Treatment of sepsis in the small tarsal joints of 11 horses with gentamicin‐impregnated polymethylmethacrylate beads

Abstract

Gentamicin-impregnated polymethylmethacrylate beads were used to treat infective arthritis in the small tarsal joints of 11 severely lame horses. Under general anaesthesia, between five and 10 beads were placed into a 7 to 8 mm tract drilled across the affected joint and, in all except one horse, they were left in place for 14 days. Two of the horses were euthanased for reasons other than persistent tarsal joint sepsis, but the other nine survived and seven of them returned to their previous level of athletic performance.

A review of the characteristics and treatment of methicillin‐resistant Staphylococcus aureus (MRSA) in the horse and a case series of MRSA infection in four horses

“…Antimicrobial impregnated implants can be used in some sites (Holcombe et al. 1997; Booth et al. 2001), although those utilising gentamicin should obviously be used with caution in equine MRSA infections reported as gentamicin resistant.…”

“…Evidence is also lacking for the use of topical applications of antiseptic solutions such as chlorhexidine digluconate, but these may have a role to play in management of infections. Antimicrobial impregnated implants can be used in some sites (Holcombe et al 1997;Booth et al 2001), although those utilising gentamicin should obviously be used with caution in equine MRSA infections reported as gentamicin resistant. (Henry and Galloway 1995).…”

“…Good evidence for nonMRSA infections in horses with various antimicrobials (Butson et al 1996;Holcombe et al 1997Booth et al 2001. One reported equine use in methicillin-resistant S. epidermidis infection (Trostle et al 2001).…”

Use of antibiotic impregnated polymethylmethacrylate beads for the treatment of chronic mandibular osteomyelitis in a Bennett's wallaby (Macropus rufo‐griseus rufogriseus)

“…13 AIPMMA beads provide a prolonged, local concentration of antibiotic in both bone and soft tissue, whilst avoiding systemic toxic effects of gentamicin. 9,11,12 Gentamicin and clindamycin are released from the beads down a concentration gradient, reaching concentrations higher than those achieved by systemic administration.…”

Orthopaedic infections; laboratory testing and response to therapy

“…While systemic antimicrobials remain central to successful treatment of synovial sepsis, the advantages of local antimicrobial therapy have become well known and its use increasingly popular. Local delivery methods such as direct injection, intravenous or intraosseous regional perfusion, continuous intrasynovial antimicrobial infusion and antimicrobial laden beads have been shown to achieve local tissue or synovial drug concentrations higher than systemic drug administration in normal horses (Whitehair et al 1992b;Lescun et al 2000;Farnsworth et al 2001;Werner et al 2003;Lescun et al 2006b;Haerdi-Landerer et al 2010) and their use has been documented in the management of a variety of orthopaedic infections in the horse (Schneider et al 1992a;Whitehair et al 1992a;Holcombe et al 1997;Booth et al 2001;Meagher et al 2006;Lescun et al 2006a). Strong evidence-based support for the efficacy of local antimicrobial use, compared to systemic treatments alone, is currently lacking.…”