Pharmacokinetics, pharmacodynamics and local tolerance at injection site of marbofloxacin administered by regional intravenous limb perfusion in standing horses.
Authors: Lallemand Elodie, Trencart Pierre, Tahier Carine, Dron Frederic, Paulin Angelique, Tessier Caroline
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Regional Intravenous Limb Perfusion of Marbofloxacin in Standing Horses Marbofloxacin administered via regional intravenous limb perfusion (RIVLP) achieves substantially higher concentrations in synovial fluid than in systemic circulation, with synovial area-under-the-curve measurements approximately 27-fold greater than plasma levels—a pharmacokinetic advantage that positions this technique as a valuable approach for treating joint and soft-tissue infections in the equine distal limb. Six standing horses received marbofloxacin (0.67 mg/kg) injected into one forelimb under tourniquet application, with the contralateral limb serving as a saline control, allowing researchers to measure drug concentrations in blood and synovial fluid whilst systematically assessing local tolerance through ultrasonography, limb circumference measurements and inflammation scoring. Predicted efficacy indices suggested this dosing strategy would achieve therapeutic outcomes against common pathogens including Enterobacteriaceae and *Staphylococcus aureus*, with no lameness, inflammation or vascular complications observed during the 48-hour assessment period. Whilst a modest increase in subcutaneous thickness occurred at injection sites, the absence of clinical significance and the favourable safety profile support RIVLP as a practical, effective method for delivering high local antibiotic concentrations to distal limb infections in standing sedated horses. The technique's applicability in field settings and lower systemic drug exposure may offer particular advantages over systemic fluoroquinolone therapy, particularly where intra-articular pathology or deep soft-tissue involvement is suspected.
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Practical Takeaways
- •Regional intravenous limb perfusion with marbofloxacin (0.67 mg/kg) is a safe, well-tolerated technique for standing sedated horses that achieves high antibiotic concentrations where distal limb infections occur.
- •This method may offer superior drug delivery to joints and soft tissues compared to systemic administration, making it particularly valuable for radiocarpal and other distal joint infections.
- •Consider this technique for susceptible bacterial infections in the distal limb, especially when systemic antibiotics have limitations or when high local concentrations are needed.
Key Findings
- •Marbofloxacin achieved significantly higher concentrations in synovial fluid (AUCINF 78.64 µg h/mL) compared to plasma (2.85 µg h/mL) following regional intravenous limb perfusion.
- •Efficacy indices (AUC0-24/MIC90 and Cmax/MIC90) predicted favorable outcomes against Enterobacteriaceae and Staphylococcus aureus in synovial infections.
- •No lameness, visual inflammation, or vein ultrasonographic changes occurred between treated and control limbs, with minimal local tolerance issues.
- •A single mild adverse effect of increased subcutaneous thickness was noted in marbofloxacin-injected limbs compared to controls.