Legendre A M, Rohrbach B W, Toal R L, Rinaldi M G, Grace L L, Jones J B
Department of Small Animal Clinical Sciences, University of Tennessee, Knoxville 37901-1071, USA.
J Vet Intern Med. 1996 Nov-Dec;10(6):365-71. doi: 10.1111/j.1939-1676.1996.tb02082.x.
One hundred twelve client-owned dogs with blastomycosis were treated with itraconazole, 5 or 10 mg/kg/d. The first group of 70 dogs treated in 1987 and 1988 received 10 mg/kg/d (group 1), and the second group of 42 dogs treated after October 1988 received 5 mg/kg/d (group 2). Even though the groups were treated at different times, the dogs were similar in age and gender distribution, number of sites involved, and percent and severity of pulmonary involvement. The proportion of dogs cured with a 60-day course of itraconazole was similar for both groups (53.6% versus 54.3%) and for a second historical control group treated with amphotericin B (57%); the recurrence rate was also similar, 20%, 21.4%, and 20%, respectively. Dogs treated with itraconazole had similar mortality rates (25.7% at 5 mg/kg/d; 25% at 10 mg/kg/day) to those treated with amphotericin B (23%). Seventeen of the 23 dogs that died (74%), did so during the first week of treatment; these early deaths were usually attributed to respiratory failure. The only site of infection that was significantly associated with failure (death or recurrence) was the brain. There was a marked difference in survival times between dogs without lung disease or with mild lung disease compared with dogs with moderate or severe lung disease. Serum itraconazole concentrations reached steady state by 14 days of treatment. Dogs receiving 5 mg/kg/d of itraconazole (group 2) had mean serum concentrations of 3.55 +/- 2.81 mg/mL (range, 0.67 to 10.8 micrograms/mL), whereas dogs receiving 10 micrograms/kg/d (group 1) had mean concentrations of 13.46 +/- 8.49 micrograms/mL (range, 1.8 to 28 micrograms/mL) (P < or = .001). There was no association between cure and serum itraconazole concentrations. Dogs in group 1 had significantly more adverse effects than dogs in group 2 (P = .046). Anorexia was the most common adverse effect, occurring in 14.9% of dogs in group 1. Only 8% of dogs in group 2 had adverse effects. Serum concentrations of itraconazole were positively correlated with serum alkaline phosphatase and alanine aminotransferase activities. Our findings indicate that itraconazole administered at a dose of 5 mg/kg/d is the drug of choice for blastomycosis in dogs.
112只患有芽生菌病的家养犬接受了伊曲康唑治疗，剂量为5或10mg/kg/天。1987年和1988年治疗的第一组70只犬接受10mg/kg/天（第1组），1988年10月后治疗的第二组42只犬接受5mg/kg/天（第2组）。尽管两组治疗时间不同，但犬的年龄和性别分布、受累部位数量、肺部受累百分比和严重程度相似。两组接受60天伊曲康唑疗程治愈的犬比例相似（53.6%对54.3%），与接受两性霉素B治疗的第二个历史对照组（57%）相似；复发率也相似，分别为20%、21.4%和20%。接受伊曲康唑治疗的犬死亡率（5mg/kg/天为25.7%；10mg/kg/天为25%）与接受两性霉素B治疗的犬（23%）相似。23只死亡犬中有17只（74%）在治疗的第一周内死亡；这些早期死亡通常归因于呼吸衰竭。唯一与治疗失败（死亡或复发）显著相关的感染部位是大脑。与患有中度或重度肺部疾病的犬相比，无肺部疾病或轻度肺部疾病的犬生存时间有显著差异。治疗14天时伊曲康唑血清浓度达到稳态。接受5mg/kg/天伊曲康唑治疗的犬（第2组）平均血清浓度为3.55±2.81mg/mL（范围为0.67至10.8μg/mL），而接受10μg/kg/天治疗的犬（第1组）平均浓度为13.46±8.49μg/mL（范围为1.8至28μg/mL）（P≤0.001）。治愈与伊曲康唑血清浓度之间无关联。第1组犬的不良反应明显多于第2组犬（P = 0.046）。厌食是最常见的不良反应，在第1组14.9%的犬中出现。第2组只有8%的犬有不良反应。伊曲康唑血清浓度与血清碱性磷酸酶和丙氨酸转氨酶活性呈正相关。我们的研究结果表明，5mg/kg/天剂量的伊曲康唑是犬芽生菌病的首选药物。
