Stability of 1% voriconazole solution in a constant‐rate infusion pump for topical ocular delivery to horses

Smith, Kathryn M; Maxwell, Lara K.; Gull, Tamara; Payton, Mark E.; Gilmour, Margi A.

doi:10.1111/vop.12155

Cited by 7 publications

(4 citation statements)

References 20 publications

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“…Antimicrobial administration through SPLs has been previously reported to reduce the incidence of infection. [1][2][3][4][7][8][9][10][12][13][14][15]17,[21][22][23][24][25] In the present study, SPL systems with antimicrobials administered through them experienced fewer ocular complications than those without antimicrobials administered through them. Interestingly, SPLs that did not have antimicrobials administered through them did not experience any nonocular complications.…”

Section: Discussionmentioning

confidence: 76%

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O phthalmic disease presents a treatment challenge in equids with corneal and anterior uveal tract conditions that need frequent topical medications, including ophthalmic solutions and ointments. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] With increased frequency of topical medication application, horses sometimes become progressively evasive or violent toward the handler, creating a dangerous environment for the horse and the caretaker. 1,11,13,[16][17][18][19][20] Treatment failure due to the inability to administer an appropriate quantity or frequency of medication may result in progression of disease or enucleation.

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confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] With increased frequency of topical medication application, horses sometimes become progressively evasive or violent toward the handler, creating a dangerous environment for the horse and the caretaker. 1,11,13,[16][17][18][19][20] Treatment failure due to the inability to administer an appropriate quantity or frequency of medication may result in progression of disease or enucleation. 2,17,19,21 To mitigate handler safety risks, inappropriate treatment application, and adverse behavior development, veterinarians may place a subpalpebral lavage system (SPL) to administer topical ophthalmic medications safely and efficiently.…”

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confidence: 99%

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Dorsally placed commercially available subpalpebral lavage systems have low complication rates in horses

Stewart

Lack

Telle

et al. 2022

javma

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OBJECTIVE To retrospectively evaluate the complication rate following dorsal placement of a commercially available 1-hole subpalpebral lavage system (SPL) at a veterinary teaching hospital. ANIMALS 102 client-owned horses with ophthalmic disease. PROCEDURES Medical records of horses (2010 to 2020) with ophthalmic disease were reviewed to determine whether a commercially available SPL system was dorsally placed. Data collected from the medical record included signalment, presenting complaint(s), diagnosis, ophthalmic procedures performed, SPL laterality, hospital service that placed the SPL, anesthetic technique for placement (general anesthesia or sedation with local nerve blocks), duration of SPL management while hospitalized or at home, type of enclosure for the horse, use of eye protection, duration of time the SPL was in place, location of SPL management (home vs hospital), types and numbers of medications administered, recorded complications, and outcome of the globe. Complications experienced during treatment were categorized as either ocular or nonocular. The χ2 test for independence test and Fisher exact test were performed to examine the relationship between the department that placed the SPL, method of anesthesia, antimicrobial administration, type of facial protection used, and complication type and rate. RESULTS Overall complication rate for SPL systems was 29.1% (37/127), with 21.2% (27/127) being ocular complications and 7.9% (10/127) being nonocular complications. SPL complication rate was not affected by any variable that was examined. CLINICAL RELEVANCE Commercially available SPL systems placed dorsally have a low ocular complication rate. These SPL systems may be placed by veterinarians with varied training backgrounds and managed at home without significantly increasing complication rate.

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Section: Discussionmentioning

confidence: 76%

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Dorsally placed commercially available subpalpebral lavage systems have low complication rates in horses

Stewart

Lack

Telle

et al. 2022

javma

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“…17 Although topical administration of voriconazole solution may be performed easily by using a subpalpebral lavage system, continuous rate infusion (CRI) of voriconazole solution using a CRI pumps is not recommended because voriconazole becomes unstable owing to the high temperature in CRI pumps. 18 Furthermore, during long treatment periods for equine keratomycosis, use of a CRI system or frequent topical administration may become difficult because of CRI device-related issues and/ or horses being fractious. 17,19 Oral administration of voriconazole achieves excellent systemic bioavailability, 20 and, based on published minimum inhibitory concentration (MIC) results, dosing at 4.0 mg/kg once daily achieves adequate plasma concentrations for the treatment of systemic aspergillosis in horses.…”

Section: Introductionmentioning

confidence: 99%

Utility of systemic voriconazole in equine keratomycosis based on pharmacokinetic‐pharmacodynamic analysis of tear fluid following oral administration

Tamura

Okano

Kuroda

et al. 2020

Veterinary Ophthalmology

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Objective To clarify the detailed pharmacokinetics (PK) of orally administered voriconazole in tear fluid (TF) of horses for evaluating the efficacy of voriconazole secreted into TF against equine keratomycosis. Animals studied Five healthy Thoroughbred horses. Procedures Voriconazole was administrated through a nasogastric tube to each horse at a single dose of 4.0 mg/kg. TF and blood samples were collected before and periodically throughout the 24 hours after administration. Voriconazole concentrations in plasma and TF samples were analyzed using liquid chromatography‐electrospray tandem‐mass spectrometry. The predicted voriconazole concentration in both samples following multiple dosing every 24 hours was simulated by the superposition principle. Results The mean maximum voriconazole concentrations in plasma and TF were 3.3 μg/mL at 1.5 h and 1.9 μg/mL at 1.6 h, respectively. Mean half‐life in both samples were 16.4 and 25.2 h, respectively. The ratio of predicted AUC 0–24 at steady state in TF (51.3 μg∙h/mL) to previously published minimum inhibitory concentration (MIC) of Aspergillus and Fusarium species was >100 and 25.7, respectively. Conclusions This study demonstrated the detailed single‐dose PK of voriconazole in TF after oral administration and simulated the predicted concentration curves in a multiple oral dosing. Based on the analyses of PK‐PD, the simulation results indicated that repeated oral administration of voriconazole at 4.0 mg/kg/d achieves the ratio of AUC to MIC associated with treatment efficacy against Aspergillus species. The detailed PK‐PD analyses against pathogenic fungi in TF can be used to provide evidence‐based medicine for equine keratomycosis.

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Practical field ophthalmology

Dwyer¹

2016

Equine Ophthalmology

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Stability of 1% voriconazole solution in a constant‐rate infusion pump for topical ocular delivery to horses

Abstract: Voriconazole 1% solution is not compatible for use in a CRI/SPL unit at temperatures between 23 and 40 °C. Voriconazole 1% solution is stable in the commercial glass vial when stored at controlled temperatures as high as 40 °C for up to 30 days.

Cited by 7 publications

References 20 publications

Dorsally placed commercially available subpalpebral lavage systems have low complication rates in horses

Dorsally placed commercially available subpalpebral lavage systems have low complication rates in horses

Utility of systemic voriconazole in equine keratomycosis based on pharmacokinetic‐pharmacodynamic analysis of tear fluid following oral administration

Practical field ophthalmology

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