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Clinical decision making
What is an appropriate dose of voriconazole for the treatment of aspergillosis in African grey parrots (Psittacus erithacus)?
  1. Luke O’Connor,
  2. Kristen Reyher,
  3. Emma Place and
  4. Tariq Abou-Zahr
  1. University of Bristol
  2. Great Western Exotics, Vets Now Referrals

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Clinical scenario

An African grey parrot (Psittacus erithacus) is presented to your practice with severe dyspnoea, inappetence and loss of body condition. Following a diagnostic workup, aspergillosis of the air sacs is diagnosed. Itraconazole (Fungitraxx 10 mg/ml oral solution for ornamental birds; Petlife International) is licensed for the treatment of aspergillosis in birds, but itraconazole toxicity has been reported in this species. Voriconazole is an alternative antifungal agent, not licensed for use in veterinary species, that can be prescribed under the cascade. You wonder what the most appropriate dose would be to treat this parrot.

The question

In [an African grey parrot with aspergillosis] is [low dose voriconazole (6 mg/kg)] or [high dose voriconazole (10 to 18 mg/kg)] more appropriate [for treatment of aspergillosis]?

Search parameters

The search terms Aspergillus OR aspergillosis OR mycoses OR mycosis AND ‘African grey parrot’ OR ‘African gray parrot’ OR ‘African grey parrots’ OR ‘African gray parrots’ OR ‘Timneh grey parrot’ OR ‘Psittacus erithacus’ OR ‘Psittacus erithacus timneh’ OR ‘Psittacus timneh’ AND Voriconazole were used.

Search outcome

  • Two relevant papers found in CAB Abstracts

  • One relevant paper found in Medline

  • Two relevant papers from both Medline and CAB.

Search last performed: December 7, 2017

Summary of evidence

Paper 1: Pharmacokinetics of voriconazole after oral administration of single and multiple doses in African grey parrots (Psittacus erithacus timneh)1

Patient group: Twenty healthy Timneh African grey parrots were assigned to one of two groups. Group 1 (n=12) received single doses at day 0 of either 6 mg/kg, …

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Footnotes

  • Authors of this Critically Appraised Topic

    Luke O’Connor, Kristen Reyher, Emma Place – University of Bristol

    Tariq Abou-Zahr – Great Western Exotics, Vets Now Referrals

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