It was first reported following intramuscular injection of bismuth salt, but can occur as a complication of various other drugs such as nonsteroid anti-inflammatory drugs, corticosteroids, local anesthetics and interferon alpha.
Noting that reactogenicity and immunogenicity of vaccine therapy are impacted by successful intramuscular penetration, these authors recommend that the BMI be used as a factor in determining needle-length for deltoid intramuscular injection.
Their main drawbacks are that they are only suitable for intramuscular injection, appropriate sites can be difficult to hit, the volume of injection is limited and they are not easy for use on large numbers of animals.
According to WHO, intramuscular injection (IMI) is an administration of medications parenterally through a skin puncture by a syringe and a needle deep into a large muscle of the body for prophylactic or curative purposes1.
Jackson and her associates said, noting that the factors contributing to this association are unclear, but might be a result of an increased likelihood of inadequate intramuscular injection in larger children.