Small Animal Dermatology, 3rd edition

CHAPTER 35 MYCOSES, DEEP 525

Dogs:

Itraconazole 5–10 mg/kg PO q24h or divided BID: side effects (uncommon)

include hepatotoxicity (elevated ALT), vasculitis

Fluconazole 5 mg/kg PO BID: side effects (mild) include anorexia, vomiting

Ketoconazole 5–15 mg/kg PO BID: side effects (mild) include anorexia,

vomiting

Posaconazole 5–10 mg/kg PO q24h or divided BID: side effects include

anorexia, vomiting, hepatotoxicity

Cats:

Itraconazole 5–15 mg/kg PO q24h or divided BID or 25–50 mg total dose

BID: side effects (uncommon) include anorexia, vomiting, depression, hep-

atotoxicity

Fluconazole 50 mg PO q24h to BID: side effects (uncommon) include

anorexia, vomiting, depression, hepatotoxicity

Ketoconazole 5–10 mg/kg PO q24h or 50 mg total dose BID: side effects

(common) include anorexia, vomiting, depression, fever, hepatotoxicity,

neurologic disturbances

Posaconazole 5–7.5 mg/kg PO q24h or divided BID: side effects include

anorexia, vomiting, hepatotoxicity, facial pruritus

If side effects noted, discontinue until signs abate and restart at a lower dose;

slowly increase to the recommended dose if possible

Monitor serum ALT during treatment

Treatment continued for at least 30 days after resolution of the clinical lesions;

typical treatment length 3 months.

 Amphotericin B:
AMB/desoxycholate or L-AMB/lipid formulations
Dogs: AMB 0.5 mg/kg IV over 4–6 h or L-AMB 1–3 mg/kg IV over 2 h; 3 times/

week; fluid diuresis recommended

Cats: AMB 0.25 mg/kg IV over 4–6 h or L-AMB 1 mg/kg IV over 2 h; 3 times/

week; fluid diuresis recommended

AMB may be administered subcutaneously with 300–500 mL sodium chloride

0.45%/dextrose 2.5%

Side effects of AMB therapy can be severe and include cumulative nephrotoxicity,

fever, inappetence, vomiting, and phlebitis

Serum creatinine and BUN should be monitored during treatment; elevation in

creatinine>20 of baseline or BUN greater than 50 mg/dL warrants discontinua-

tion

Urinalysis: discontinue treatment if granular casts are noted.

 Combination of AMB and ketoconazole may be used in dogs that have not responded

to either drug alone or have exhibited significant toxicity:

Combination therapy may not be more effective than single-drug therapy in the

treatment of coccidioidomycoses

Administer AMB as described to a total cumulative dosage of 4–6 mg/kg, together

with ketoconazole at 10 mg/kg PO divided daily for at least 8–12 months