Abstract
ABSTRACT: Intravenous regional limb perfusion (IRLP) is an efficient method to treat horses with synovial infections. However, information on the dose, volume, and intervals of administration is lacking. The aim of this study was to evaluate the intra-articular concentration of gentamicin administered by IRLP in horses over 24 h post-administration and evaluate the influence of the total perfused volume. Twenty horses were assigned to two treatment groups. Gentamicin 60 group (G60, n=10) and Gentamicin 250 group (G250, n=10) received IRLP of 6.6 mg/kg of gentamicin diluted in Ringer’s lactate for a total volume of 60 ml (G60) and 250 ml (G250), respectively. Synovial fluid harvests were performed in the metacarpophalangeal joint before (0) and 4, 8, 12, 16, 20, and 24 hours after IRLP. Agar diffusion was the assay for measuring gentamicin concentrations. Four hours after IRLP, the intra-articular concentration of gentamicin was 47.58±49.21 μg/ml in G60 and 10.92±6.11 μg/ml in G250. During the 24 h of harvest, the intra-articular concentration of gentamicin remained above the minimum inhibitory concentration for horses (MIC; 2 μg/ml) in both experimental groups. In G60, the concentration of gentamicin in synovial fluid reached the maximal concentration and remained 8 to 10-fold higher than the MIC (Cmax: 16 to 20 μg/ml) during 12 h after IRLP. These findings support that IRLP with 6.6 mg/kg of gentamicin diluted to a volume of 60 ml promotes intra-articular concentrations higher than 250 ml, remaining above the MIC for 24 h and at the maximum concentration for 12 h.
Highlights
Among the conditions that affect the joints of horses, septic arthritis is the most serious, which can result in rapid destruction of the articular cartilage and, when associated with osteomyelitis, irreversible loss of the articular surface can be a consequence (LLOYD et al, 1990; MORTON, 2005).Antimicrobial drug administration through the systemic route may be considered ineffective for Approved 06.11.20 Returned CR-2019-0496.R3 by the authorRural, v.50, n.11, removal of infectious processes in the distal limbs of horses due to a low blood supply, that tends to get worse after installing an inflammatory process (WHITEHAIR et al, 1992a; MORTON, 2005; DORIA et al, 2015)
When the intravenous regional limb perfusion (IRLP) is performed with antibiotics, the high concentration of the drug, administered in a vein occluded by a tourniquet, generates a very high concentration gradient between the intravascular space and the tissues, which maximizes the diffusion process to all adjacent structures, especially those with little vascularity, such as cartilaginous tissue, ligaments and joint capsules, where pathogens are protected
The highest IA concentration of gentamicin in Gentamicina 250 (G250) was identified at the sequential periods: 4 (T4) (10.92±6.11 μg/ml) and T8 (8.10±3.47 μg/ml); there was no significant difference between T4 and T8
Summary
Among the conditions that affect the joints of horses, septic arthritis is the most serious, which can result in rapid destruction of the articular cartilage and, when associated with osteomyelitis, irreversible loss of the articular surface can be a consequence (LLOYD et al, 1990; MORTON, 2005).Antimicrobial drug administration through the systemic route may be considered ineffective for Approved 06.11.20 Returned CR-2019-0496.R3 by the authorRural, v.50, n.11, removal of infectious processes in the distal limbs of horses due to a low blood supply, that tends to get worse after installing an inflammatory process (WHITEHAIR et al, 1992a; MORTON, 2005; DORIA et al, 2015). The intravenous regional limb perfusion (IRLP) technique is an efficient method for the treatment of horses affected by synovial infections, which significantly reduces morbidity and mortality (BUTT et al, 2001; CIMETTI et al, 2004; RUBIO-MARTINEZ & CRUZ, 2006). The IRLP is a technique that consists of infusing a drug into a region of the organism that is vascularly isolated from the systemic circulation (SANTSCHI et al, 1998; RUBIO-MARTÍNEZ & CRUZ, 2006). The IRLP with antibiotics aims to increase the intra-articular concentration and the diffusion of the drug through the distal tissues of the affected limb of a horse, expanding the bactericidal effect, reducing the treatment time and minimizing adverse systemic effects (PARRA-SANCHEZ et al, 2006; RUBIOMARTÍNEZ & CRUZ, 2006; ERRICO et al, 2008; GILLIAM et al, 2008)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
