Page 1349 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

1324 CHAPTER 13

VetBooks.ir Table 13.6 Local and regional antimicrobial therapy options for infections of synovial structures

INTRAOSSEOUS INTRAVENOUS INTRASYNOVIAL
Method Use a 4.5 mm or 5.5 mm cannulated Use a butterfly needle (25 gauge) or Direct daily injection or use of
screw. Can be placed standing or a catheter. Can be performed on constant rate infusion (CRI)
under GA. Perfuse under sedation saphenous, cephalic or abaxial pump
over 30–45 minutes sesamoid vessel
Amikacin Administer 1 mg/kg q24 h for Same as intraosseous Administer 125–250 mg by direct
3–5 days diluted in 10 ml of total injection q24 h for 3–5 days. If
saline volume. Inject slowly over a used in a CRI pump, will deliver
period of 2–4 minutes 10 ml (2,500 mg/450 kg) of
amikacin/day
Gentamicin Administer 1–2 mg/kg q24 h for Same as intraosseous Administer 100–300 mg by direct
3–5 days diluted in 10 ml of total injection q24 h for 3–5 days. If
saline volume. Inject slowly over a used in a CRI pump, will deliver
period of 2–4 minutes 6 ml (600 mg/450 kg) of
gentamicin/day
Ceftiofur Administer 1 mg/kg q24 h for Same as intraosseous Administer 150 mg by direct
3–5 days diluted in 10 ml of total injection. If used in a CRI pump,
saline volume. Inject slowly over a make a 50% ceftiofur solution
period of 2–4 minutes (25 mg/ml) and deliver 0.5 ml
solution/hour (300 mg/day)
Vancomycin Administer 300 mg diluted to a Same as intraosseous Not recommended
maximum of 5 mg/ml and give at a
speed of 2 ml/min or 10 mg/min
q24 h for 3–5 days
Advantages Good concentration in synovial fluid, Very good concentration lasting over Very good concentrations lasting
medullary cavity and tendons distal 24 hours over 24 hours
to perfusion site. Concentrations
persist up to 24 hours and slightly
longer compared with intravenous
perfusion. Very well tolerated.
Minimal side-effects
Disadvantages Need special equipment. Painful Very difficult in cases where cellulitis Daily injection needed. CRI device
perfusion. Potential blemish over prevents identification of the vessel. sometimes may not work
perforated bone. Avoid proximity to Repeated injection necessary if properly
any tendon catheter not placed. Catheter may
kink or dislodge. Difficult to
maintain in distal extremity.
Sloughing of hoof possible if
vascular damage occurs at the level
of the distal extremity

suspensory ligament have been involved. Intrathecal Whether tenorrhaphy is used or not, the subsequent
injuries have the added dimension of a contaminated rehabilitation period often spans an entire year. The
synovial cavity, and therefore extrathecal injuries are use of tenorrhaphy is controversial. In general, it is
simpler to manage. Prompt and aggressive therapy is advocated in cases where the tendon edges have not
recommended. Management of lacerated flexor ten- been severely damaged (Fig. 13.44) and the injury is
dons requires time and money, and many horses may intrathecal. In addition, it appears that tenorrhaphy
not return to their previous level of athletic activity. allows a quicker gain in tensile strength during the