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Cañizares-Cooz D, Rojo-Solís C, Rubio-Langre S, García-Párraga D, Encinas T, Morón-Elorza P. Updates on antifungal pharmacotherapy in elasmobranchs: pharmacokinetics of 4 mg/kg voriconazole after IM and IV administration in undulate skates ( Raja undulata) maintained under human care. Front Vet Sci 2024; 11:1376851. [PMID: 38903684 PMCID: PMC11186998 DOI: 10.3389/fvets.2024.1376851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 05/27/2024] [Indexed: 06/22/2024] Open
Abstract
Introduction Fungal diseases are frequently associated with elevated mortality rates in elasmobranchs. Currently, there is a notable absence of scientifically validated therapeutic medications that can ensure both effectiveness and safety when administered to this group of animals. The empirical prescription of azole antifungal agents, particularly voriconazole, has been posited as a potentially efficacious treatment approach for addressing most common mycoses in sharks and rays. However, there are still no published pharmacokinetic studies supporting its use in elasmobranchs and there is a lack of scientific base for its utilization in elasmobranchs. Methods For this study, voriconazole was administered intravenously (IV) and intramuscularly (IM), at a single dose of 4 mg/kg to six adult undulate skates (Raja undulata). A washout period of 8 weeks was left between each route of administration. Blood samples were collected both before and at ten predetermined intervals after each dosing (0.25, 0.5, 1, 1.5, 2, 4, 8, 12, 24, and 36 h after drug administration). Plasma concentrations were quantified using a validated high-performance liquid chromatography method, and pharmacokinetic (PK) data was analyzed through non-compartmental methods. Results The mean extrapolated concentration at 0 h (C0) after IV administration was 27.19 ± 7.15 μg/mL and the mean peak plasma concentrations (Cmax) ± SEM after IM administration resulted 2.98 ± 0.28 μg/mL at a mean time to maximum concentration (T max) of 1.33 ± 0.17 h. Terminal half-lives were calculated and resulted 11.18 ± 1.32 h for IV injections and 9.59 ± 1.38 h for IM injections. The area under the curve extrapolated to infinity was determined as 58.14 ± 2.79 h·μg/ml following IV injections and 37.60 ± 6.67 h·μg/ml following IM injections. The IM-administered voriconazole exhibited a mean absolute bioavailability of 64.67 ± 11.47%. Discussion These discoveries provide backing for the possible application of voriconazole through the intramuscular route in undulate skates and support using lower dosage regimens compared to those required for oral administration, emphasizing the importance of conducting further pharmacokinetic studies with antifungals in elasmobranchs.
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Affiliation(s)
- Daniela Cañizares-Cooz
- Department of Pharmacology and Toxicology, Faculty of Veterinary Medicine, Complutense University of Madrid, Madrid, Spain
| | - Carlos Rojo-Solís
- Veterinary Services, Oceanogràfic, Ciudad de las Artes y las Ciencias. C/ Eduardo Primo Yúfera (Científic) 1B, Valencia, Spain
| | - Sonia Rubio-Langre
- Department of Pharmacology and Toxicology, Faculty of Veterinary Medicine, Complutense University of Madrid, Madrid, Spain
| | - Daniel García-Párraga
- Veterinary Services, Oceanogràfic, Ciudad de las Artes y las Ciencias. C/ Eduardo Primo Yúfera (Científic) 1B, Valencia, Spain
- Research Department, Fundación Oceanogràfic de la Comunitat Valenciana, Oceanogràfic, C/ Eduardo Primo Yúfera (Científic) 1B, Valencia, Spain
| | - Teresa Encinas
- Department of Pharmacology and Toxicology, Faculty of Veterinary Medicine, Complutense University of Madrid, Madrid, Spain
| | - Pablo Morón-Elorza
- Department of Pharmacology and Toxicology, Faculty of Veterinary Medicine, Complutense University of Madrid, Madrid, Spain
- Research Department, Fundación Oceanogràfic de la Comunitat Valenciana, Oceanogràfic, C/ Eduardo Primo Yúfera (Científic) 1B, Valencia, Spain
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Patson CN, Elsmo EJ, Trepanier L, Garner MM, Murray MJ, Bronson E, Clarke LL, Cox SK, Ossiboff RJ, Iredale ME, Miller BM, Waxman L, Littman E, Thurber MI. FATAL ACUTE HEMOLYSIS FOLLOWING TRIAZOLE THERAPY IN AFRICAN PENGUINS ( SPHENISCUS DEMERSUS). J Zoo Wildl Med 2024; 55:479-489. [PMID: 38875206 DOI: 10.1638/2023-0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 06/16/2024] Open
Abstract
Aspergillosis is a major cause of morbidity and mortality in penguins, with triazole antifungal drugs being commonly used for prophylaxis and treatment. This report describes 15 cases of fatal hemolysis associated with liquid itraconazole and voriconazole formulations administered to African penguins (Spheniscus demersus) from four institutions. All penguins underwent stressful events (e.g. relocation, induced molt) and were administered commercial liquid itraconazole formulations or compounded voriconazole liquid suspension. Observed clinical signs in affected penguins prior to death included hyporexia, weight loss, lethargy, dyspnea, red-tinged droppings, and obtunded mentation. Intra- and extravascular hemolysis and hemoglobinuric nephrosis were the primary pathologic manifestations on postmortem examination. The concentration-dependent hemolytic potentials of itraconazole, voriconazole, and commercial and compounded vehicle suspensions were evaluated in vitro by exposing chicken whole blood as a surrogate for penguin blood. Hemoglobin content in blood plasma was then measured by spectrophotometry. Neither itraconazole nor voriconazole alone induced hemolysis in vitro. The vehicle ingredients sorbitol and hydromellose induced hemolysis, but not at predicted plasma levels in chicken erythrocytes, suggesting neither the azole antifungals nor their major vehicles alone were likely to contribute to hemolysis in vivo in these penguins. Potential mechanisms of toxicosis include generation of an unmeasured reactive metabolite causing hemolysis, preexisting erythrocyte fragility, or species-specific differences in hemolytic thresholds that were not assessed in the chicken erythrocyte model. More research is needed on the potential for toxicosis of azole antifungal drugs and carrier molecules in this and other avian species.
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Affiliation(s)
- Courtney N Patson
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI 53706, USA
| | | | - Lauren Trepanier
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI 53706, USA
| | | | | | | | - Lorelei L Clarke
- Wisconsin Veterinary Diagnostic Laboratory, Madison, WI 53706, USA
| | - Sherry K Cox
- University of Tennessee College of Veterinary Medicine, Knoxville, Tennessee 37996, USA
| | - Robert J Ossiboff
- Department of Comparative Diagnostic and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL 32608, USA
| | - Marley E Iredale
- Department of Comparative Diagnostic and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL 32608, USA
| | - Bryce M Miller
- Department of Comparative Diagnostic and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL 32608, USA
| | | | | | - Mary I Thurber
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI 53706, USA,
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Cañizares-Cooz D, García-Párraga D, Plá-González E, Rojo-Solis C, Encinas T, Morón-Elorza P. Fungal Diseases in Elasmobranchs and Their Possible Treatment with a Special Mention to Azole Antifungal Agents. Animals (Basel) 2023; 14:43. [PMID: 38200774 PMCID: PMC10778029 DOI: 10.3390/ani14010043] [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: 11/12/2023] [Revised: 12/09/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Elasmobranchs currently constitute an important part of the animal collection of many aquariums worldwide. Their maintenance under human care has allowed us to describe and identify new pathogens and diseases affecting them, as well as to determine different treatments for these diseases. Great advances in elasmobranch husbandry have been developed. METHODS A search was performed on scientific databases as PubMed and other specialized sources (IAAAM archive). RESULTS Little information on pharmacotherapeutics is available in this taxonomic group, and treatments lack a scientific base and instead are frequently dependent on empirical knowledge. Pharmacokinetic studies are the first step to determining therapeutic protocols that are safe and effective. The available bibliography shows that a majority of the mycoses recorded in cartilaginous fish are severe, aggravated by the fact that the antifungal treatments administered, following the guidelines used for teleost species, are ineffective in elasmobranchs. Azoles appear to be a promising group of antifungals for use in treating systemic mycoses in sharks and rays. CONCLUSIONS Based on the findings of this review, it is essential to investigate the pharmacokinetics of the different antifungals in these species in order to provide therapeutic options for fungal infections in cartilaginous fish.
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Affiliation(s)
- Daniela Cañizares-Cooz
- Department of Pharmacology and Toxicology, Faculty of Veterinary Medicine, Complutense University of Madrid, Av. Puerta de Hierro s/n, 28040 Madrid, Spain; (T.E.); (P.M.-E.)
| | - Daniel García-Párraga
- Fundación Oceanogràfic de la Comunitat Valenciana, C/Eduardo Primo Yúfera (Científic) 1B, 46013 Valencia, Spain; (D.G.-P.); (E.P.-G.)
- Veterinary Services, Oceanogràfic, Ciudad de las Artes y las Ciencias, C/Eduardo Primo Yúfera (Científic) 1B, 46013 Valencia, Spain;
| | - Emma Plá-González
- Fundación Oceanogràfic de la Comunitat Valenciana, C/Eduardo Primo Yúfera (Científic) 1B, 46013 Valencia, Spain; (D.G.-P.); (E.P.-G.)
| | - Carlos Rojo-Solis
- Veterinary Services, Oceanogràfic, Ciudad de las Artes y las Ciencias, C/Eduardo Primo Yúfera (Científic) 1B, 46013 Valencia, Spain;
| | - Teresa Encinas
- Department of Pharmacology and Toxicology, Faculty of Veterinary Medicine, Complutense University of Madrid, Av. Puerta de Hierro s/n, 28040 Madrid, Spain; (T.E.); (P.M.-E.)
| | - Pablo Morón-Elorza
- Department of Pharmacology and Toxicology, Faculty of Veterinary Medicine, Complutense University of Madrid, Av. Puerta de Hierro s/n, 28040 Madrid, Spain; (T.E.); (P.M.-E.)
- Fundación Oceanogràfic de la Comunitat Valenciana, C/Eduardo Primo Yúfera (Científic) 1B, 46013 Valencia, Spain; (D.G.-P.); (E.P.-G.)
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Woods SJ, Hughes-Medlicott NJ, McDowell A. Pharmacokinetics in Penguins Compared to Other Avian Species: A Review of Enrofloxacin and Voriconazole. Mol Pharm 2023; 20:4430-4442. [PMID: 37579225 DOI: 10.1021/acs.molpharmaceut.3c00520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
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.
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Affiliation(s)
- Stacey J Woods
- School of Pharmacy, University of Otago, Dunedin 9054, New Zealand
| | | | - Arlene McDowell
- School of Pharmacy, University of Otago, Dunedin 9054, New Zealand
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Visvanathan N, Lim JYA, Chng HT, Xie S. A Critical Review on the Dosing and Safety of Antifungals Used in Exotic Avian and Reptile Species. J Fungi (Basel) 2023; 9:810. [PMID: 37623581 PMCID: PMC10455840 DOI: 10.3390/jof9080810] [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: 05/31/2023] [Revised: 07/25/2023] [Accepted: 07/25/2023] [Indexed: 08/26/2023] Open
Abstract
Antifungals are used in exotic avian and reptile species for the treatment of fungal diseases. Dose extrapolations across species are common due to lack of species-specific pharmacological data. This may not be ideal because interspecies physiological differences may result in subtherapeutic dosing or toxicity. This critical review aims to collate existing pharmacological data to identify antifungals with the most evidence to support their safe and effective use. In the process, significant trends and gaps are also identified and discussed. An extensive search was conducted on PubMed and JSTOR, and relevant data were critically appraised. Itraconazole or voriconazole showed promising results in Japanese quails, racing pigeons and inland bearded dragons for the treatment of aspergillosis and CANV-related infections. Voriconazole neurotoxicity manifested as seizures in multiple penguins, but as lethargy or torticollis in cottonmouths. Itraconazole toxicity was predominantly hepatotoxicity, observed as liver abnormalities in inland bearded dragons and a Parson's chameleon. Differences in formulations of itraconazole affected various absorption parameters. Non-linearities in voriconazole due to saturable metabolism and autoinduction showed opposing effects on clearance, especially in multiple-dosing regimens. These differences in pharmacokinetic parameters across species resulted in varying elimination half-lives. Terbinafine has been used in dermatomycoses, especially in reptiles, due to its keratinophilic nature, and no significant adverse events were observed. The use of fluconazole has declined due to resistance or its narrow spectrum of activity.
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Affiliation(s)
- Naresh Visvanathan
- Department of Pharmacy, National University of Singapore, Singapore 117559, Singapore
| | - Jolise Yi An Lim
- Department of Pharmacy, National University of Singapore, Singapore 117559, Singapore
| | - Hui Ting Chng
- Department of Pharmacy, National University of Singapore, Singapore 117559, Singapore
| | - Shangzhe Xie
- Mandai Wildlife Group, 80 Mandai Lake Road, Singapore 729826, Singapore
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Pharmaceutics for free-ranging wildlife: Case studies to illustrate considerations and future prospects. Int J Pharm 2022; 628:122284. [DOI: 10.1016/j.ijpharm.2022.122284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/03/2022] [Accepted: 10/07/2022] [Indexed: 11/24/2022]
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THE ISOLATION AND ANTIMICROBIAL SENSITIVITY OF ASPERGILLUS FUMIGATUS FROM FROZEN RESPIRATORY TISSUES OF PENGUINS FROM ZOOLOGICAL COLLECTIONS IN THE UNITED KINGDOM, 2007-2018. J Zoo Wildl Med 2021; 51:591-597. [PMID: 33480534 DOI: 10.1638/2019-0160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2020] [Indexed: 11/21/2022] Open
Abstract
Fifty-eight frozen postmortem lung and air sac samples were collected from penguins housed at 21 zoological collections throughout the United Kingdom, from 2007 to 2018. Aspergillus fumigatus, a significant respiratory pathogen of penguins in captivity, was isolated from 15 of the 22 penguins with gross lesions. Of the penguins with gross lesions of aspergillosis at postmortem examination, the pathogen was cultured from 63.6% (15 of 22) of frozen samples. Aspergillus fumigatus was cultured from 2.7% (1 of 36) of tissues collected from penguins without gross lesions at postmortem. Additionally, of 18 fresh samples that cultured A. fumigatus at the time of postmortem, 15 samples (83%) yielded isolates that were successfully cultured from frozen tissue. Minimum inhibitory concentration (MIC) data demonstrated that all isolates were susceptible to terbinafine and voriconazole, and all were resistant to itraconazole, using published MIC cutoff values. Comparison isolates from fresh tissues had identical antimicrobial susceptibility to isolates from the same tissues after being frozen. This study demonstrates that A. fumigatus can be isolated from frozen respiratory tissues of penguins, even after freezing for more than 10 yr.
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Arné P, Risco-Castillo V, Jouvion G, Le Barzic C, Guillot J. Aspergillosis in Wild Birds. J Fungi (Basel) 2021; 7:241. [PMID: 33807065 PMCID: PMC8004873 DOI: 10.3390/jof7030241] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 01/23/2023] Open
Abstract
The ubiquitous fungi belonging to the genus Aspergillus are able to proliferate in a large number of environments on organic substrates. The spores of these opportunistic pathogens, when inhaled, can cause serious and often fatal infections in a wide variety of captive and free-roaming wild birds. The relative importance of innate immunity and the level of exposure in the development of the disease can vary considerably between avian species and epidemiological situations. Given the low efficacy of therapeutic treatments, it is essential that breeders or avian practitioners know the conditions that favor the emergence of Aspergillosis in order to put adequate preventive measures in place.
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Affiliation(s)
- Pascal Arné
- Ecole Nationale Vétérinaire d’Alfort, Centre Hospitalier Universitaire Vétérinaire de la Faune Sauvage (Chuv-FS), 94700 Maisons-Alfort, France; (V.R.-C.); (C.L.B.)
- Ecole Nationale Vétérinaire d’Alfort, Dynamic Research Group UPEC, EnvA, USC Anses, 94700 Maisons-Alfort, France; (G.J.); (J.G.)
| | - Veronica Risco-Castillo
- Ecole Nationale Vétérinaire d’Alfort, Centre Hospitalier Universitaire Vétérinaire de la Faune Sauvage (Chuv-FS), 94700 Maisons-Alfort, France; (V.R.-C.); (C.L.B.)
- Ecole Nationale Vétérinaire d’Alfort, Dynamic Research Group UPEC, EnvA, USC Anses, 94700 Maisons-Alfort, France; (G.J.); (J.G.)
- Ecole Nationale Vétérinaire d’Alfort, Biopôle Alfort, 94700 Maisons-Alfort, France
| | - Grégory Jouvion
- Ecole Nationale Vétérinaire d’Alfort, Dynamic Research Group UPEC, EnvA, USC Anses, 94700 Maisons-Alfort, France; (G.J.); (J.G.)
- Ecole Nationale Vétérinaire d’Alfort, Biopôle Alfort, 94700 Maisons-Alfort, France
| | - Cécile Le Barzic
- Ecole Nationale Vétérinaire d’Alfort, Centre Hospitalier Universitaire Vétérinaire de la Faune Sauvage (Chuv-FS), 94700 Maisons-Alfort, France; (V.R.-C.); (C.L.B.)
| | - Jacques Guillot
- Ecole Nationale Vétérinaire d’Alfort, Dynamic Research Group UPEC, EnvA, USC Anses, 94700 Maisons-Alfort, France; (G.J.); (J.G.)
- Ecole Nationale Vétérinaire d’Alfort, Biopôle Alfort, 94700 Maisons-Alfort, France
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Azmanis P, Pappalardo L, Sara ZAJ, Silvanose C, Naidoo V. Pharmacokinetics of voriconazole after a single intramuscular injection in large falcons (Falco spp.). Med Mycol 2021; 58:661-666. [PMID: 31608415 DOI: 10.1093/mmy/myz102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/17/2019] [Accepted: 10/06/2019] [Indexed: 01/25/2023] Open
Abstract
Voriconazole is one of the main azoles used to treat invasive aspergillosis in falconry raptors and birds. Despite the fact that there are studies for oral and intravenous use of voriconazole in birds, there are none for its effect after intramuscular use. Empirical use of intramuscular voriconazole in falcons, indicated quicker therapy response than the oral one. Aim of this study is to evaluate the in vivo pharmacokinetic disposition of injectable voriconazole after a single intramuscular injection in large falcons (i.e., Gyrfalcons, Saker falcons, Peregrine falcons). No clinical side effects were observed in the falcons. Absorption of voriconazole was rapid (0.5-2 hours) and reached a plasma level (>1 μg/ml) which is above the minimal inhibitory concentration (MIC) for all known Aspergillus strains. This level was maintained for 16 to 20 hours, thus indicating that a single injection of 12.5 mg/kg is not enough if T > MIC is taken into consideration. On a newer aspect, according to the AUC24 unbound: MIC parameter would be indicated that this dose would be rather sufficient for most Aspergillus strains.
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Affiliation(s)
- P Azmanis
- Dubai Falcon Hospital, Dubai, United Arab Emirates (Azmanis, Silvanose)
| | - L Pappalardo
- Department of Biology, Chemistry and Environmental Studies, American University of Sharjah (AUS), United Arab Emirates (Pappalardo, Sara)
| | - Ziad A J Sara
- Department of Biology, Chemistry and Environmental Studies, American University of Sharjah (AUS), United Arab Emirates (Pappalardo, Sara)
| | - C Silvanose
- Dubai Falcon Hospital, Dubai, United Arab Emirates (Azmanis, Silvanose)
| | - V Naidoo
- Biomedical Research Center (BRC), Faculty of Veterinary Science, University of Pretoriaz, Republic of South Africa (Naidoo)
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Zalesak SM, Sanchez CR, Pich AA, Papich MG. Preliminary Pilot Study of Itraconazole After a Single Oral Dose of a Veterinary Formulation Solution in African Penguins ( Spheniscus demersus). J Avian Med Surg 2020; 34:52-56. [PMID: 32237682 DOI: 10.1647/1082-6742-34.1.52] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Aspergillosis is a common cause of morbidity and mortality in captive penguins. Itraconazole, an antifungal drug, is commonly used to treat aspergillosis infections in avian species; however, commercially available human formulations are costly, and studies have shown the effectiveness of compounded formulations to be unreliable. The US Food and Drug Administration (FDA) recently approved a veterinary formulation of itraconazole, Itrafungol, for use in cats. This study provides preliminary results from limited sampling evaluating whether this veterinary formulation is suitable for future studies in the African penguin (Spheniscus demersus). A 20 mg/kg PO itraconazole dose was administered to 9 African penguins. Blood samples were taken over the course of 24 hours; each sample was collected from a different bird to minimize stress to the animals. Plasma was analyzed by high-performance liquid chromatography for concentrations of itraconazole. The drug was absorbed in all penguins, and plasma concentrations in 5 of 9 penguins (56%) were found to be greater than the established therapeutic dose of 1.0 µg/ mL. To our knowledge, this is the first study that has investigated a 20 mg/kg dose of itraconazole in a penguin species. The small sample size limits the conclusions that can be drawn from this preliminary study. Nonetheless, we demonstrate encouraging evidence that the FDA-approved formulation of oral itraconazole solution should be considered for future study as a cost-effective treatment for aspergillosis in African penguins and other avian species.
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Affiliation(s)
- Selina M Zalesak
- College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843, USA,
| | | | - Ashley A Pich
- College of Veterinary Medicine, Ohio State University, Columbus, OH 43210, USA
| | - Mark G Papich
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607, USA
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Abstract
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.
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Affiliation(s)
- Ophélie Cojean
- Zoological Medicine Service, Clinique vétérinaire Benjamin Franklin, 38 rue du Danemark, ZA Porte Océane II, Brech 56400, France
| | - Sylvain Larrat
- Zoological Medicine Service, Clinique vétérinaire Benjamin Franklin, 38 rue du Danemark, ZA Porte Océane II, Brech 56400, France
| | - Claire Vergneau-Grosset
- Service de médecine zoologique, Département de sciences cliniques, Faculté de médecine vétérinaire, Université de Montréal, 3200 rue Sicotte, Saint-Hyacinthe, Quebec J2S 2M2, Canada.
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Therapy of Non-Dermatophytic Mycoses in Animals. J Fungi (Basel) 2018; 4:jof4040120. [PMID: 30380772 PMCID: PMC6308939 DOI: 10.3390/jof4040120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 10/21/2018] [Accepted: 10/29/2018] [Indexed: 12/13/2022] Open
Abstract
This review focuses on aspects of antimycotic therapy specific to veterinary medicine. In the first part, drug availability, limited mostly by economic consideration but also by clinical applicability and specific adverse effects, is described for polyenes, 5 fluorocytosine, azoles, echinocandins and terbinafine. In the second part, current knowledge and experience in the treatment of selected fungal infections are overviewed. These mycoses include disseminated mold infections in small animals (dogs and cats) and avian species, upper respiratory tract infections of small animals (sino-nasal and sino-orbital aspergillosis) and horses (guttural pouch mycosis), eumycetoma, infections caused by dimorphic fungi, (blastomycosis, histoplasmosis, coccidioidomycosis, paracoccidioidomycosis and sporothrichosis) and by yeasts and yeast-like microorganism (Cryptococcus spp. and Malassezia pachydermatis).
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Parsley RA, Mutlow AG, Hansted J, Taverne FJ, Tell LA, Gehring R. Application of different pharmacokinetic models to describe and predict pharmacokinetics of voriconazole in magellanic penguins following oral administration. J Vet Pharmacol Ther 2018; 42:74-84. [PMID: 30175535 PMCID: PMC7379668 DOI: 10.1111/jvp.12709] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 07/31/2018] [Indexed: 12/23/2022]
Abstract
Aspergillosis is a condition causing serious morbidity and mortality in captive penguins and other bird species. It can be treated with antifungal drugs, such as voriconazole. However, the pharmacokinetics of voriconazole are variable between different animal and bird species. Therefore, the pharmacokinetics of voriconazole were investigated in this study in Magellanic penguins. Pharmacokinetic models were constructed and applied to predict the pharmacokinetics of voriconazole during long-term treatment in Magellanic penguins, since the voriconazole treatment duration in chronic aspergillosis cases can last up to several months. Plasma voriconazole concentration-time data from adult Magellanic penguins (Spheniscus magellanicus; n = 15) following a single oral (PO) dose of either 2.5 mg/kg or 5 mg/kg in a herring in three separate study periods 7-12 months apart were collected. Mean plasma voriconazole concentrations were above the targeted MIC for Aspergillus fumigatus for 2 hr following a single 2.5 mg/kg voriconazole dose while the plasma concentrations exceeded the MIC for least 24 hr following a 5 mg/kg dose. Nonlinear mixed-effects modeling was used to fit two pharmacokinetic models, one with first-order and another with saturable elimination, to the single-dose data. Fits were good for both, as long as dose was included as a covariate for the first-order model so that clearance was lower and the half-life longer for animals receiving the 5 mg/kg dose. Although the single-dose data suggested saturated elimination at higher concentrations, the model with saturable elimination did not predict plasma voriconazole concentrations well for a clinical aspergillosis case receiving long-term treatment, possibly because of induction of metabolizing enzymes with chronic exposure. Pharmacokinetic models should accurately predict plasma drug concentrations for different dosage regimens in order to be applicable in the field. Future studies should focus on determining clearance at steady-state to be able to refine the pharmacokinetic models presented here and improve model performance for long-term oral voriconazole administration in Magellanic penguins.
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Affiliation(s)
- Ruth A Parsley
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, California
| | | | | | - Femke J Taverne
- Veterinary Pharmacotherapeutics and Pharmacy Group, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Lisa A Tell
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, California
| | - Ronette Gehring
- Veterinary Pharmacotherapeutics and Pharmacy Group, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
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Abstract
The use of antifungals in birds is characterized by interspecies and interindividual variability in the pharmacokinetics, affecting drug safety and efficacy. Oral antifungal drug absorption is a complex process affected by drug formulation characteristics, gastrointestinal anatomy, and physiology. New antifungal drug delivery systems can enhance drug stability, reduce off-target side effects, prolong residence time in the blood, and improve efficacy. Topical administration of antifungals through nebulization shows promising results. However, therapeutic output is highly influenced by drug formulation and type of nebulizer, indicating these factors should be taken into account when selecting this medication route.
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Affiliation(s)
- Gunther Antonissen
- Department of Pharmacology, Toxicology and Biochemistry, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, Merelbeke 9820, Belgium; Department of Pathology, Bacteriology and Avian Diseases, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, Merelbeke 9820, Belgium.
| | - An Martel
- Department of Pathology, Bacteriology and Avian Diseases, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, Merelbeke 9820, Belgium
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