Addendum to: A Candida glabrata Bronchopneumonia Treated With Voriconazole in a Tursiops truncates  presented at the 2006 IAAAM conference.

Since the case was presented during the 2006 IAAAM conference we have had the dubious privilege to have treated three other cases of Candida glabrata infection, one of which is a chronic recurrent infection.

During our second case the animal became anorexic after three weeks of Vfend treatment. Treatment was stopped immediately. At the time, liver enzymes (ALAT, ASAT, GGT) were two fold higher then the normal values. The animal became completely anorexic for 14 days and liver enzymes rose further to 8 to 10 times the normal value. The animal then rediscovered his appetite and a month later liver values had dropped to normal again.

Serum levels of voriconazole indicated a severe over dosage. The breakdown time of voriconazole was determined and applied to three other cases.

The present dosage scheme we use is:

For a 180 kg Bottlenose dolphin

1. Loading dose three consecutive days of 1200 mg Voriconazole (BID 600 mg PO)

2. Maintenance dose 1200 mg once a week (BID 600 mg PO). Serum levels have been monitored in two animals.

 For a 130 kg bottlenose dolphin

1. Maintenance dose 1000 mg once a week (BID 500 mg PO). Serum levels have been monitored in one animal.

With these regimens, serum levels remain at 9 to 12 μg/ml, which is slightly high but tolerated well by dolphins. The animal with the aforementioned liver reaction has now been treated for 5 months continuously with these dosages without untoward effects.

Details will be published in the scientific literature in due course.