Читать книгу Fractures in the Horse - Группа авторов - Страница 158

Antimicrobials are essential in surgical repair, especially in cases of open contaminated fractures. Many different drugs can be used, each with well‐documented systemic effects and potential toxicity; however, effects on bone healing in horses are lacking. In vitro and in vivo experimental studies have shown that systemic administration of antimicrobials in general seems to have little or no direct effect on bone cells. However, implantable delivery systems that release high concentrations over time have shown some detrimental effects on bone [59]. This has also been shown on metal implant coatings [60]. In a study of multiple antimicrobials, although detrimental effects on osteoblast number and activity were seen, amikacin, tobramycin and vancomycin were the least cytotoxic [61]. Despite the potential negative influences, the positive effects outweigh concerns. Ideally, use should be targeted (Chapter 14) but, in reality, antimicrobials are usually started before target organisms are known, and clinicians must choose drugs based on their understanding of likely pathogens, severity of infection and potential consequences.