VORICONAZOLE TOXICITY IN MULTIPLE PENGUIN SPECIES

Area of Science:

• Veterinary Medicine
• Pharmacology
• Avian Health

Background:

• Aspergillosis is a common fungal disease in captive penguins.
• Itraconazole resistance is increasing, leading to the use of voriconazole.
• Previous pharmacokinetic data for voriconazole in penguins was lacking, resulting in empiric dosing.

Purpose of the Study:

• To describe cases of voriconazole toxicity in penguins.
• To determine voriconazole plasma concentrations in affected penguins.
• To highlight the need for species-specific dosing and therapeutic drug monitoring.

Main Methods:

• A case series of 24 penguins across six species from nine institutions.
• Clinical signs of toxicity were recorded.
• Plasma voriconazole concentrations were measured in 18 penguins exhibiting toxicity signs.

Main Results:

• Voriconazole toxicity was observed in 24 penguins, with clinical signs including anorexia, lethargy, and neurological deficits.
• Measured plasma voriconazole concentrations ranged from 8.12 to 64.17 μg/ml.
• Penguins with concentrations above 30 μg/ml showed moderate to severe neurological signs, exceeding human therapeutic levels.

Conclusions:

• Empiric voriconazole dosing in penguins can lead to toxicity, particularly neurological signs.
• Species-specific dosing and therapeutic drug monitoring are crucial for safe and effective voriconazole use in penguins.
• Further pharmacokinetic studies are warranted to establish appropriate dosing guidelines.