What is the dose of fluconazole for Candida albicans infection?

From the Guidelines

Treatment of Candida Albicans Infection

For the treatment of Candida albicans infection, fluconazole is recommended at a dose of 800 mg (12 mg/kg) as a loading dose, followed by 400 mg (6 mg/kg) daily 1. This dosing regimen is based on the clinical practice guidelines for the management of candidiasis, which suggest that fluconazole is effective for the treatment of candidemia and other forms of candidiasis, including oropharyngeal, esophageal, and vaginal candidiasis, as well as urinary tract infections 1.

Key Considerations

• The dose of fluconazole may need to be adjusted in patients with renal impairment, as the drug is primarily eliminated by the kidneys 1.
• Fluconazole is generally well-tolerated, but it can interact with other medications and cause adverse effects, such as hepatic injury and CNS side effects 1.
• The duration of treatment with fluconazole typically ranges from 7 to 30 days, depending on the severity and location of the infection 1.

Specific Treatment Regimens

• For oropharyngeal candidiasis, a dose of 200 mg on the first day, followed by 100 mg daily for 7-14 days may be sufficient 1.
• For esophageal candidiasis, a dose of 200 mg on the first day, followed by 100 mg daily for 14-21 days is recommended 1.
• For candidemia, treatment should continue for at least 2 weeks after documented clearance of Candida species from the bloodstream and resolution of symptoms attributable to candidemia 1.

From the FDA Drug Label

Dosage and Administration in Adults: ... Systemic Candida infections: For systemic Candida infections including candidemia, disseminated candidiasis, and pneumonia, optimal therapeutic dosage and duration of therapy have not been established. In open, noncomparative studies of small numbers of patients, doses of up to 400 mg daily have been used Urinary tract infections and peritonitis: For the treatment of Candida urinary tract infections and peritonitis, daily doses of 50 to 200 mg have been used in open, noncomparative studies of small numbers of patients.

The dose of fluconazole for Candida albicans infection is not explicitly stated in the label. However, for systemic Candida infections, doses of up to 400 mg daily have been used, and for Candida urinary tract infections and peritonitis, daily doses of 50 to 200 mg have been used 2.

From the Research

Dose of Fluconazole for Candida albicans Infection

The dose of fluconazole for Candida albicans infection can vary depending on the severity of the infection and the patient's response to treatment.

• The study 3 reported that a patient with recurrent episodes of oropharyngeal candidiasis was treated with doses of fluconazole ranging from 100 to 800 mg per day.
• Another study 4 found that fluconazole was effective in treating systemic fungal infections, including Candida albicans, at a dosage of 200-400 mg daily.
• A study 5 suggested that an average fluconazole dose of >200 mg/day, a dose/MIC ratio of >400, and an AUC24/MIC ratio of >400 were associated with a higher 30-day survival rate and better microbiological response in patients with C. albicans BSI.
• The study 6 reported that high-dose fluconazole therapy (≥600 mg/day) was effective in treating candidemia in patients with solid tumors, with a response rate of 95%.
• A cost-effectiveness analysis 7 found that empiric high-dose fluconazole therapy (loading dose of 1600 mg followed by 800 mg daily) was a more effective but more expensive treatment strategy than low-dose fluconazole (loading dose of 800 mg followed by 400 mg daily) for suspected invasive candidiasis in ICU patients.

Factors Affecting Dose

Several factors can affect the dose of fluconazole required to treat Candida albicans infection, including:

• Severity of the infection: More severe infections may require higher doses of fluconazole.
• Patient's response to treatment: Patients who do not respond to standard doses of fluconazole may require higher doses.
• Susceptibility of the Candida isolate: Isolates with decreased susceptibility to fluconazole may require higher doses.
• Presence of underlying medical conditions: Patients with underlying medical conditions, such as chronic kidney disease, may require adjusted doses of fluconazole.