title: Some pharmacokinetic indices of oral fluconazole administration to koalas (Phascolarctos cinereus) infected with cryptococcosis.
abstract: Three asymptomatic koalas serologically positive for cryptococcosis and two symptomatic koalas were treated with 10 mg/kg fluconazole orally, twice daily for at least 2 weeks. The median plasma Cmax and AUC0-8 h for asymptomatic animals were 0.9 μg/mL and 4.9 μg/mL·h, respectively; and for symptomatic animals 3.2 μg/mL and 17.3 μg/mL·h, respectively. An additional symptomatic koala was treated with fluconazole (10 mg/kg twice daily) and a subcutaneous amphotericin B infusion twice weekly. After 2 weeks the fluconazole Cmax was 3.7 μg/mL and the AUC0-8 h was 25.8 μg/mL*h. An additional three koalas were treated with fluconazole 15 mg/kg twice daily for at least 2 weeks, with the same subcutaneous amphotericin protocol co-administered to two of these koalas (Cmax : 5.0 μg/mL; mean AUC0-8 h : 18.1 μg/mL*h). For all koalas, the fluconazole plasma Cmax failed to reach the MIC90 (16 μg/mL) to inhibit C. gattii. Fluconazole administered orally at either 10 or 15 mg/kg twice daily in conjunction with amphotericin is unlikely to attain therapeutic plasma concentrations. Suggestions to improve treatment of systemic cryptococcosis include testing pathogen susceptibility to fluconazole, monitoring plasma fluconazole concentrations, and administration of 20-25 mg/kg fluconazole orally, twice daily, with an amphotericin subcutaneous infusion twice weekly.
authors.affiliation: Faculty of Veterinary Science, The University of Sydney, Sydney, NSW, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Govendir
authors.affiliation: Faculty of Veterinary Science, The University of Sydney, Sydney, NSW, Australia.
authors.forename: L A
authors.initials: LA
authors.lastname: Black
authors.affiliation: Faculty of Veterinary Science, The University of Sydney, Sydney, NSW, Australia.
authors.forename: S E
authors.initials: SE
authors.lastname: Jobbins
authors.affiliation: Faculty of Veterinary Science, The University of Sydney, Sydney, NSW, Australia.
authors.forename: B
authors.initials: B
authors.lastname: Kimble
authors.affiliation: Centre of Veterinary Education, The University of Sydney, Sydney, NSW, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Malik
authors.affiliation: Faculty of Veterinary Science, The University of Sydney, Sydney, NSW, Australia.
authors.forename: M B
authors.initials: MB
authors.lastname: Krockenberger
mesh_terms: D000284:Administration, Oral; D000818:Animals; D000935:Antifungal Agents / Q000008:administration & dosage / Q000097:blood / Q000493:pharmacokinetics* / Q000627:therapeutic use; D003453:Cryptococcosis / Q000188:drug therapy / Q000662:veterinary*; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage / Q000097:blood / Q000493:pharmacokinetics* / Q000627:therapeutic use; D008297:Male; D048368:Phascolarctidae / Q000097:blood / Q000378:metabolism / Q000382:microbiology*
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole