泊沙康唑治疗犬难治性球孢子菌病。
Posaconazole treatment of refractory coccidioidomycosis in dogs.
机构信息
Valley Fever Center for Excellence, The University of Arizona, Tucson, Arizona, USA.
Veterinary Specialty Center of Tucson, Tucson, Arizona, USA.
出版信息
J Vet Intern Med. 2021 Nov;35(6):2772-2777. doi: 10.1111/jvim.16282. Epub 2021 Oct 18.
BACKGROUND
The majority of dogs with coccidioidomycosis recover with administration of fluconazole or itraconazole, although some cases are refractory or the dogs do not tolerate administration of these medications.
OBJECTIVES
The objective was to describe the treatment outcomes and therapeutic monitoring of 8 dogs with refractory coccidioidomycosis treated with posaconazole.
ANIMALS
Eight dogs with refractory coccidioidomycosis.
METHODS
Retrospective case series. Medical records from Veterinary Specialty Center of Tucson were searched to identify dogs with refractory coccidioidomycosis that were treated with posaconazole. Clinical information and the results of monitoring trough serum posaconazole concentrations were retrieved.
RESULTS
Eight dogs with refractory coccidioidomycosis were treated with 2.5 to 10 mg/kg per day of posaconazole. Six of 8 dogs recovered or developed clinical remission while administered posaconazole. Thirteen serum concentrations from 8 dogs tested were >1 μg/mL (range, 1.52 to >6 μg/mL) and the drug was well-tolerated by 7 dogs. One dog required dosage reductions and treatment was ultimately discontinued because of hepatotoxicosis.
CONCLUSIONS AND CLINICAL IMPORTANCE
Posaconazole should be considered as a treatment option for dogs with refractory coccidioidomycosis. Monitoring of indicators of liver function or injury along with therapeutic drug monitoring is recommended to tailor dosage in the event of hepatic toxicosis.
背景
大多数患有球孢子菌病的狗在服用氟康唑或伊曲康唑后即可康复，但有些病例是难治性的，或者狗不能耐受这些药物的治疗。
目的
本研究旨在描述 8 例难治性球孢子菌病犬应用泊沙康唑治疗的结果和治疗监测情况。
动物
8 例难治性球孢子菌病犬。
方法
回顾性病例系列研究。检索了图森兽医专科中心的病历，以确定接受泊沙康唑治疗的难治性球孢子菌病犬。检索了临床信息和监测泊沙康唑谷浓度的结果。
结果
8 例难治性球孢子菌病犬每天接受 2.5 至 10mg/kg 的泊沙康唑治疗。8 例中有 6 例在给予泊沙康唑时恢复或出现临床缓解。8 只犬的 13 个血清浓度>1μg/ml（范围 1.52 至>6μg/ml），7 只犬对药物耐受良好。1 只狗需要减少剂量，最终因肝毒性而停止治疗。
结论和临床意义
泊沙康唑应被视为治疗难治性球孢子菌病犬的一种选择。建议在发生肝毒性时监测肝功能或损伤的指标以及治疗药物监测，以调整剂量。
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