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Lin XB, Hu XG, Tang ZX, Guo PH, Liu XM, Liang T, Xia YZ, Lui KY, Chen P, Tang KJ, Chen X, Cai CJ. Pharmacokinetics of Voriconazole in Peritoneal Fluid of Critically Ill Patients. Antimicrob Agents Chemother 2023; 67:e0172122. [PMID: 37022169 PMCID: PMC10190584 DOI: 10.1128/aac.01721-22] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/01/2023] [Indexed: 04/07/2023] Open
Abstract
Data on the distribution of voriconazole (VRC) in the human peritoneal cavity are sparse. This prospective study aimed to describe the pharmacokinetics of intravenous VRC in the peritoneal fluid of critically ill patients. A total of 19 patients were included. Individual pharmacokinetic curves, drawn after single (first dose on day 1) and multiple (steady-state) doses, displayed a slower rise and lower fluctuation of VRC concentrations in peritoneal fluid than in plasma. Good but variable penetration of VRC into the peritoneal cavity was observed, and the median (range) peritoneal fluid/plasma ratios of the area under the concentration-time curve (AUC) were 0.54 (0.34 to 0.73) and 0.67 (0.63 to 0.94) for single and multiple doses, respectively. Approximately 81% (13/16) of the VRC steady-state trough concentrations (Cmin,ss) in plasma were within the therapeutic range (1 to 5.5 μg/mL), and the corresponding Cmin,ss (median [range]) in peritoneal fluid was 2.12 (1.39 to 3.72) μg/mL. Based on the recent 3-year (2019 to 2021) surveillance of the antifungal susceptibilities for Candida species isolated from peritoneal fluid in our center, the aforementioned 13 Cmin,ss in peritoneal fluid exceeded the MIC90 of C. albicans, C. glabrata, and C. parapsilosis (0.06, 1.00, and 0.25 μg/mL, respectively), which supported VRC as a reasonable choice for initial empirical therapies against intraabdominal candidiasis caused by these three Candida species, prior to the receipt of susceptibility testing results.
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Affiliation(s)
- Xiao-bin Lin
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiao-guang Hu
- Department of Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhao-xia Tang
- Department of Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Peng-hao Guo
- Department of Clinical Laboratory, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiao-man Liu
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Tao Liang
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yan-zhe Xia
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ka Yin Lui
- Department of Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Pan Chen
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ke-jing Tang
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiao Chen
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chang-jie Cai
- Department of Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Wirth F, Ishida K. Antifungal drugs: An updated review of central nervous system pharmacokinetics. Mycoses 2020; 63:1047-1059. [PMID: 32772402 DOI: 10.1111/myc.13157] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/23/2020] [Accepted: 08/02/2020] [Indexed: 01/06/2023]
Abstract
Invasive fungal infections (IFIs) in the central nervous system (CNS) are particularly hard to treat and are associated with high morbidity and mortality rates. Four chemical classes of systemic antifungal agents are used for the treatment of IFIs (eg meningitis), including polyenes, triazoles, pyrimidine analogues and echinocandins. This review will address all of these classes and discuss their penetration and accumulation in the CNS. Treatment of fungal meningitis is based on the antifungal that shows good penetration and accumulation in the CNS. Pharmacokinetic data concerning the entry of antifungal agents into the intracranial compartments are faulty. This review will provide an overview of the ability of systemic antifungals to penetrate the CNS, based on previously published drug physicochemical properties and pharmacokinetic data, for evaluation of the most promising antifungal drugs for the treatment of fungal CNS infections. The studies selected and discussed in this review are from 1990 to 2019.
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Affiliation(s)
- Fernanda Wirth
- Laboratory of Antifungal Chemotherapy, Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Kelly Ishida
- Laboratory of Antifungal Chemotherapy, Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
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Sierra-Rodriguez T, Groover ES, Lascola KM, Mora-Pereira M, Lee YH, Duran SH, Ravis WR, Spangler E, Hathcock T, Wooldridge AA. Clinical Feasibility and Airway Deposition of Nebulized Voriconazole in Healthy Horses. J Equine Vet Sci 2020; 94:103246. [PMID: 33077094 DOI: 10.1016/j.jevs.2020.103246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/05/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Abstract
Voriconazole (VRC) is a potential treatment for pneumomycosis in horses. The objectives of this study were to determine if the delivery of Vfend using a Flexineb nebulizer produced clinically significant [VRC] in lower airways. The hypothesis was that [VRC] after delivery by nebulization would be greater in the pulmonary epithelial lining fluid than plasma. A secondary objective was to determine [VRC] in upper airways through the collection of nasopharyngeal wash (NPW) samples. Voriconazole solution [Vfend-6.25 mg/mL, 100 (n = 2), 200 (n = 3), 500 (n = 1) mg] was nebulized once in 6 healthy geldings. Clinical responses, duration of nebulization, and [VRC] at various time points (up to 8 hours) in plasma, bronchoalveolar lavage fluid (BALF) supernatant and cell pellet, and NPW samples were recorded. Voriconazole (Vfend-6.25 mg/mL, 200 mg) was nebulized in 5 additional, healthy geldings, and [VRC] was measured in NPW samples pre- and postnebulization at time points up to 8 hours. The antifungal activity of BALF and NPW samples was determined using agar disk diffusion. Concentrations of voriconazole were below detection in plasma, BALF supernatant, and cell pellets for all time points and doses except the BALF cell pellet (0.4 μg/g) immediately after nebulization of 500 mg. For 5 horses, administered 200 mg of Vfend, mean [VCR] in NPW at the end of nebulization and 1, 6, and 8 hours postnebulization were: 30.8 ± 29, 1.0 ± 0.84, 0.2 ± 0.19, and 0.34 ± 0.67 μg/mL, respectively. Only NPW samples obtained immediately postnebulization showed antifungal activity. A nebulized Vfend solution is not recommended for the treatment of pneumomycosis in horses.
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Affiliation(s)
- Tamara Sierra-Rodriguez
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL
| | - Erin S Groover
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL
| | - Kara M Lascola
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL
| | - Mariano Mora-Pereira
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL
| | - Yann H Lee
- Department of Drug Discovery and Development, Harrison School of Pharmacy, Auburn University, Auburn, AL
| | - Sue H Duran
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL
| | - William R Ravis
- Department of Drug Discovery and Development, Harrison School of Pharmacy, Auburn University, Auburn, AL
| | - Elizabeth Spangler
- Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, AL
| | - Terri Hathcock
- Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, AL
| | - Anne A Wooldridge
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL.
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Tamura N, Okano A, Kuroda T, Niwa H, Kusano K, Matsuda Y, Fukuda K, Mita H, Nagata S. Utility of systemic voriconazole in equine keratomycosis based on pharmacokinetic-pharmacodynamic analysis of tear fluid following oral administration. Vet Ophthalmol 2020; 23:640-647. [PMID: 32383526 PMCID: PMC7496923 DOI: 10.1111/vop.12764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 03/24/2020] [Accepted: 03/24/2020] [Indexed: 11/30/2022]
Abstract
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 AUC0–24 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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Affiliation(s)
- Norihisa Tamura
- Miho Training Center, Japan Racing Association, Racehorse Hospital, Ibaraki, Japan.,Japan Racing Association, Equine Research Institute, Tochigi, Japan
| | - Atsushi Okano
- Miho Training Center, Japan Racing Association, Racehorse Hospital, Ibaraki, Japan
| | - Taisuke Kuroda
- Miho Training Center, Japan Racing Association, Racehorse Hospital, Ibaraki, Japan
| | - Hidekazu Niwa
- Japan Racing Association, Equine Research Institute, Tochigi, Japan
| | - Kanichi Kusano
- Miho Training Center, Japan Racing Association, Racehorse Hospital, Ibaraki, Japan
| | - Yoshikazu Matsuda
- Miho Training Center, Japan Racing Association, Racehorse Hospital, Ibaraki, Japan
| | - Kentaro Fukuda
- Miho Training Center, Japan Racing Association, Racehorse Hospital, Ibaraki, Japan
| | - Hiroshi Mita
- Japan Racing Association, Equine Research Institute, Tochigi, Japan
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Mora-Pereira M, Abarca EM, Duran S, Ravis W, McMullen RJ, Fischer BM, Lee YHP, Wooldridge AA. Sustained-release voriconazole-thermogel for subconjunctival injection in horses: ocular toxicity and in-vivo studies. BMC Vet Res 2020; 16:115. [PMID: 32295599 PMCID: PMC7160932 DOI: 10.1186/s12917-020-02331-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 04/05/2020] [Indexed: 12/13/2022] Open
Abstract
Background Keratomycosis is a relatively common, sight threatening condition in horses, where treatment is often prolonged and costly. Subconjunctival (SCo) injections offer less resistance to drug diffusion than the topical route, resulting in better penetration to the ocular anterior segment. Voriconazole, a second generation triazole antifungal, is effective against common fungal organisms causing keratomycosis. If combined with a thermogel biomaterial, voriconazole can be easily injected in the SCo space to provide sustained drug release. The purpose of this study was to evaluate the drug concentrations in the anterior segment and clinical effects after SCo injections of voriconazole-containing thermogel: poly (DL-lactide-co-glycolide-b-ethylene glycol-b-DL-lactide-co-glycolide) (PLGA-PEG-PLGA) in healthy equine eyes. Results Voriconazole aqueous humor (AH) and tear concentrations were compared between 6 horses, receiving 1% voriconazole applied topically (0.2 mL, q4h) (Vori-Top) or 1.7% voriconazole-thermogel (0.3 mL) injected SCo (Vori-Gel). For the Vori-Gel group, voriconazole concentrations were measured in AH and tears at day 2 and then weekly for 23 days, and at day 2 only for the Vori-Top group. Ocular inflammation was assessed weekly (Vori-Gel) using the modified Hackett-McDonald scoring system. Ocular tissue concentrations of voriconazole following SCo 1.7% voriconazole-thermogel (0.3 mL) injections were evaluated post euthanasia in 6 additional horses at 3 different time points. Three horses received bilateral injections at 2 h (n = 3, right eye (OD)) and 48 h (n = 3, left eye (OS)) prior to euthanasia, and 3 horses were injected unilaterally (OS), 7 days prior to euthanasia. Voriconazole-thermogel was easily injected and well tolerated in all cases, with no major adverse effects. On day 2, drug concentrations in tears were higher in the Vori-Top, but not statistically different from Vori-Gel groups. For the Vori-Gel group, voriconazole was non-quantifiable in the AH at any time point. Total voriconazole concentrations in the cornea were above 0.5 μg/g (the target minimum inhibitory concentration (MIC) for Aspergillus sp.) for up to 48 h; however, concentrations were below this MIC at 7 days post treatment. Conclusions Voriconazole-thermogel was easily and safely administered to horses, and provided 48 h of sustained release of voriconazole into the cornea. This drug delivery system warrants further clinical evaluation.
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Affiliation(s)
- Mariano Mora-Pereira
- J. T. Vaughan Large Animal Teaching Hospital, Auburn University, Auburn, AL, USA
| | - Eva M Abarca
- J. T. Vaughan Large Animal Teaching Hospital, Auburn University, Auburn, AL, USA.
| | - Sue Duran
- J. T. Vaughan Large Animal Teaching Hospital, Auburn University, Auburn, AL, USA
| | - William Ravis
- Department of Drug Discovery and Development, Auburn University, Auburn, AL, USA
| | - Richard J McMullen
- J. T. Vaughan Large Animal Teaching Hospital, Auburn University, Auburn, AL, USA
| | - Britta M Fischer
- J. T. Vaughan Large Animal Teaching Hospital, Auburn University, Auburn, AL, USA
| | | | - Anne A Wooldridge
- J. T. Vaughan Large Animal Teaching Hospital, Auburn University, Auburn, AL, USA
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Affiliation(s)
- A. J. Stewart
- School of Veterinary Science Equine Specialist Hospital University of Queensland Gatton Queensland Australia
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Paper spray high-resolution accurate mass spectrometry for quantitation of voriconazole in equine tears. Anal Bioanal Chem 2019; 411:5187-5196. [PMID: 31123782 DOI: 10.1007/s00216-019-01898-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/19/2019] [Accepted: 05/06/2019] [Indexed: 01/12/2023]
Abstract
Paper spray high-resolution accurate mass spectrometry is a fast and versatile analysis method. This ambient ionization technique enables the quantitation of xenobiotics in complex biological matrices without chromatography or conventional sample extraction. The simplicity, rapidity, and affordability of the paper spray mass spectrometry (PS-MS) method make the technique especially attractive for clinical investigations where fast and affordable sample analysis is crucial. A new PS-MS method for the quantitation of voriconazole in equine tears was developed and validated. For a concentration range of 10 to 1000 ng/mL, good linearity (R2 > 0.99), inter- and intra-run precision (coefficient of variation (CV) max. 11.9%), accuracy (bias of the nominal concentration ± 13.9%), and selectivity (signal areas of the double blanks represent 0.13 ± 0.05% of the lower limit of quantitation (LLOQ) signal in equine tears) were observed. The quantitation of voriconazole was based on three product ions and calculated relative to the isotope-labeled internal standard, voriconazole-d3, which had a final concentration of 250 ng/mL in the standards and samples. The matrix effect of the method showed an ionization suppression by reduction of the voriconazole response to 63.6%, 70.2%, and 81.9% for 30 ng/mL, 450 ng/mL, and 900 ng/mL in equine tears compared with voriconazole in solvent (methanol:water, 50:50, v:v). The method was used to analyze 126 study samples collected for a pharmacokinetic study investigating a novel approach for treatment of fungal keratitis in horses. Therefore, the integrity of the sample dilution (n = 6, CV 6.90%, and bias of nominal concentration + 8.40%) and the carryover effect (increase from 0.33 ± 0.21% to 1.33 ± 0.89% of the signal of the LLOQ) was further investigated. To our knowledge, this method is the first application of PS-MS for quantitation of drug concentrations in tears from any species.
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Chen L, Zhu L, Li M, Li N, Qi F, Wang N. Predicting the Effects of Different Triazole Antifungal Agents on the Pharmacokinetics of Tamoxifen. AAPS PharmSciTech 2019; 20:24. [PMID: 30604153 DOI: 10.1208/s12249-018-1219-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/11/2018] [Indexed: 01/12/2023] Open
Abstract
Tamoxifen is an antiestrogen drug that is widely used in the adjuvant chemotherapy of estrogen receptor-α (ERα)-positive breast cancer. Chemotherapy could suppress immune function in breast cancer patients, which may cause invasive fungal infections (IFIs). Triazoles (voriconazole, fluconazole, and itraconazole) were commonly used for IFI. The physiologically based pharmacokinetic (PBPK) models were developed to investigate the influence of different triazoles on tamoxifen pharmacokinetics in this paper. To investigate the influence of different triazoles (voriconazole, fluconazole, itraconazole) on tamoxifen pharmacokinetics. Adjusted physicochemical data and pharmacokinetic parameters of voriconazole, fluconazole, itraconazole, and tamoxifen were obtained from published literatures. PBPK models were built and verified in healthy subjects using GastroPlus™. Voriconazole, itraconazole, and tamoxifen were administered orally. Fluconazole was administered intravenously. Simulated plasma concentration-time curves of the voriconazole, fluconazole, itraconazole, and tamoxifen showed good agreement with the observed profiles, respectively. The DDI simulations showed that the pharmacokinetic parameters of tamoxifen were increased by various degrees when coadministered with different triazoles. In healthy subjects, the area under the plasma concentration-time curve from 0 to t h (AUC0-t) of tamoxifen was increased by 41%, 5%, and1% when coadministrated with voriconazole, fluconazole, and itraconazole, respectively. The PBPK models adequately characterized the pharmacokinetics of tamoxifen and triazoles. Among the three triazoles, voriconazole exhibited the greatest effect on tamoxifen pharmacokinetics. In clinical practice, an effective dosage adjustment of tamoxifen may need to be considered and TDM for tamoxifen is advisable to guide dosing and optimize therapy when coadministered with voriconazole.
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Abstract
Fungi are clinically important causes of ocular infections in the horse. Keratomycosis is the most common; however, a diverse range of mycotic infections, affecting numerous ocular tissues, may be encountered. Many equine mycoses are diagnostic and therapeutic challenges. Prompt and appropriate treatment is essential to minimize morbidity and reduce the likelihood of vision loss. Knowledge of the characteristics and properties of equine ophthalmology antifungal medications is essential to selecting an optimal treatment strategy, including selection of appropriate medication and effective administration route. Newer delivery methods and devices are available and can contribute to an improved outcome in select situations.
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Affiliation(s)
- Eric C Ledbetter
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Cornell University Hospital for Animals, CVM Box 34, Ithaca, NY 14853, USA.
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Parsley RA, Tell LA, Gehring R. Pharmacokinetics of a single dose of voriconazole administered orally with and without food to red-tailed hawks (Buteo jamaicensus). Am J Vet Res 2017; 78:433-439. [DOI: 10.2460/ajvr.78.4.433] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lemetayer JD, Dowling PM, Taylor SM, Papich MG. Pharmacokinetics and distribution of voriconazole in body fluids of dogs after repeated oral dosing. J Vet Pharmacol Ther 2015; 38:451-6. [DOI: 10.1111/jvp.12208] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 01/16/2015] [Indexed: 01/21/2023]
Affiliation(s)
- J. D. Lemetayer
- Small Animal Clinical Sciences; Western College of Veterinary Medicine; University of Saskatchewan; Saskatoon SK Canada
| | - P. M. Dowling
- Veterinary Biomedical Sciences; Western College of Veterinary Medicine; University of Saskatchewan; Saskatoon SK Canada
| | - S. M. Taylor
- Small Animal Clinical Sciences; Western College of Veterinary Medicine; University of Saskatchewan; Saskatoon SK Canada
| | - M. G. Papich
- Department of Molecular Biomedical Sciences; College of Veterinary Medicine; North Carolina State University; Raleigh NC USA
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Abstract
Fungal respiratory disease is a rare occurrence in horses. Fungal organisms are ubiquitous in the equine environment; however, there is a geographic predisposition for disease development, with fungal respiratory infections seen more commonly by practitioners working in tropical or subtropical environments. Diagnosis and treatment of fungal respiratory infections pose a challenge for the equine practitioner, and the prognosis for complete resolution of infection is often guarded; however, new antifungal medications are likely to improve treatment success. This article summarizes the available literature regarding the cause, diagnosis, and treatment of equine fungal respiratory disease.
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Affiliation(s)
- Allison J Stewart
- J.T. Vaughan Large Animal Teaching Hospital, Department of Clinical Sciences, Auburn University College of Veterinary Medicine, 1500 Wire Road, Auburn, AL 36849, USA.
| | - Rosemary S Cuming
- J.T. Vaughan Large Animal Teaching Hospital, Department of Clinical Sciences, Auburn University College of Veterinary Medicine, 1500 Wire Road, Auburn, AL 36849, USA
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Abstract
Voriconazole concentrations were determined in autopsy samples of eight patients who had been treated for a median of 7 days (interquartile range [IQR], 5 days). Voriconazole penetrates well into various tissues, with median levels of 6.26 μg/g ((interquartile range [IQR], 7.87 μg/g) in the lung, 3.41 μg/g (IQR, 16.72 μg/g) in the brain, 6.89 μg/g (IQR, 24.16 μg/g) in the liver, 6.47 μg/g (IQR, 6.19 μg/g) in the kidneys, 5.60 μg/g (IQR, 11.49 μg/g) in the spleen, and 7.55 μg/g (IQR, 16.91 μg/g) in the myocardium.
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