Amikacin Concentrations in Healthy Neonatal Foals

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Curious about the scientific evidence behind treating joint infections in foals? This eye-opening conversation with Dr. David Wallace explores groundbreaking research validating common clinical practices while revealing surprising limitations.

Septic joints in foals present a clinical challenge requiring both local and systemic antimicrobial therapy. Until now, veterinarians have largely extrapolated treatment protocols from adult horses without solid evidence supporting these approaches in neonatal patients. Dr. Wallace's research addresses this critical knowledge gap, examining whether concurrent intravenous regional limb perfusion (IRLP) and systemic amikacin administration achieves therapeutic concentrations in both compartments.

The results offer reassurance that splitting the amikacin dose—one-third for regional perfusion and two-thirds systemically—effectively treats both joint infections and underlying systemic disease. Most joints achieved therapeutic concentrations, though significant challenges emerged with hind limb perfusions. The metatarsophalangeal joint consistently failed to reach target levels, revealing important technical limitations around tourniquet placement and vascular integrity that clinicians should consider when treating these patients.

This conversation highlights numerous opportunities for future research, from evaluating alternative tourniquet designs to determining appropriate dose adjustments for multiple affected limbs. Dr. Wallace emphasizes that individual patient response remains paramount, reminding us that "foals are not small horses" and require specialized approaches. Whether you're a practicing veterinarian, student, or equine enthusiast, this episode provides valuable insights into evidence-based care for our youngest equine patients. Subscribe now to stay updated on the latest advances in veterinary medicine!

JAVMA article: https://doi.org/10.2460/javma.24.10.0678

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