What is the prescription guideline for fluconazole in candidiasis (fungal infection)?

From the Guidelines

Fluconazole is recommended at a loading dose of 800 mg (12 mg/kg), followed by a daily dose of 400 mg (6 mg/kg) for the treatment of candidiasis, with dosage adjustments necessary for patients with renal impairment 1.

Key Considerations

• The dosage regimen may vary depending on the severity of the illness, with higher doses required for invasive candidiasis 1.
• For patients with renal impairment, the dose should be reduced by 50% if creatinine clearance is <50 mL/min 1.
• Fluconazole is effective against most Candida species, but its activity is reduced against C. glabrata and C. krusei 1.

Specific Treatment Regimens

• For uncomplicated Candida vulvovaginitis, a single 150-mg oral dose of fluconazole is recommended 1.
• For severe acute Candida vulvovaginitis, fluconazole 150 mg, given every 72 hours for a total of 2 or 3 doses, is recommended 1.
• For oropharyngeal candidiasis, esophageal candidiasis, and vaginal candidiasis, fluconazole is considered standard therapy, with dosages ranging from 100-400 mg daily for 7-21 days 1.

Monitoring and Precautions

• Monitor for side effects including hepatotoxicity, QT prolongation, and potential drug interactions, particularly with medications metabolized through the CYP450 system 1.
• Consider the influence of fluconazole on a patient's drug regimen when adding or removing an azole antifungal agent 1.

From the FDA Drug Label

Dosage and Administration in Adults: Single Dose Vaginal candidiasis: The recommended dosage of fluconazole tablets for vaginal candidiasis is 150 mg as a single oral dose. Oropharyngeal candidiasis: The recommended dosage of fluconazole tablets for oropharyngeal candidiasis is 200 mg on the first day, followed by 100 mg once daily. Esophageal candidiasis: The recommended dosage of fluconazole tablets for esophageal candidiasis is 200 mg on the first day, followed by 100 mg once daily. Systemic Candida infections: For systemic Candida infections including candidemia, disseminated candidiasis, and pneumonia, optimal therapeutic dosage and duration of therapy have not been established. 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 prescription guideline for fluconazole in candidiasis (fungal infection) is as follows:

• Vaginal candidiasis: 150 mg as a single oral dose
• Oropharyngeal candidiasis: 200 mg on the first day, followed by 100 mg once daily for at least 2 weeks
• Esophageal candidiasis: 200 mg on the first day, followed by 100 mg once daily for a minimum of three weeks and for at least two weeks following resolution of symptoms
• Systemic Candida infections: optimal therapeutic dosage and duration of therapy have not been established, but doses up to 400 mg daily have been used
• Urinary tract infections and peritonitis: daily doses of 50 to 200 mg have been used 2

From the Research

Prescription Guideline for Fluconazole in Candidiasis

• The recommended dose of fluconazole for vaginal candidiasis is a single oral dose of 150 mg 3, 4, 5.
• For recurrent vulvovaginal candidiasis, weekly treatment with fluconazole (150 mg) for six months can be effective in preventing symptomatic vulvovaginal candidiasis 6.
• The dose of fluconazole for candidal infections caused by non-albicans Candida species can vary from 50 to 400 mg daily, with a median duration of treatment of 21 days 7.
• Fluconazole is effective against the most common non-albicans Candida species, although higher doses may be required for infections caused by Candida glabrata 7.
• It is not recommended to use fluconazole during pregnancy or lactation 4.

Efficacy and Safety

• The clinical response to treatment with fluconazole is excellent, with 97% of patients cured or markedly improved after 5 to 16 days 3.
• The incidence of side-effects is low, and consists mainly of mild gastrointestinal complaints 3.
• Abnormal laboratory test results occur in a small percentage of patients, but are minor and of minimal clinical significance 3.
• Fluconazole is well tolerated and has a low rate of side effects, making it a preferred treatment option for many patients 5.