Pharmacokinetics and Relative Bioavailability of Orally Administered Innovator-Formulated Itraconazole Capsules and Solution in Healthy Dogs

Background

Itraconazole is commonly used for treatment of systemic and cutaneous mycoses in veterinary medicine. Two formulations, capsule and solution, are used interchangeably in dogs. However, marked differences in bioavailability have been reported in other species. Similar investigations have not been performed in dogs.

Objective

To determine and compare pharmacokinetics of itraconazole in dogs after oral administration of commercially available capsule and solution formulations intended for use in humans.

Animals

Eight healthy, adult, purpose‐bred dogs.

Methods

Dogs received approximately 10 mg/kg of innovator‐formulated itraconazole solution and capsule PO in randomized, crossover design with a 10‐day washout period. To ensure maximal absorption, solution was administered to fasted dogs, whereas capsules were co‐administered with food. Blood samples were collected at predetermined time points, and plasma drug concentrations were measured using high‐pressure liquid chromatography. Pharmacokinetic parameters were determined with compartmental analysis.

Results

The mean relative bioavailability of the capsule was 85% that of the solution, but drug absorption was variable, and overall drug concentrations were similar between formulations. Mean elimination half‐lives of both formulations were nearly identical at approximately 33 hours. Regardless of formulation, simulations suggest that a loading dose of 20 mg/kg, followed by 10 mg/kg once every 24 hours, will result in plasma concentrations considered to be adequate in most dogs.

Conclusions and Clinical Importance

Contrary to findings reported in other species, overall drug exposures after capsule and solution administration are not substantially different in dogs. Despite some pharmacokinetic differences between itraconazole capsule and solution, formulation‐specific dosages do not appear to be necessary.

Efficacy of once-daily clindamycin hydrochloride in the treatment of superficial bacterial pyoderma in dogs

Twenty-one dogs with canine superficial bacterial pyoderma were treated with clindamycin at a dosage of approximately 11 mg/kg body weight, q 24 hours, given orally for 14 to 42 days. All dogs were reexamined on days 14, 28, and, if necessary, 42 and given a clinical score of excellent (i.e., complete remission), good (i.e., primary lesions resolved but secondary lesions evident), fair (i.e., partial improvement but primary lesions still evident), or poor (i.e., no improvement or worsening of the lesions). A clinical score of excellent was obtained in 71.4% (15/21) of the dogs in this study within 14 to 28 days.

Advances in the diagnosis and treatment of atopy

Regarding the diagnosis of atopy, the emphasis in this article has been on how to use the initial history and physical examination findings to lead the clinician towards this diagnosis. After a systematic approach to the differential diagnosis of pruritus in the dog has been completed, the diagnosis of atopy can be further evaluated using one of the specific allergy tests available. The author's preference is the IDST to aid in the confirmation of the presence of atopy. Regarding the treatment of atopy, the emphasis in this article has been on the use of immunotherapy as the specific treatment for this disease. Careful monitoring of dogs on immunotherapy is essential to obtain optimum results, and response rates to treatment may be significantly improved by implementing various modifications in the standard hyposensitization protocol being used by the clinician.

Type-1 hypersensitivity reactions to Malassezia pachydermatis extracts in atopic dogs

OBJECTIVE

To investigate the potential allergenic role of the yeast Malassezia pachydermatis in dogs with clinical diagnosis of atopic dermatitis.

ANIMALS

5 clinically normal nonatopic dogs, 10 atopic dogs with cytologic evidence of Malassezia dermatitis, and 12 atopic dogs without cytologic evidence of Malassezia dermatitis.

PROCEDURE

A crude yeast extract was produced by disrupting the cell wall of M pachydermatis. The crude extract and 8 of its fractions, which were generated by fractionation in a high-performance liquid chromatography column, were injected along with 46 commercial allergens for intradermal allergy testing of normal and atopic sample populations. Significant difference between atopic populations was evaluated, using a threshold concentration of crude yeast extract that failed to induce wheal-and-flare responses in normal nonatopic dogs.

RESULTS

Atopic dogs with cytologic evidence of Malassezia dermatitis had significantly greater wheal-and-flare reactions to intradermal injection of crude extract of M pachydermatis than did atopic dogs without cytologic evidence of Malassezia dermatitis.

CONCLUSIONS

It is concluded that M pachydermatis is capable of promoting type-1 hypersensitivity reactions in dogs with an atopic dermatitis phenotype.

CLINICAL RELEVANCE

Currently, Malassezia dermatitis is principally managed by use of antifungal chemotherapy. Because the yeast appears to be a contributing allergen in dogs with atopic dermatitis, hyposensitization with M pachydermatis extracts may offer a future alternative to extended or repeated episodic administration of antifungals for extended control of recurrent infections.

Effects of propofol anesthesia on intradermally injected histamine phosphate in clinically normal dogs

OBJECTIVE

To compare skin test reactivity of ID injected histamine phosphate in clinically normal dogs that were physically restrained or anesthetized with propofol.

ANIMALS

12 clinically normal adult dogs.

PROCEDURE

Nonanesthetized dogs (group 1) were restrained and shaved on the right side of the thorax. A single injection of sterile buffered saline solution (negative control) and 5 serial dilutions of histamine phosphate (0.05 ml each) were injected ID. Wheal size was measured after 15 minutes. Propofol anesthetized dogs (group 2) were shaved, and saline solution and histamine were administered ID. Wheal size was measured as for nonanesthetized dogs. Hemoglobin saturation, heart and respiratory rates, and times to sternal recumbency and standing were recorded for anesthetized dogs. Twenty-four hours later, groups were reversed, and testing was repeated on the left side of the thorax.

RESULTS

Mean wheal size was significantly (P < 0.05) less in dogs during propofol anesthesia. Heart and respiratory rates were well maintained but hemoglobin saturation decreased during the first 6 minutes of anesthesia.

CONCLUSIONS AND CLINICAL RELEVANCE

Although statistically significant, the difference in mean wheal size may not be clinically important. Propofol anesthesia may be used during ID skin testing in atopic dogs. Further studies to assess effects of propofol on the reactivity of ID injected aeroallergens should be performed before recommending its use.

German shepherd dog pyoderma: a prospective study of 12 dogs

Twelve German shepherd dogs, each diagnosed as having a recurrent or refractory deep pyoderma (i.e., German shepherd dog pyoderma [GSP]), were evaluated for several parameters over a six-year period. Results indicated that GSP could be associated with flea allergy dermatitis, atopic dermatitis, food allergy, cell-mediated immunodeficiency, or hypothyroidism, or could be an idiopathic disease. The combination of diseases present for a given dog varied from case to case. Adequate control of the pyoderma was achieved only after each identified underlying disease was treated specifically, along with aggressive concurrent medical therapy using systemic antibiotics and medicated baths.

Quantity and distribution of Malassezia organisms on the skin of clinically normal dogs

OBJECTIVE

To define the extent to which Malassezia organisms can be recovered from the skin of clinically normal dogs and to assess differences in organism recovery related to anatomic sampling site and to method of collection.

DESIGN

Prospective, controlled study.

ANIMALS

19 clinically normal dogs.

PROCEDURE

The number of Malassezia pachydermatis organisms were determined in fungal cultures of samples obtained from the skin of clinically normal dogs, using an adhesive tape method to obtain samples from 10 sites/dog. Additionally, 3 methods (direct impression, swabbing technique, and superficial skin scraping) that are commonly used for obtaining samples for cytologic examination were evaluated.

RESULTS

Malassezia organisms were found in low numbers as part of the microflora of the skin of clinically normal dogs. Number of organisms differed significantly for various anatomic locations (chin, highest number; inguinal and axillary regions, lowest number). Malassezia organisms were identified more frequently by use of adhesive tape and fungal culturing than by the methods used for cytologic examination. However, comparing methods used for obtaining samples for cytologic examination with each other, marked differences were not detected in our ability to recover yeast organisms among the 3 techniques.

CLINICAL IMPLICATIONS

Although Malassezia spp is part of the microflora of the skin of clinically normal dogs, it is extremely difficult to detect the organism by any of the 3 sampling methods used for sample collection for cytologic examination. Therefore, anatomic site and method of sample collection should be considered when attempting to make a diagnosis of Malassezia dermatitis.

Infectious crusting dermatoses

Although there are numerous dermatoses in the horse in which the formation of crusts occurs, there are two relatively common and important infectious crusting dermatoses, namely, dermatophytosis and dermatophilosis. This article reviews the current concepts regarding the etiology and pathogenesis of each disease, as well as the more common clinical presentations, methods of diagnosis, and treatment.

Pharmacokinetics of L-thyroxine after its oral administration in dogs

Twelve mature (5 sexually intact males, 4 castrated males, and 3 females) mixed-breed dogs were surgically thyroidectomized and used in a Latin-square design pharmacokinetic study of orally administered L-thyroxine. The dogs were treated with 44, 22, and 11 micrograms of L-thyroxine/kg as a single morning dose or in divided doses, morning and evening. Serum concentration of thyroxine (T4) was evaluated to determine a number of pharmacokinetic variables for comparison. Mean steady-state concentrations (Css) were determined from the area under the curve. Variables were analyzed for comparisons between dosages by use of ANOVA. Concentration at steady state was highest for dogs of the 44-micrograms/kg of body weight once-daily group and was lowest for dogs of the group given 11 micrograms/kg in 2 daily doses. Single daily administration resulted in higher Css, except at the 22-micrograms/kg/d dosage. Clearance was faster for the 22- and 44-micrograms/kg/d dosages than for the 11-micrograms/kg/d dosage. The half-life (t1/2) and mean residence time (MRT) also were shorter for the 44-micrograms/kg/d dosage, possibly indicating more rapid elimination of the drug at higher doses and dose-dependent kinetics. Perhaps, as the dogs' metabolism increased with higher iodothyronine concentrations, hormone degradation was accelerated. Interval (divided vs single dose) caused some expected changes: maximal concentration was higher and minimal concentration was lower when single administration was used. These undulations resulted in iodothyronine concentrations above the physiologic range for a number of hours, whereas concentration closer to physiologic ranges was achieved by use of divided doses.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnosis of food allergy in dogs

The diagnosis of food allergy was confirmed in 51 dogs while the responsiveness to a 60-day home-cooked restricted dietary trial (elimination-diet trial) was evaluated. The primary clinical sign of allergy detected and evaluated in all dogs was persistent and nonseasonally pruritic skin disease. The duration of time between starting the elimination-diet trial and remission of clinical signs was recorded. Dogs were then reexposed to diets that had been fed before testing, and the duration of time before pruritus recurred was recorded. The elapsed time during which dogs were being fed an elimination diet before remission of clinical signs was 1 to 3 weeks in 13 dogs, 4 to 6 weeks in 25 dogs, 7 to 8 weeks in 10 dogs, and 9 to 10 weeks in 3 dogs. Findings indicated that the recommendation of a 3-week elimination-diet trial for diagnosis of food allergy was adequate for only 25% of the dogs. It is recommended that test diets be fed for at least 10 weeks before a food allergy is ruled out.

Serum and tissue cage fluid concentrations of ciprofloxacin after oral administration of the drug to healthy dogs

Ciprofloxacin, a fluoroquinolone antimicrobial agent, was administered orally to 4 healthy dogs at dosage of approximately 11 and 23 mg/kg of body weight, every 12 hours for 4 days, with a 4-week interval between dosing regimens. Serum and tissue cage fluid (TCF) concentrations of ciprofloxacin were measured after the first and seventh dose of each dosing regimen. The peak concentration was greatest in the serum after multiple doses of 23 mg/kg (mean +/- SEM; 5.68 +/- 0.54 micrograms/ml) and least in the TCF after a single dose of 11 mg/kg (0.43 +/- 0.54 micrograms/ml). The time to peak concentration was not influenced by multiple dosing or drug dose, but was longer for TCF (6.41 +/- 0.52 hour) than for serum (1.53 +/- 0.52 hour). Accumulation of ciprofloxacin was reflected by the area under the concentration curve from 0 to 12 hours after administration (AUC0----12). The AUC0----12 was greatest in the serum after multiple doses of 23 mg/kg (31.95 +/- 1.90 micrograms.h/ml) and least in the TCF after a single dose of 11 mg/kg (3.87 +/- 1.90 micrograms.h/ml). The elimination half-life was not influenced by multiple dosing or dose concentration, but was greater for TCF (14.59 +/- 1.91 hours) than for serum (5.14 +/- 1.91 hours). The percentage of TCF penetration (AUCTCF/AUCserum) was greater after multiple doses (95.76 +/- 6.79%) than after a single dose (55.55 +/- 6.79%) and was not different between doses of 11 and 23 mg/kg. Both dosing regimens of ciprofloxacin resulted in continuous serum and TCF concentrations greater than 90% of the minimal inhibitory concentration for the aerobic and facultative anaerobic clinical isolates tested, including Pseudomonas aeruginosa.

Serum and tissue fluid norfloxacin concentrations after oral administration of the drug to healthy dogs

Norfloxacin, a 4-quinolone antibiotic, was administered orally to 4 healthy dogs at dosages of 11 and 22 mg/kg of body weight, every 12 hours for 4 days, with a 4-week interval between dosing regimens. Serum and tissue cage fluid (TCF) norfloxacin concentrations were measured at 0, 0.5, 1, 1.5, 2, 3, 4, 5, 6, 8, 10, and 12 hours after the first and seventh dose of each dosing regimen. When administered at a dosage of 11 mg/kg, the mean peak serum concentration (Cmax) was 1.0 microgram/ml at 1 hour, the time of mean peak concentration (Tmax) after the first dose. After the seventh dose, the Cmax was 1.4 micrograms/ml at Tmax of 1.5 hours. The Tmax for the TCF concentration was 5 hours, with Cmax of 0.3 microgram/ml and 0.7 microgram/ml after the first and seventh dose, respectively. When administered at a dosage of 22 mg/kg, the serum Tmax was 2 hours after the first dose, with Cmax of 2.8 micrograms/ml. After the seventh dose, the serum Tmax was 1.5 hours, with Cmax of 2.8 micrograms/ml. The Tmax for the TCF concentration was 5 hours after the first and seventh doses, with Cmax of 1.2 micrograms/ml and 1.6 micrograms/ml, respectively. After the seventh dose, the serum elimination half-life was 6.3 hours for a dosage of 11 mg/kg and was 6.7 hours for a dosage of 22 mg/kg. For serum concentration, the area under the curve from 0 to 12 hours (AUC0----12) was 8.77 micrograms.h/ml and 18.27 micrograms.h/ml for dosages of 11 mg/kg and 22 mg/kg, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Thyroid and immunologic status of dogs with perianal fistula

Lymphocyte-proliferation responses, absolute lymphocyte counts, and thyrotropin-stimulation responses were determined in 33 dogs with perianal fistula; serum immunoglobulin values also were determined in 15 of the 33 dogs. Lymphocytes were stimulated with concanavalin A, pokeweed mitogen, and phytohemagglutinin and were cultured with medium containing normal pooled canine serum or fresh patient's autologous serum. Initially, lymphocytes from 9 dogs (27.3%) had depressed stimulation responses to greater than or equal to 1 phytomitogen, and 4 of the 9 dogs had absolute lymphopenia. One month after recovery in these 9 dogs, lymphocytes from 4 dogs (66.7%) had normal proliferation responses. Of immunoglobulin determinations in 15 dogs, serum IgA values were 32 to 185 mg/dl (mean, 69 +/- 10 mg/dl) and were low in 2 dogs (13%), and serum IgM values were 48 to 610 mg/dl (mean, 263 to 46 mg/dl) and were high in 8 dogs (53%). Serum IgG values were 1,050 to 3,220 mg/dl (mean, 2,339 +/- 165 mg/dl) and were high in 10 dogs (71%). After thyrotropin stimulation, 1 dog was considered hypothyroid. Neither pathogenesis nor prognosis of canine perianal fistula was clarified via immunoglobulin concentrations or absolute lymphocyte counts. Based on lymphocyte-proliferation assays, suppression of cell-mediated immunity was probably a result of perianal fistula, rather than a cause of the fistula.

Bacterial population and histologic changes in dogs with perianal fistula

Ages of 44 dogs with perianal fistula, ranged from 6 months to 13 years (mean, 5.2 years). German Shepherd Dogs and Irish Setters were statistically (P less than 0.01) over-represented compared with those breeds in a canine hospital population (n = 22,047) for the same period. There was a 2:1 male-to-female ratio, with 38 (86.4%) of dogs sexually intact and 6 (13.6%) of dogs neutered. Eleven types of bacterial organisms were recovered from deep perianal tissues of which Escherichia coli, Staphylococcus aureus, beta-hemolytic streptococci, and Proteus mirabilus were most common. Organisms were not recovered from 7 dogs. Of 93 isolates, 88.3% were susceptible to gentamicin, 80.5% to cephalothin, 79.2% to chloramphenicol, and 74% to trimethoprim-sulfamethoxazole. Fifty-one biopsy specimens from 44 dogs were classified as having early, intermediate-, and late-stage lesions based on the amount of fibrosis, severity of the inflammatory response, and, if present, depth of sinus tracts. In most biopsy specimens, all 3 stages were represented in the same histologic section. In 45 specimens, most inflamed lesions were in the dermis of the zona cutanea. Hidradenitis was present in 22 biopsy specimens and was associated with the formation of epithelial-lined sinus tracts.

Antipruritic drugs

Symptomatic treatment of pruritus is an important adjunct to the systematic approach of attempting to define the etiology of a pruritic skin disease. This article includes a description of the various systemic and topical antipruritic preparations available to veterinary dermatologists as well as their recommended dosages.

Evaluation of the patient with otitis externa

This article considers the history, physical examination, cytologic evaluation of smears and fungal and bacterial culture and sensitivity testing, clinical interpretation of information obtained from a biopsy of the external ear canal, and ancillary aids for the evaluation of the patient with otitis externa.

Cutaneous atypical mycobacteriosis in cats

Cutaneous infection with atypical mycobacteria was observed in 6 cats. All cats had cutaneous or subcutaneous masses, with or without fistulous tracts. Diagnosis was determined by microbial culture. Transmission studies were done in 1 case. Treatment, which included antibiotics or surgery, or both, was usually unsuccessful, but remission without treatment did occur. In 3 cats available for long-term evaluation, there has been no recurrence of disease.