Advances in Avian Clinical Therapeutics

Pharmacokinetics in Penguins Compared to Other Avian Species: A Review of Enrofloxacin and Voriconazole

Australasia is home to unique and endangered avian species. Drug administration to this group of animal patients for prophylaxis and treatment is challenging from a number of different perspectives. A key limitation for optimal drug dosing in birds is the lack of published pharmacokinetic studies to guide dose requirements. The aim of this review was to systematically investigate published literature on pharmacokinetics in penguin species and compare that with the pharmacokinetics of other avian species with a focus on two drugs: enrofloxacin and voriconazole. The review was conducted following PRISMA guidelines. A systematic literature search was performed in Pubmed, Embase, Scopus, and Web of Science databases. A key finding is that penguin pharmacokinetics differs from other avian species, with weight-adjusted AUC and Cmax values higher than most other avian species (e.g., for enrofloxacin, the AUC in the African penguin is 85.7 μg h/mL, which is more than double the other bird species). Doses for some avian species may be successfully extrapolated from other avian species; however, it appears important to consider factors other than just body weight (e.g., clearance mechanism and drug physicochemical characteristics). Consequently, there is an important need for robust pharmacokinetic data in wildlife species to ensure optimal therapy for this special group of patients. As part of this review, we identify key aspects that should be considered when estimating dose in species for which there is limited pharmacokinetic information available.

PHARMACOKINETICS OF CEFTIOFUR CRYSTALLINE-FREE ACID ADMINISTERED VIA INTRAMUSCULAR INJECTION IN WHOOPING CRANES (GRUS AMERICANA)

The objective of this study was to evaluate the pharmacokinetic properties of a single dose of ceftiofur crystalline-free acid (CCFA) in whooping cranes (Grus americana). Ceftiofur crystalline-free acid is a long-acting, injectable, third-generation cephalosporin antibiotic drug. A preliminary study evaluated CCFA administered intramuscularly in the pectoral or thigh muscle at 20 or 30 mg/kg IM to a single adult whooping crane for each dose. On the basis of these data, a dose of 30 mg/kg IM of CCFA was administered to five additional whooping cranes, and blood was collected at various time points from 0 to 288 h. Pharmacokinetic parameters for ceftiofur equivalents were determined and reached concentrations above minimum inhibitory concentrations of various bacteria in other avian species (>1 µg/ml) for at least 96 h in all birds, and for 144 h in two birds. From these findings, ceftiofur crystalline-free acid appears to be a long-acting antibiotic option for whooping cranes and may be dosed every 96 h; however, additional multidose studies are needed.

Tolerability of Atovaquone—Proguanil Application in Common Buzzard Nestlings

Simple Summary

Many wild animals, and particularly birds, are commonly infected and can suffer health consequences by blood parasites related to Plasmodium, the causative agents of malaria in humans. Atovaquone–proguanil (Malarone^®, GlaxoSmithKline) is one of the most popular drugs for the treatment of malaria infections in humans and is commonly used for the treatment of birds in captivity. Our aim was to test the potential effects of Malarone^® within one week of treatment on the growth rate, body condition, and blood chemistry of common buzzard nestlings, a widely distributed Eurasian bird of prey. We found no evidence of detrimental effects of a single dose in common buzzard nestlings with an average dosage of 11 mg/kg, compared with the 7 mg/kg recommended daily dosage in humans. Although Malarone^® is commonly used in wildlife rehabilitation centres, and our results do not indicate acute toxicity, further studies are needed to determine the half-life and potential long-term effects of Malarone^® treatment in birds.

Abstract

Differences in drug tolerability among vertebrate groups and species can create substantial challenges for wildlife and ex situ conservation programmes. Knowledge of tolerance in the use of new drugs is, therefore, important to avoid severe toxicity in species, which are both commonly admitted in veterinary clinics and are of conservation concern. Antimalarial drugs have been developed for use in human medicine, but treatment with different agents has also long been used in avian medicine, as haemosporidian infections play a major role in many avian species. This study investigates the effects of the application of atovaquone–proguanil (Malarone^®, GlaxoSmithKline) in common buzzards (Buteo buteo). The potential effects of treatment on body condition, growth rate, and chemical blood parameters of nestlings were assessed. All individuals survived the treatment, and no effects on body condition, growth rate, and chemical blood parameters were observed. Our results suggest the tolerability of Malarone^® in common buzzards at a single dose of on average 11 mg/kg body weight. For its safe use, we recommend further studies to determine pharmacokinetics in different avian species as well as to assess the effects of repeated treatment.

Cardiovascular Diseases in Pet Birds: Therapeutic Options and Challenges

Cardiovascular disease, including congestive heart failure, pericardial disease, and atherosclerosis, is becoming increasingly better recognized in companion birds. A wide range of medications is available to treat these conditions, including diuretics, vasodilators, positive and negative inotropes, antiarrhythmic agents, and pentoxifylline. This review systematically discusses each of these drug classes and their potential applications in avian species. Although treatment approaches remain largely empirical and extrapolated from small animal and human medicine, the management strategies presented here have the potential to both maintain quality of life and extend survival time for the avian cardiac patient.

Psittacine Sedation and Anesthesia

Successful management of sedation/anesthesia of psittacine species relies on familiarity with their specific anatomy and physiology, and detailed knowledge of the recent advancements in applied pharmacology of the anesthetics and perianesthetic monitoring of cardiovascular and respiratory functions. Each sedation/anesthetic plan should be patient-specific, developed based on preexisting conditions, size, species, age, and estimated risk. Other key factors to improve safety, quality of perioperative care, and client satisfaction are anticipation of complications, extension of close monitoring to the recovery phase, multimodal analgesic approach, stress prevention/reduction, and transparent communication with the owner.

Identifying the Stressors Impacting Rescued Avian Wildlife

Simple Summary

Stress evaluation in wildlife is valuable tool for rehabilitation and injury prevention. This pilot study investigated categories of stress in rescued birds. We determined three categories of stressors (preliminary, primary and secondary) using clinical data of rescued birds from Adelaide, South Australia. It was discovered that birds are highly susceptible to impact injuries (e.g., flying into a building window) and vehicle-related injuries as preliminary stressors, which often result in hospitalisation of birds. Immobility and abnormal behaviour represented the most common primary stressor, while the most common secondary stressors included trauma and fracture. Furthermore, the most common outcome in clinics due to exposure of birds to these three stressor categories was euthanasia.

Abstract

Urbanisation exposes avian wildlife to an array of environmental stressors that result in clinical admission and hospitalisation. The aim of this pilot study was to conduct a retrospective analysis of clinical data and characterise this based on categories of stress experienced by avian wildlife patients. The results from this study indicated that impact injuries (n = 33, 25%) and vehicle-related injuries (n = 33, 25%) were the most common occurring preliminary stressors that resulted in the hospitalisation of avian wildlife. The most common outcome of avian patients that suffered from vehicle-related injuries was euthanasia (n = 15, 45%), as was avian patients that suffered from impact injuries (n = 16, 48%). Immobility (n = 105, 61%) and abnormal behaviour (n = 24, 14%) were the most commonly occurring primary stressors of avian patients. Finally, trauma (n = 51, 32%) and fractures (n = 44, 27%) were the most common occurring secondary stressors in avian patients. The most common outcome of all these stressors was euthanasia. This study provided further evidence towards the notion that human- and urbanisation-related stressors are the main causes of hospitalisation of avian wildlife, but also indicated that birds admitted as a result of human-related stressors are more likely to be euthanised than released. This study also provided a categorisation system for the stressors identified in avian wildlife patients (preliminary, primary and secondary) that may be used to monitor the stress categories of wildlife patients and gain a deeper understanding of the complex notion of stress.

Clinical Management of Avian Renal Disease

Treatment of avian renal disease relies on supportive care, such as fluid therapy and nutritional support. Analgesia and adaptations of the environment are indicated in cases of renal disease associated with painful joints. Other treatments vary with the underlying etiology and may include systemic antibiotics, antifungal therapy, vitamin A supplementation, or chelation therapy.

Emergencies and Critical Care of Commonly Kept Fowl

Fowl are birds belonging to one of the 2 biological orders, the game fowl or land fowl (Galliformes) and the waterfowl (Anseriformes). Studies of anatomic and molecular similarities suggest these two groups are close evolutionary relatives. Multiple fowl species have a long history of domestication. Fowl are considered food-producing animals in most countries and clinicians should follow legislation regarding reportable diseases and antibiotic use, even if they are pets. This article reviews aspects of emergency care for most commonly kept fowl, including triage, patient assessment, diagnostic procedures, supportive care, short-term hospitalization, and common emergency presentations.

Exposure and food web transfer of pharmaceuticals in ospreys (Pandion haliaetus): Predictive model and empirical data

The osprey (Pandion haliaetus) is a well-known sentinel of environmental contamination, yet no studies have traced pharmaceuticals through the water-fish-osprey food web. A screening-level exposure assessment was used to evaluate the bioaccumulation potential of 113 pharmaceuticals and metabolites, and an artificial sweetener in this food web. Hypothetical concentrations in water reflecting "wastewater effluent dominated" or "dilution dominated" scenarios were combined with pH-specific bioconcentration factors (BCFs) to predict uptake in fish. Residues in fish and osprey food intake rate were used to calculate the daily intake (DI) of compounds by an adult female osprey. Fourteen pharmaceuticals and a drug metabolite with a BCF greater than 100 and a DI greater than 20 µg/kg were identified as being most likely to exceed the adult human therapeutic dose (HTD). These 15 compounds were also evaluated in a 40 day cumulative dose exposure scenario using first-order kinetics to account for uptake and elimination. Assuming comparable absorption to humans, the half-lives (t1/2 ) for an adult osprey to reach the HTD within 40 days were calculated. For 3 of these pharmaceuticals, the estimated t1/2 in ospreys was less than that for humans, and thus an osprey might theoretically reach or exceed the HTD in 3 to 7 days. To complement the exposure model, 24 compounds were quantified in water, fish plasma, and osprey nestling plasma from 7 potentially impaired locations in Chesapeake Bay. Of the 18 analytes detected in water, 8 were found in fish plasma, but only 1 in osprey plasma (the antihypertensive diltiazem). Compared to diltiazem detection rate and concentrations in water (10/12 detects, <method detection limits [MDL]-173 ng/L), there was a lower detection frequency in fish (31/233 detects, <MDL-2400 ng/L); however when present in fish, all values exceeded the maximum diltiazem concentration found in water. Diltiazem was found in all 69 osprey plasma samples (540-8630 ng/L), with 41% of these samples exceeding maximum concentrations found in fish. Diltiazem levels in fish and osprey plasma were below the human therapeutic plasma concentration (30000 ng/L). Effect thresholds for diltiazem are unknown in ospreys at this time, and there is no evidence to suggest adverse effects. This screening-level exposure model can help identify those compounds that warrant further investigation in high-trophic level species.

Detection and drivers of exposure and effects of pharmaceuticals in higher vertebrates

Pharmaceuticals are highly bioactive compounds now known to be widespread environmental contaminants. However, research regarding exposure and possible effects in non-target higher vertebrate wildlife remains scarce. The fate and behaviour of most pharmaceuticals entering our environment via numerous pathways remain poorly characterized, and hence our conception and understanding of the risks posed to wild animals is equally constrained. The recent decimation of Asian vulture populations owing to a pharmaceutical (diclofenac) offers a notable example, because the exposure route (livestock carcasses) and the acute toxicity observed were completely unexpected. This case not only highlights the need for further research, but also the wider requirement for more considered and comprehensive 'ecopharmacovigilance'. We discuss known and potential high risk sources and pathways in terrestrial and freshwater ecosystems where pharmaceutical exposure in higher vertebrate wildlife, principally birds and mammals, may occur. We examine whether approaches taken within existing surveillance schemes (that commonly target established classes of persistent or bioaccumulative contaminants) and the risk assessment approaches currently used for pesticides are relevant to pharmaceuticals, and we highlight where new approaches may be required to assess pharmaceutical-related risk.