Synovial fluid and plasma concentrations of ceftiofur after regional intravenous perfusion in the horse.
Authors: Pille Frederik, De Baere Siegrid, Ceelen Liesbeth, Dewulf Jeroen, Croubels Siska, Gasthuys Frank, De Backer Patrick, Martens Ann
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Ceftiofur Delivery to Equine Radiocarpal Joints Regional intravenous perfusion (RIP) — a targeted drug delivery method using tourniquet application — has theoretical advantages over systemic administration for treating joint infections, but its effectiveness for antibiotics in equine practice required quantification. Researchers compared synovial fluid and plasma ceftiofur concentrations in five horses receiving either 2 g ceftiofur via RIP or intravenous injection, with a 14-day washout period between treatments; samples were collected over 24 hours and analysed using high-performance liquid chromatography. RIP achieved mean peak synovial concentrations of 392.7 µg/mL at 30 minutes, compared to just 2.72 µg/mL following IV administration, and critically, synovial levels remained above the minimum inhibitory concentration (1 µg/mL) for susceptible pathogens for more than 24 hours after RIP. Whilst considerable variation existed between individual horses regardless of technique, RIP produced no adverse effects and maintained therapeutically relevant antibiotic concentrations substantially longer than systemic dosing. For practitioners managing confirmed or suspected radiocarpal infections caused by cephalosporin-susceptible organisms, RIP with ceftiofur represents a pharmacologically justified adjunctive approach that delivers higher local drug concentrations whilst potentially reducing systemic antibiotic exposure.
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Practical Takeaways
- •RIP with ceftiofur achieves dramatically higher antibiotic concentrations in the joint (144× higher peak concentration) compared to systemic IV injection, making it substantially more effective for treating joint infections
- •Therapeutic levels are maintained for over 24 hours with RIP, allowing for single or less frequent dosing compared to systemic administration for joint infections
- •RIP is a safe, well-tolerated technique with no adverse effects observed, making it a practical addition to your infection management toolkit for radiocarpal and other synovial joint infections
Key Findings
- •Regional intravenous perfusion (RIP) achieved mean synovial fluid ceftiofur peak concentration of 392.7 µg/mL at 0.5 hours post-injection versus only 2.72 µg/mL with systemic IV administration
- •RIP maintained synovial fluid ceftiofur concentrations above the minimal inhibitory concentration (1 µg/mL) for common pathogens for more than 24 hours
- •Large inter-individual variation in synovial fluid and plasma ceftiofur concentrations was observed between horses regardless of administration method
- •RIP technique produced no adverse effects and may be a beneficial adjunctive therapy for cephalosporin-susceptible equine synovial infections