Can a pediatric patient take Diflucan (fluconazole)?

Fluconazole (Diflucan) Use in Pediatric Patients

Yes, pediatric patients can take fluconazole (Diflucan) with appropriate age-based dosing adjustments, as it is FDA-approved for multiple indications in children and has established safety and efficacy data for pediatric use. 1

Approved Indications and Dosing

Oropharyngeal Candidiasis

• For children 6 months and older: 6 mg/kg on first day, followed by 3 mg/kg once daily 1
• Treatment should continue for at least 2 weeks to prevent relapse 1

Esophageal Candidiasis

• For children 6 months and older: 6 mg/kg on first day, followed by 3 mg/kg once daily 1
• Doses up to 12 mg/kg/day may be used based on clinical response 1
• Minimum treatment duration: 3 weeks and at least 2 weeks following symptom resolution 1

Systemic Candida Infections

Dosing varies by age:

• 3 months or older: Loading dose of 25 mg/kg (max 800 mg) on first day, followed by 12 mg/kg daily (max 400 mg) 1
• Birth to 3 months with gestational age ≥30 weeks: 25 mg/kg on first day, followed by 12 mg/kg daily 1
• Birth to 3 months with gestational age <30 weeks: 25 mg/kg on first day, followed by 9 mg/kg daily 1

Cryptococcal Meningitis

• Loading dose: 12 mg/kg on first day 1
• Maintenance: 6 mg/kg once daily 1
• Duration: 10-12 weeks after CSF becomes culture negative 1
• For suppression in HIV-infected children: 6 mg/kg once daily 1

Age-Specific Pharmacokinetic Considerations

Neonates and Infants

• Neonates have a prolonged half-life (55-90 hours) compared to adults (30 hours) 2
• Volume of distribution is 2-3 fold higher in neonates than adults, falling to <1 L/kg by 3 months of age 2
• For very-low-birth-weight infants, fluconazole may accumulate due to immature renal function 2
• During first 2 weeks of life, dose should be administered every 72 hours; in weeks 2-4, every 48 hours; after 4 weeks, daily dosing is appropriate 3

Children

• Children have more rapid clearance (half-life ~14 hours) than adults 2
• For life-threatening infections in children, consider 6 mg/kg every 12 hours 2

Special Populations

Children on ECMO

• 3 months and older: 35 mg/kg loading dose (max 800 mg), followed by 12 mg/kg daily (max 400 mg) 1
• Birth to 3 months with gestational age <30 weeks: 35 mg/kg loading dose, followed by 9 mg/kg daily 1
• Birth to 3 months with gestational age ≥30 weeks: 35 mg/kg loading dose, followed by 12 mg/kg daily 1

Renal Impairment

• Dosage reduction required based on creatinine clearance 1
• For children with renal insufficiency, dosage reduction should parallel adult recommendations 1
• Creatinine clearance estimation formula for children: K × linear length or height (cm) ÷ serum creatinine (mg/100 mL) 1
  • K = 0.55 for children older than 1 year
  • K = 0.45 for infants

Prophylaxis Recommendations

Allogeneic HSCT

• Fluconazole 8-12 mg/kg daily IV or orally from day 0 until day +75 post-transplant (A-I) 2
• Should only be used if institutional incidence of invasive mold infections is low 2

AML and Recurrent Leukemia

• Fluconazole 8-12 mg/kg IV or orally after last dose of chemotherapy until neutrophil recovery (A-I) 2

Primary Prophylaxis in HIV-Infected Infants

• Not indicated (DII) 2

Safety Profile

• Fluconazole is generally well-tolerated in pediatric populations 4
• Common side effects include diarrhea, vomiting, and elevated liver enzymes 4
• Safety has been established in studies of 577 children ages 1 day to 17 years receiving doses of 1-15 mg/kg/day 1
• Therapeutic drug monitoring recommended when using higher doses to maintain concentrations between 4-20 μg/mL 3

Important Precautions

1. Species-specific considerations: Fluconazole lacks activity against Candida krusei (intrinsic resistance) and often has reduced activity against Candida glabrata 5

2. Pregnancy: Use with caution in pregnant patients as high doses have been associated with fetal abnormalities in animal studies 1

3. Drug interactions: Consider potential interactions with other medications, particularly in patients receiving chemotherapy or immunosuppressants 2

4. Duration of therapy: Inadequate treatment duration may lead to recurrence of infection 1

Fluconazole has maintained its position as a first-line treatment option for many cases of invasive candidiasis in pediatric patients over the past decades, with established efficacy and safety data supporting its use 5.