싸이클로스포린, 케토코나졸, 0.1% 타크로리무스 연고제제로 병용 치료한 군 사역견의 항문주위 누공 3례 Combination Therapy with Ciclosporine, Ketoconazole and 0.1% Tacrolimus Ointment for Fast Reduction of Perianal Fistulae Lesions in Three Military Working Dogs원문보기
세 마리의 군 사역견이 신체검사와 직장 검사 등을 통해 항문주위 누공으로 진단되었다. 초기 치료는 단기간의 싸이클로스포린과 케토코나졸과 0.1%의 타크로리무스 연고제제로 시작하였다. 병변이 거의 다 치료가 되었을 시점부터 0.1% 타크로리무스 연고제제를 도포 횟수를 줄여서 실시하였다. 세 마리 모두에서 병변은 2-8주 사이에 별다른 부작용을 동반하지 않고 거의 대부분 사라졌으며, 완치는 증례 1, 2, 3에서 각 13, 6, 4주에 이루어졌다. 이 세가지 약물의 병용 프로토콜은 항문낭과도 연결된 항문주위 누공에서도 병변을 해소하는데 효과적이었으며, 특히 초기에 빠른 병변의 해소에 도움이 되어 병변으로부터 발생되는 고통을 경감시켜주는 기간이 늘어나는 것이 강점이라고 할 수 있다. 또한 시간적인 측면 외에도 경제적인 측면에서도 도움이 되므로 개에서 발생하는 항문주위 누공에 효과적인 치료 프로토콜로 유용하게 사용될 수 있을 것으로 사료된다.
세 마리의 군 사역견이 신체검사와 직장 검사 등을 통해 항문주위 누공으로 진단되었다. 초기 치료는 단기간의 싸이클로스포린과 케토코나졸과 0.1%의 타크로리무스 연고제제로 시작하였다. 병변이 거의 다 치료가 되었을 시점부터 0.1% 타크로리무스 연고제제를 도포 횟수를 줄여서 실시하였다. 세 마리 모두에서 병변은 2-8주 사이에 별다른 부작용을 동반하지 않고 거의 대부분 사라졌으며, 완치는 증례 1, 2, 3에서 각 13, 6, 4주에 이루어졌다. 이 세가지 약물의 병용 프로토콜은 항문낭과도 연결된 항문주위 누공에서도 병변을 해소하는데 효과적이었으며, 특히 초기에 빠른 병변의 해소에 도움이 되어 병변으로부터 발생되는 고통을 경감시켜주는 기간이 늘어나는 것이 강점이라고 할 수 있다. 또한 시간적인 측면 외에도 경제적인 측면에서도 도움이 되므로 개에서 발생하는 항문주위 누공에 효과적인 치료 프로토콜로 유용하게 사용될 수 있을 것으로 사료된다.
Three military working dogs (MWDs) were diagnosed with perianal fistulae after a complete physical examination and rectal palpation. The initial treatment protocol was used with short-term oral ciclosporine (CyA) and ketoconazole and 0.1% topical tacrolimus ointment. When lesions were nearly healed,...
Three military working dogs (MWDs) were diagnosed with perianal fistulae after a complete physical examination and rectal palpation. The initial treatment protocol was used with short-term oral ciclosporine (CyA) and ketoconazole and 0.1% topical tacrolimus ointment. When lesions were nearly healed, treatment was continued with 0.1% tacrolimus ointment only at a lower frequency. The lesions improved significantly within 2-8 weeks with no noticeable side effects. Complete recovery was determined at weeks 13, 6, and 4 for cases 1, 2, and 3, respectively. This combination protocol was effective at resolving or reducing perianal fistulae (PAF) lesions even communicating with anal sacs in three dogs. The major benefit of this protocol was the rapid reduction of fistulae lesions and this could be helpful to extend the pain-free period. Moreover, this protocol appeared cost-saving as well as time-saving option for PAF dogs.
Three military working dogs (MWDs) were diagnosed with perianal fistulae after a complete physical examination and rectal palpation. The initial treatment protocol was used with short-term oral ciclosporine (CyA) and ketoconazole and 0.1% topical tacrolimus ointment. When lesions were nearly healed, treatment was continued with 0.1% tacrolimus ointment only at a lower frequency. The lesions improved significantly within 2-8 weeks with no noticeable side effects. Complete recovery was determined at weeks 13, 6, and 4 for cases 1, 2, and 3, respectively. This combination protocol was effective at resolving or reducing perianal fistulae (PAF) lesions even communicating with anal sacs in three dogs. The major benefit of this protocol was the rapid reduction of fistulae lesions and this could be helpful to extend the pain-free period. Moreover, this protocol appeared cost-saving as well as time-saving option for PAF dogs.
* AI 자동 식별 결과로 적합하지 않은 문장이 있을 수 있으니, 이용에 유의하시기 바랍니다.
제안 방법
Fistulae communicating with the both anal sac, neither sac could be palpated distinctly (Fig 1, left). After clipping and cleaning around the affected area, 2.5 mg/kg CyA, 5 mg/kg ketoconazole twice daily, 0.1% topical ointment once daily, and antibiotics (metronidazole, 15 mg/kg, PO, twice a day) were prescribed. Three weeks after commencing therapy, the affected area was dramatically reduced.
Each dog was treated with CyA (Sandimmun Neoral®, Novartis Pharmaceuticals, Germany), ketoconazole (5 mg/kg, bid), metronidazole (15 mg/kg, bid) and 0.1% topical tacrolimus ointment (0.1% Protopic® ointment, Astellas Pharma Inc., Korea).
1% tacrolimus ointment once daily. Four weeks following the first visit, the fistulae were completely healed (Fig 3, right), and 0.1% tacrolimus was applied 2-3 times per week for six weeks. No recurrence sign is seen up to 22 months.
A complete history, including the onset of clinical symptoms and any prior medical or surgical treatments, was obtained from each handler. Physical examinations, complete blood counts (CBC), and serum biochemistry profiles were performed on each dog prior to treatment. Rectal examinations were performed while the dogs were sedated.
The purpose of this paper is to describe three canine PAF cases treated with initial short-term systemic CyA and ketoconazole with 0.1% tacrolimus ointment and longterm management with 0.1% tacrolimus ointment only which have not been reported to the author’s knowledge.
참고문헌 (15)
Bryden JS, Joe GH. Long-term prospective evaluation of topically applied 0.1% tacrolimus ointment for treatment of perianal sinuses in dogs. J Am Vet Med Assoc 2009; 235: 397-404.
House AK, Guitian J, Gregory SP, Hardie RJ. Evaluation of the effect of two dose rates of cyclosporine on the severity of perianal fistulae lesions and associated clinical signs in dogs. Vet Surg 2006; 35: 543-549.
Jamieson PM, Simpson JW, Kirby BM, Else RW. Association between anal furunculosis and colitis in the dog: preliminary observations. J Small Anim Pract 2002; 43: 109-114.
Misseghers BS, Binnington AG, Mathews KA. Clinical observations of the treatment of canine perianal fistulas with topical tacrolimus in 10 dogs. Can Vet J 2000; 41: 623-627.
Partricelli AJ, Hardie RJ, McAnulty JF. Cyclosporine and ketoconazole for treatment of perianal fistulas in dogs. J Am Vet Med Assoc 2002; 220: 1009-1016.
Reitamo S, Wollenberg A, Schopf E, Perrot JL, Marks R, Ruzicka T, Christopers E, Kapp A, Lahfa M, Rubins A, Jablonska S, Rustin M. Safety and efficacy of 1 year of tacrolimus ointment monotherapy in adults with atopic dermatitis. The European tacrolimus ointment study group. Arch Dermatol 2000; 136: 999-1006.
Robins GM, Lane JG. The management of anal furunculosis. J Small Anim Pract 1973; 14: 333-342.
※ AI-Helper는 부적절한 답변을 할 수 있습니다.