Comparison of two indirect techniques for local delivery of a high dose of an antimicrobial in the distal portion of forelimbs of horses.
Abstract: To compare isolated limb retrograde venous injection (ILRVI) and isolated limb infusion (ILI) for delivery of amikacin to the synovial fluid of the distal interphalangeal and metacarpophalangeal joints and to evaluate the efficacy of use of an Esmarch tourniquet in standing horses. Methods: 6 healthy adult horses. Methods: Horses were randomly assigned in a crossover design. In ILRVI, the injection consisted of 1 g of amikacin diluted to a total volume of 60 mL administered during a 3-minute period. In ILI, the infusion consisted of 1 g of amikacin diluted to 40 mL administered during a 3-minute period followed by administration of boluses of diluent (82 mL total) to maintain vascular pressure. During ILI, the infusate and blood were circulated from the venous to the arterial circulation in 5-mL aliquots. Synovial fluid and serum samples were obtained to determine maximum amikacin concentrations and tourniquet leakage, respectively. Results: Both techniques yielded synovial concentrations of amikacin > 10 times the minimum inhibitory concentration (MIC) for 90% of isolates (80 microg/mL) and > 10 times the MIC breakpoint (160 microg/mL) of amikacin-susceptible bacteria reported to cause septic arthritis in horses. These values were attained for both joints for both techniques. Esmarch tourniquets prevented detectable loss of amikacin to the systemic circulation for both techniques. Conclusions: Both techniques reliably achieved synovial fluid concentrations of amikacin consistent with concentration-dependent killing for bacteria commonly encountered in horses with septic arthritis. Esmarch tourniquets were effective for both delivery techniques in standing horses.
Publication Date: 2008-03-04 PubMed ID: 18312131DOI: 10.2460/ajvr.69.3.334Google Scholar: Lookup
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- Comparative Study
- Journal Article
- Randomized Controlled Trial
- Research Support
- Non-U.S. Gov't
Summary
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This research paper delves into the comparative study of two indirect techniques, namely the Isolated Limb Retrograde Venous Injection (ILRVI) and Isolated Limb Infusion (ILI), for local delivery of high amikacin doses to synovial fluid of distinct interphalangeal and metacarpophalangeal joints in the forelimbs of horses. It also assesses the efficiency of an Esmarch tourniquet in standing horses.
Methods and Procedure
- The study is completed with six healthy adult horses randomly chosen for a crossover design.
- In the ILRVI method, an injection of 1 g of amikacin is diluted to a volume of 60 mL and is administered within a three-minute span.
- In the ILI method, an infusion of 1 g of amikacin is diluted to 40 mL and is given over a three-minute period, followed by the administration of diluent boluses (82 mL in total).
- During the ILI process, the infusate (fluid being infused) and blood are circulated from the venous to arterial circulation in 5 mL chunks.
Collection and Analysis of Data
- Results are based on synovial fluid and serum samples taken to identify the maximum concentrations of amikacin and any leakage of the tourniquet.
Findings
- It was found that both techniques produced synovial amikacin concentrations greater than ten times the minimum inhibitory concentration (MIC), a measure of the antibiotic’s effectiveness, for 90% of isolates, reaching 80 micrograms per milliliter (microg/mL) and over ten times the MIC breakpoint of 160 microg/mL,
- The desired concentrations were achieved by both techniques for both types of joints.
Esmarch Tourniquet Efficacy
- The research also demonstrated Esmarch tourniquets effectively prevented detectable loss of amikacin from entering the systemic circulation with both methods.
Conclusion
- Both techniques, ILRVI and ILI, are reliable in achieving synovial fluid concentrations of amikacin consistent with the concentration needed to kill bacteria commonly encountered in horses with septic arthritis.
- Moreover, Esmarch tourniquets proved to be effective in standing horses during the delivery of amikacin via both techniques.
Cite This Article
APA
Errico JA, Trumble TN, Bueno AC, Davis JL, Brown MP.
(2008).
Comparison of two indirect techniques for local delivery of a high dose of an antimicrobial in the distal portion of forelimbs of horses.
Am J Vet Res, 69(3), 334-342.
https://doi.org/10.2460/ajvr.69.3.334 Publication
Researcher Affiliations
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610, USA.
MeSH Terms
- Amikacin / administration & dosage
- Amikacin / blood
- Amikacin / pharmacokinetics
- Animals
- Anti-Infective Agents / administration & dosage
- Anti-Infective Agents / blood
- Anti-Infective Agents / pharmacokinetics
- Cross-Over Studies
- Female
- Forelimb / metabolism
- Horses / blood
- Horses / metabolism
- Infusions, Intraosseous / veterinary
- Injections, Intravenous / veterinary
- Perfusion / veterinary
- Synovial Fluid / metabolism
- Tourniquets / veterinary
Citations
This article has been cited 6 times.- 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(4):e0265971.
- Bonilla AG, Causeret L, Torrent-Crosa A. Pharmacokinetics of ceftiofur in the metacarpophalangeal joint after standing intravenous regional limb perfusion in horses. Can Vet J 2021 Sep;62(9):975-981.
- Celani G, Tulini SMR, Montesano C, Zezza D, Sergi M, Varasano V, Mortellaro CM, Compagnone D, Amorena M, Petrizzi L. Pharmacokinetics of marbofloxacin administered via intravenous regional limb perfusion in dairy cows: evaluation of two different tourniquets. Vet Rec Open 2017;4(1):e000227.
- Nieto JE, Trela J, Stanley SD, Yamout S, Snyder JR. Pharmacokinetics of a combination of amikacin sulfate and penicillin G sodium for intravenous regional limb perfusion in adult horses. Can J Vet Res 2016 Jul;80(3):230-5.
- Dória RG, Carvalho MB, Freitas SH, Laskoski LM, Colodel EM, Mendonça FS, Silva MA, Grigoletto R, Fantinato Neto P. Evaluation of intravenous regional perfusion with amphotericin B and dimethylsulfoxide to treat horses for pythiosis of a limb. BMC Vet Res 2015 Jul 16;11:152.
- Hyde RM, Lynch TM, Clark CK, Slone DE, Hughes FE. The influence of perfusate volume on antimicrobial concentration in synovial fluid following intravenous regional limb perfusion in the standing horse. Can Vet J 2013 Apr;54(4):363-7.
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