Evaluation of regional limb perfusion with erythromycin using the saphenous, cephalic, or palmar digital veins in standing horses

Abstract

There are no reported studies evaluating the use of erythromycin for regional limb perfusion (RLP) in horses. Our hypothesis was that using the cephalic and saphenous veins for RLP will enable delivery of therapeutic concentrations of erythromycin to the distal limb. Nineteen healthy horses participated in the study. The cephalic, saphenous or palmar digital (PD) vein was used to perfuse the limb with erythromycin. Synovial samples were collected from the metacarpo/metatarso-phalangeal (MCP/MTP) joint and blood samples were collected from the jugular vein. Maximum concentration (C(max)) of erythromycin in the MCP joint using the cephalic vein was 113 mg/L. The Cmax of erythromycin in the MTP joint using the saphenous vein was 38 mg/L. Erythromycin administered using the PD vein was not detectable in the MCP/MTP joint of four of six horses. Concentrations of erythromycin achieved in the synovial fluid of the MCP/MTP joint were between 152 and 452 times the minimal inhibitory concentration (MIC) for Rhodococcus equi (R. equi). In conclusion, the results indicate that when using the saphenous or cephalic veins for RLP, therapeutic concentrations of erythromycin in the MCP/MTP joint can be consistently reached [corrected].

Evaluation of regional limb perfusion with chloramphenicol using the saphenous or cephalic vein in standing horses

“…In the present study, there was no statistically significant difference in antimicrobial concentrations between the forelimb and the hindlimb joints. Nevertheless, the fact that the forelimb C max was twice as high and the AUC was 36% higher compared with the hindlimb is consistent with our previous study (Kelmer et al ., b). In that study, synovial antimicrobial concentrations were significantly higher in the forelimb.…”

“…The present RLP study produced similar results to our previous studies with amikacin, erythromycin and imipenem (Haziz et al ., ; Kelmer et al ., ,b). It appears that the method is reproducible regardless of the administered antimicrobial agent lending further credit to the efficacy of this technique, using the cephalic/saphenous veins for RLP.…”

“…Consequently, the cephalic and saphenous veins have been evaluated, both experimentally and clinically, and proved to be advantageous, alternative routes for performing RLP (Kelmer et al ., , ). Pharmacokinetic studies examining the disposition of drugs administered by RLP to the synovial structures of the distal portion of the limb of horses using proximal veins are scarce and only the disposition of amikacin and erythromycin was examined (Levine et al ., ; Kelmer et al ., ,b). There is, however, an ever‐growing problem of bacterial resistance to the commonly used antimicrobial drugs and there is an urgent need for use of newer and/or more effective ones.…”

Meropenem synovial fluid concentrations after intravenous regional limb perfusion in standing horses

“…IVRLP achieves high concentration and pressure gradients by use of a tourniquet and increased vascular volume . The pharmacokinetic parameters of IVRLP have been investigated in the horse for amikacin, gentamicin, chloramphenicol, erythromycin, enrofloxacin, imipenem, vancomycin, marbofloxacin, and ceftiofur . IVRLP produces high concentrations of antimicrobial in the synovial fluid and tissues of the entire isolated portion of the limb .…”

Plasma, subcutaneous tissue and bone concentrations of ceftiofur sodium after regional limb perfusion in horses

“…The antimicrobial would diffuse passively into the structures of the distal limb until the tourniquet was removed [1][2][3]. Since that time, RLP with antimicrobials has been investigated in multiple publications, comparing different techniques and antimicrobials used [4][5][6][7][8][9][10][11]. Aminoglycosides (gentamicin and amikacin) are the most common antimicrobials used for RLP and are effective against Gram-negative bacteria, but they have limited efficacy against Gram-positive bacterial isolates [3,4].…”