From the FDA Drug Label
The following dose equivalency scheme should generally provide equivalent exposure in pediatric and adult patients: Pediatric Patients Adults
- Some older children may have clearances similar to that of adults. Absolute doses exceeding 600 mg/day are not recommended 3 mg/kg 100 mg 6 mg/kg 200 mg 12* mg/kg 400 mg Experience with fluconazole in neonates is limited to pharmacokinetic studies in premature newborns. Oropharyngeal candidiasis: The recommended dosage of fluconazole tablets for oropharyngeal candidiasis in children is 6 mg/kg on the first day, followed by 3 mg/kg once daily. Esophageal candidiasis: For the treatment of esophageal candidiasis, the recommended dosage of fluconazole tablets in children is 6 mg/kg on the first day, followed by 3 mg/kg once daily. Systemic Candida infections: For the treatment of candidemia and disseminated Candida infections, daily doses of 6 to 12 mg/kg/day have been used in an open, noncomparative study of a small number of children Cryptococcal meningitis: For the treatment of acute cryptococcal meningitis, the recommended dosage is 12 mg/kg on the first day, followed by 6 mg/kg once daily.
The recommended treatment for fungal folliculitis in pediatric patients is not explicitly stated in the provided drug labels. However, based on the available information for other types of fungal infections, the dosage of fluconazole for pediatric patients can be determined using the dose equivalency scheme.
- For pediatric patients, the recommended dosage is 6 mg/kg on the first day, followed by 3 mg/kg once daily for oropharyngeal candidiasis, and 6 mg/kg on the first day, followed by 3 mg/kg once daily for esophageal candidiasis.
- For systemic Candida infections, daily doses of 6 to 12 mg/kg/day have been used. It is essential to note that fungal folliculitis is not explicitly mentioned in the provided drug labels, and the treatment should be determined based on the specific type of fungal infection and the patient's response to therapy. 1
From the Research
The recommended treatment for fungal folliculitis in pediatric patients is topical ketoconazole shampoo, which has been shown to lead to improvement or resolution in most cases, as demonstrated in a retrospective review of 110 cases published in 2018 2.
Treatment Options
- Topical antifungal medications, such as ketoconazole, clotrimazole, or miconazole, are the first-line therapy for fungal folliculitis in pediatric patients.
- For more extensive cases, selenium sulfide 2.5% shampoo or ketoconazole 2% shampoo can be used as a wash, left on for 5-10 minutes before rinsing, applied 2-3 times weekly.
- Oral antifungal therapy, such as fluconazole or itraconazole, may be necessary for severe or resistant cases, with dosages of 6 mg/kg once daily (maximum 200 mg) or 5 mg/kg once daily (maximum 200 mg) for 2-4 weeks, respectively.
Adjunctive Measures
- Using mild, non-fragranced soaps and wearing loose-fitting cotton clothing can help prevent recurrence.
- Avoiding sharing personal items like towels or clothing can also help prevent the spread of the infection.
Pathophysiology
- Fungal folliculitis is commonly caused by Malassezia species, which respond well to antifungal agents that disrupt fungal cell membrane synthesis, as discussed in a study published in 2004 3.
- Children often respond well to topical therapy alone, but oral treatment may be needed for widespread infection or when topical treatments fail, as noted in a study published in 2016 4.