Evaluation of the pharmacokinetics of imipenem following regional limb perfusion using the saphenous and the cephalic veins in standing horses

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

“…The synovial concentration of meropenem remained above the target concentrations for a very short period in some horses. This period was shorter than we had hypothesized as well as the period reported in previous reports on concentration‐dependent drugs but similar to results obtained with other time‐dependent drugs . Because carbapenems are considered time‐dependent antimicrobials, a longer duration above the MIC would be ideal but may not be required when these drugs are administered via IVRLP.…”

“…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 .…”

“…The pharmacokinetics of imipenem, another carbapenem antibiotic, have been investigated during IVRLP in horses . Compared with the other carbapenems, meropenem has slightly more efficacy against Gram‐negative organisms and slightly less efficacy against Gram‐positive organisms .…”

Subtourniquet pressures generated by application of wide‐rubber tourniquets in standing, sedated horses

“…Systemic blood pressure monitoring is rarely performed during standing IVRLP in clinical practice, and the use of WRT does not allow for application and maintenance of an exact STP or adjustments in STP during the tourniquet application period. Nonetheless, the application of WRTs for IVRLP without the knowledge of the exact STP generated is common practice and is seemingly efficacious at all 3 anatomical locations studied here …”

“…The use of a wide‐rubber tourniquet (WRT; Esmarch bandage; Sklar Instruments, West Chester, Pennsylvania) for equine intravenous regional limb perfusion (IVRLP) is common in both clinical settings and experimental studies . Results of experimental comparisons of tourniquet types have provided evidence that WRTs are as effective as or even superior to pneumatic tourniquets for preventing loss of antimicrobial perfusate to the systemic circulation during cephalic IVRLP.…”