median tmax was 25 minutes (range, 20 to 30 minutes). All horses had synovial fluid amikacin concentrations ≥ 160 μg/mL (therapeutic concentration for common equine pathogens) at 20 minutes after IVRLP. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that, in healthy horses, maintaining the tourniquet for 20 minutes after IVRLP of amikacin in a saphenous vein was sufficient to achieve therapeutic concentrations of amikacin in the tarsocrural joint.
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Garcia AFS, Dória RGS, Arantes JA, Reginato GM, Neubauer FG, Ribeiro G. Intravenous Regional Limb Perfusion in Standing and Recumbent Horses: A Comparative Radiographic Study. J Equine Vet Sci 2021; 98:103373. [PMID: 33663721 DOI: 10.1016/j.jevs.2021.103373] [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: 10/10/2020] [Revised: 12/18/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Abstract
Although pharmacokinetic studies of drugs administered by intravenous regional limb perfusion (IRLP) to treat equine orthopedic infections suggest efficient drug distribution in the limbs, it remains unclear whether drug perfusion is affected by the position of the horse during the procedure. This study compared the perfusion of a radiopaque contrast into tissues of the extremities of horses maintained in standing and recumbent positions during an IRLP. Radiopaque contrast was administered through IRLP into the cephalic vein of 10 healthy adult horses under general anesthesia and right lateral recumbency (RG) or under sedation and standing (SG). The same animals were used in both groups, respecting a two-week washout period. Sequential radiographic images were performed immediately at the beginning of contrast administration (T0) and after 10, 20, 30, 40, and 50 minutes. Tourniquets were removed after 30 minutes. The time required for the contrast to reach the hooves was compared between groups. Contrast reached the hooves faster in SG (114 ± 15 seconds) compared with RG (236 ± 29 seconds) (P < 0.5). SG showed more uniform perfusion of the limb vessels, whereas RG showed more deposition of the contrast in the lateral digital vein, with smaller amounts reaching the hooves. From T10 onward, soft tissue radiopacity increased, albeit more markedly in standing than in recumbent animals, remaining until T50. Contrast radiography evidenced that IRLP performed in standing position leads to a quicker and more uniform perfusion of the vasculature and a more noticeable diffusion to the tissues than in recumbent horses.
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Affiliation(s)
| | - Renata G S Dória
- Faculty of Animal Science and Food Engineering, Department of Veterinary Medicine, University of São Paulo (USP), Pirassununga, São Paulo, Brazil
| | - Julia A Arantes
- Faculty of Animal Science and Food Engineering, Department of Veterinary Medicine, University of São Paulo (USP), Pirassununga, São Paulo, Brazil
| | - Gustavo M Reginato
- Faculty of Animal Science and Food Engineering, Department of Veterinary Medicine, University of São Paulo (USP), Pirassununga, São Paulo, Brazil
| | | | - Gesiane Ribeiro
- United Metropolitan Colleges (FMU), São Paulo, São Paulo, Brazil.
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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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20
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Abrams BE, Hottinger H, Selmic LE. Use of regional limb perfusion with amikacin sulphate in the treatment of a severe soft tissue infection in the extremity of a dog. VETERINARY RECORD CASE REPORTS 2019. [DOI: 10.1136/vetreccr-2018-000777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Brittany E Abrams
- Department of Veterinary Clinical SciencesThe Ohio State UniversityCollege of Veterinary MedicineColumbusOhioUSA
| | | | - Laura Elizabeth Selmic
- Department of Veterinary Clinical SciencesThe Ohio State UniversityCollege of Veterinary MedicineColumbusOhioUSA
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Plunkett AH, Schoonover MJ, Young JM, Taylor JD, Holbrook TC. Subtourniquet pressures generated by application of wide-rubber tourniquets in standing, sedated horses. Vet Surg 2019; 48:417-423. [PMID: 30773652 DOI: 10.1111/vsu.13181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 01/17/2019] [Accepted: 01/26/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the influence of location and movement on subtourniquet pressure (STP) generated by application of a wide-rubber tourniquet (WRT) on equine limbs. STUDY DESIGN Randomized experimental cross-over design. ANIMALS Six standing, sedated horses. METHODS Horses were sedated with detomidine hydrochloride (0.2 μg/kg IV), and 4 investigators applied WRTs to the antebrachium (AB), gaskin (GK), and midmetacarpus (MC) of each horse in a predetermined, randomized order. Subtourniquet pressure was consequently measured at 10-minute intervals (T0, T10, T20, T30) for 30 minutes. Indirect systolic blood pressure (SBP) was measured presedation, postsedation, and throughout the tourniquet application period. Target STP was established as SBP + 100 mm Hg. Limb movements at each location were classified as none, low, moderate, or high, on the basis of counts and magnitude. RESULTS Mean STP did not change with time (P = .93) and exceeded SBP by 163 mm Hg (95% CI 122-205), 185 mm Hg (95% CI 156-214), and 402 mm Hg (95% CI 351-454) at the AB, GK, and MC, respectively. Mean STP at each location exceeded the target STP in 59 of 70 (81%) of the trials. Limb movements affected STP generated by tourniquets at the AB (P = .04) and MC (P < .0001) but not at the GK (P = .67). CONCLUSION Wide-rubber tourniquets applied at the AB, GK, and MC generated STP >100 mm Hg above SBP for 30 minutes in standing, sedated horses. CLINICAL SIGNIFICANCE Wide-rubber tourniquets as applied in this study can achieve and maintain the current recommended STP (SBP + 100 mm Hg) for equine IV regional limb perfusion. Number and magnitude of limb movement can decrease STP over time, potentially reducing the efficacy of a WRT.
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Affiliation(s)
- Amanda H Plunkett
- Department of Veterinary Clinical Sciences, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, Oklahoma
| | - Mike J Schoonover
- Department of Veterinary Clinical Sciences, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, Oklahoma
| | - Jenna M Young
- Department of Veterinary Clinical Sciences, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, Oklahoma
| | - Jared D Taylor
- Department of Veterinary Pathobiology, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, Oklahoma
| | - Todd C Holbrook
- Department of Veterinary Clinical Sciences, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, Oklahoma
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