Treatment of refractory sino‐nasal aspergillosis with posaconazole and terbinafine in 10 dogs

Abstract

The results of this study suggest that this combination therapy appears safe and well-tolerated for the treatment of refractory sino-nasal aspergillosis in dogs. Long-term survival is possible with prolonged treatment, but relapse is possible. Larger prospective studies are warranted to further evaluate these preliminary findings.

Successful multimodal treatment ofPaecilomyces lilacinusinfection in a dog

“…29 Additionally, the safety of combined posaconazole and terbinafine therapy has recently been reported in a clinical study. 28 The skin lesions responded well to this therapy; however, it did not prevent the development of further, although milder, lesions when immunosuppressive treatment with prednisolone was reintroduced. This again highlights the importance of tapering of immune-suppressive therapy for the successful management of deep mycoses.…”

“…A previous in vitro study reported the combination of terbinafine with second‐generation azoles reduced the MIC of both drugs against P lilacinus isolates 29. Additionally, the safety of combined posaconazole and terbinafine therapy has recently been reported in a clinical study 28. The skin lesions responded well to this therapy; however, it did not prevent the development of further, although milder, lesions when immunosuppressive treatment with prednisolone was reintroduced.…”

“…Posaconazole was introduced due to its in vitro24 and in vivo9 proposed efficacy and its likely improved safety profile in dogs compared with voriconazole 25–27. A recently published study showed that posaconazole was safe and well tolerated for six months in 10 dogs with sinonasal aspergillosis 28. Furthermore, the elevated liver enzymes identified in this case raised concern over a potential hepatopathy, and therefore a drug with the least potential for hepatic dysfunction was sought.…”

“…[25][26][27] A recently published study showed that posaconazole was safe and well tolerated for six months in 10 dogs with sinonasal aspergillosis. 28 Furthermore, the elevated liver enzymes identified in this case raised concern over a potential hepatopathy, and therefore a drug with the least potential for hepatic dysfunction was sought.…”

Comparison of two minimally invasive enilconazole perendoscopic infusion protocols for the treatment of canine sinonasal aspergillosis

“…Oral treatments with antifungal drugs (azole derivatives) have generally poor to moderate efficacy, require prolonged administration and are commonly associated with adverse effects (Peeters & Clercx ). However, improved clinical remission rates were recently reported for combination treatment with posaconazole and terbinafine (Stewart & Bianco ). Treatment with enilconazole or clotrimazole infusion administered topically through catheters placed surgically, blindly or endoscopically have been associated with higher success rates (Peeters & Clercx , Billen & Peeters ).…”