Itraconazole for the Treatment of Cryptococcosis in Cats

Abstract

ltraconazole was used in 3 5 cats with cryptococcosis. Treatment response was determined by comparing clinical signs before, during, and after treatment. It could not be evaluated in 7 cats because they died during treatment from causes unrelated to cryptococcosis. Of the remaining 28 cats, treatment response was classified as success in 16 cats (57%). as improvement in 8 cats (29%). and as a failure in 4 (1 4%). The failures were due to death or euthanasia from drug toxicity (1 cat), progressive fungal disease (2 cats), and relapse 1 year after treatment (1 cat). The cats that improved did not undergo a 1 -year posttreatment e-I- Materials and Methods Treatment ProtocolThe study was conducted as a prospective nonrandomized trial at 28 veterinary hospitals. Cats with microbiological and histopathological or cytologic evidence of cryptococcosis were entered into the study. All cats were tested for circulating feline leukemia virus (FELV) p27 antigen, and 27 of the cats were tested for antibodies against feline immunodeficiency virus (FIV). The initial dose of itraconazole was 50 mg/d PO sid for cats weighing less than 3.2 kg and 100 mg/d PO sid for cats weighing 3.2 kg or more. The drug was administered with food. No other systemic or topical antifungal agents were given. The initial dose of itraconazole was administered unless drug toxicity developed. Itraconazole treatment was continued for 2 months beyond resolution of all clinical signs. If toxicity occurred, treatment uation because they were lost to follow-up (3 cats), died or were euthanatized for other reasons (4 cats), or had a noncompliant owner (1 cat). For the 1 6 cats in which treatment was successful, the median itraconazole dose was 13.8 mg/kg body weight daily (range, 10.9 to 26.7 mg/kg/ d), and the median duration of treatment was 8.5 months (range, 4 to 1 6 months). Five of these cats had previously been treated unsuccessfully with ketoconazole. with itraconazole was temporarily discontinued until adverse effects abated. Then the itraconazole was reinstituted at half the previous dose. J Vet Intern Monitoring During TreatmentDuring treatment, physical examination and serum alanine aminotransferase (ALT) activities were assessed monthly in each cat. Subsequently, after completion of itraconazole treatment, the cats were reevaluated twice a year. At these times, the cats' pretreatment serum biochemical studies were repeated if clinically indicated. EvaluationsTreatment response was determined by comparing clinical signs before, during, and after treatment. Treatment response was recorded as success, improvement, or failure. Success was recorded if the cat had complete resolution of clinical signs at the time of treatment cessation and if clinical remission was maintained for at least 1 year after treatment. A cat was considered improved if its clinical signs had resolved at the end of treatment, but follow-up was less than 1 year. A cat was also considered improved when clinical

Antifungal agents of use in animal health – practical applications

“…Long‐term oral itraconazole (5 mg/kg once or twice daily) is effective for treatment of feline cryptococcosis (Medleau et al ., 1990, 1995; Kano et al ., 1997) and histoplasmosis (Hodges et al ., 1994).…”

Long‐term outcome of therapy for 59 cats and 11 dogs with cryptococcosis

“…The main side effect of ITZ in cats and dogs is a cumulative, dose‐related, reversible hepatotoxicity, which is heralded by inappetence and increased serum ALT activity. Despite limited CNS penetration, ITZ has been used successfully to treat cryptococcal meningitis in people, cats and experimental rabbits 22–24 . FCZ is generally thought to have comparable or superior efficacy to ITZ, with the conspicuous advantage of reliable penetration into the brain, eye, CSF and urine.…”

Treatment of refractory feline sporotrichosis with a combination of intralesional amphotericin B and oral itraconazole

“…In the present study, blood and biochemical analysis disclosed no adverse effects in the cats, even when the maximum systemic dose was exceeded, in agreement with others 29 who have observed no systemic consequences in a human patient with cutaneous alternariosis after IL administration of the drug. The asymptomatic increase in alanine aminotransferase in five animals might be attributed to the use of itraconazole 35 …”