Update on antifungal therapy

Treatment of thoracolumbar spinal cord compression associated with Histoplasma capsulatum infection in a cat

“…Itraconazole or fluconazole is often the primary drug choice for animals with histoplasmosis. 7,24 Because histoplasmosis involving the CNS is uncommon in people and animals, well-defined guidelines do not exist regarding antifungal agent choice or duration of treatment. Controversy exists as to whether fluconazole should be used in dogs and cats with CNS disease because of its ability to cross the blood-brain barrier and achieve higher concentrations in the CSF than itraconazole.…”

Successful management of an intracranial phaeohyphomycotic fungal granuloma in a dog

“…8,9 However, voriconazole has a broader spectrum than fluconazole and itraconazole and is reported to be 50 to 100 times as potent against certain fungal species and also to have excellent bioavailability and ability in penetrating the brain and CSF. 1,8,25,28,29 No adverse effect was noted with doses of 3 to 12 mg/kg (1.4 to 5.5 mg/lb) in healthy dogs in a laboratory setting, other than autoinduction of its own metabolism and increased liver cytochrome P450 concentrations. 29 Such pharmacokinetic and pharmacodynamic data suggest voriconazole may be a first-choice drug for treatment of cerebral phaeohyphomycosis in dogs, although further study is required.…”

“…20 However, brain concentrations of itraconazole are higher during fungal infection, 23 and this may help to explain why it is comparable to fluconazole for the treatment of cryptococcal meningitis in humans. 24 The bioavailability of itraconazole is affected by variations in diet and gastric pH, 25 and the drug has been associated with various adverse effects including anorexia (≤ 15% of dogs), 26 gastrointestinal disturbance, 25 and rare cases of hepatotoxicosis. 25,27 Fluconazole has been suggested as the treatment of choice for various CNS fungal infections in dogs.…”

“…24 The bioavailability of itraconazole is affected by variations in diet and gastric pH, 25 and the drug has been associated with various adverse effects including anorexia (≤ 15% of dogs), 26 gastrointestinal disturbance, 25 and rare cases of hepatotoxicosis. 25,27 Fluconazole has been suggested as the treatment of choice for various CNS fungal infections in dogs. 8,9 However, voriconazole has a broader spectrum than fluconazole and itraconazole and is reported to be 50 to 100 times as potent against certain fungal species and also to have excellent bioavailability and ability in penetrating the brain and CSF.…”

Effect of Multiple Oral Dosing of Fluconazole on the Pharmacokinetics of Cyclosporine in Healthy Beagles

“…Fcz penetrates the blood-brain, blood-prostate and blood-ocular barriers, and high concentrations are found in cerebrospinal fluid, urine and ocular fluids [14,31]. Fcz shows efficacy against aspergillosis, candidiasis, coccidioidomycosis, cryptococcosis and histoplasmosis in animal models [10,13,26]. Although canine renal transplantation is still developing as a salvage treatment for end-stage chronic renal failure, systemic fungal infection should be considered a fatal complication of severely immunosuppressed conditions.…”