Effects of a 10% dimethyl sulfoxide solution on radiocarpal joint amikacin pharmacokinetics during intravenous regional limb perfusion in standing sedated horses.
Authors: Kilcoyne Isabelle, Nieto Jorge, Magdesian K Gary, Nottle Bridget F
Journal: Veterinary surgery : VS
Summary
# Editorial Summary Intravenous regional limb perfusion (IVRLP) is an established technique for delivering high antibiotic concentrations to distal limb joints, but optimising drug penetration into synovial fluid remains clinically relevant. This randomised crossover study investigated whether adding 10% dimethyl sulphoxide (DMSO)—a known penetration enhancer—to amikacin perfusate would improve radiocarpal joint drug concentrations compared with conventional 0.9% saline diluent in seven healthy adult horses. Although the DMSO group achieved numerically higher peak amikacin concentrations (1361.8 ± 593 μg/mL versus 860 ± 481.6 μg/mL), this 58% difference did not reach statistical significance (p = 0.058), and time to peak concentration was similar between groups (23 minutes with DMSO *vs* 18 minutes with saline; p = 0.161). No adverse reactions were observed with DMSO use, indicating the technique is safe to apply clinically. Whilst these findings suggest DMSO does not enhance synovial drug delivery as substantially as anticipated, the lack of harm combined with the trend towards higher concentrations warrants further investigation into DMSO's potential benefits during IVRLP, particularly regarding tissue penetration beyond the synovial space and efficacy against biofilm-associated infections in clinical cases.
Read the full abstract on PubMed
Practical Takeaways
- •DMSO can be safely used as a carrier solution for amikacin during radiocarpal joint perfusion without compromising antibiotic delivery or causing adverse effects
- •DMSO shows a trend toward higher peak synovial concentrations (though not statistically significant), potentially offering enhanced therapeutic benefit with further investigation
- •Both perfusate solutions achieved therapeutic concentrations in synovial fluid within clinically relevant timeframes, allowing practitioner choice based on other clinical factors
Key Findings
- •Mean amikacin peak concentration (CMAX) was 1361.8 μg/mL with 10% DMSO versus 860 μg/mL with 0.9% NaCl, but this difference was not statistically significant (p = 0.058)
- •Time to peak concentration (TMAX) was 23 minutes with DMSO and 18 minutes with NaCl (p = 0.161), representing no significant difference
- •No adverse effects were observed with 10% DMSO solution use during intravenous regional limb perfusion
- •10% DMSO as a perfusate vehicle is feasible for amikacin delivery and does not negatively impact synovial antibiotic levels