[Embolia cutis medicamentosa. Circumscribed skin necrosis following intramuscular injections].
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Twenty-one adult horses were randomly assigned into 7 groups of 3 and were treated for 5 days with procaine penicillin G, benzathine penicillin , or phenylbutazone in various combinations and dosage schedules. Serum concentration of penicillin was measured serially over a 7-day period. The highest mean peak serum concentration was 2.06 micrograms/ml. Comparable peak values were seen 2 to 4 hours after administration of 22,000 IU of procaine penicillin G/kg of body weight given once or twice daily. A minimum serum concentration of 0.25 micrograms/ml was selected as adequate for efficacy against organisms that can be considered sensitive to penicillin. Once daily administration of procaine penicillin G and, although peak concentrations were lower, some regimens of procaine and benzathine penicillin G did maintain this concentration. Concurrent phenylbutazone administration did not affect serum concentration of penicillin appreciably.
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Dapsone is the drug of first choice in the treatment of leprosy. Although the oral route of administration has been mostly used, recent studies of patient compliance revealed that only about 50% of the tables received by the patients are actually taken. It is generally assumed that irregular self-medication favors the development of dapsone resistance. The need for a more reliable route of administration led us to investigate the possibility of an i.m. dapsone depot injection. To achieve effective blood levels for 3-4 weeks, suspensions of large dapsone particles in an aqueous vehicle were made. In a trial with 20 leprosy patients in Nigeria, injection of 900 mg dapsone i.m. as a mixture of particle sizes less than 90 micrometer (20%) and 90-125 micrometer (80%) resulted in a serum level above 0.5 microgram/ml for 18 +/- 5 days with a mean peak concentration of 3.1 +/- 0.9 microgram/ml (n = 10). Injection of 1200 mg of the same particle-size mixture led to peak concentrations of 2.7 +/- 1.0 microgram/ml and maintenance of the level above 0.5 microgram/ml for 25 +/- 3 days (n = 5). After injection of 1200 mg (particle size less than 90 micrometer), serum levels were kept above 0.5 microgram/ml for 21 +/- 5 days with a maximum concentration of 3.9 +/- 1.2 microgram/ml (n = 5). Serum levels were measured using a rapid non-extractive HPLC method. The injections were very well tolerated. Due to these encouraging results, the dosage and formulation will be further optimized.
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It has been proposed that prophylactic administration of lidocaine i.m. can prevent ventricular arrhythmias during myocardial infarction. Thus we studied the pharmacokinetics of lidocaine after i.m. injection of 300 mg in the deltoid muscle and subsequent infusion to maintain antiarrhythmically effective plasma levels. The mean duration for exceeding a threshold concentration of 1.5 mg/l after 300 mg lidocaine i.m. was about 2 h; maximum concentrations were reached after 10 min and amounted to 3.2 mg/l (n = 10). By varying the infusion onset after i.m. injection (1 or 2 h later) and the infusion rates from 0.029-0.039 mg/kg X min, steady-state plasma levels of lidocaine were found to be in the therapeutic range (1.5-6 mg/l) for 5 h of observation. Long-lasting infusions (greater than 10 h) may result in increased plasma concentrations of lidocaine due to reduced body clearance.
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