What is the recommended dosage of Diflucan (fluconazole) for treating a yeast infection in a wound?

Fluconazole Dosage for Yeast Infections in Wounds

For treating a yeast infection in a wound, fluconazole should be administered at 400 mg (6 mg/kg) on the first day, followed by 200-400 mg (3-6 mg/kg) daily for 2 weeks. 1

Dosing Rationale and Considerations

The recommended dosage is based on the Infectious Diseases Society of America (IDSA) guidelines for treating systemic Candida infections, which include wound infections. This dosage provides adequate tissue penetration and antifungal activity against most Candida species.

Key dosing principles:

• Loading dose: 400 mg (6 mg/kg) on day 1
• Maintenance dose: 200-400 mg (3-6 mg/kg) daily
• Duration: At least 2 weeks, continuing until clinical improvement is observed

Treatment Algorithm

1. Initial Assessment:

   • Confirm yeast infection through wound culture if possible
   • Assess severity of infection and patient factors (immunocompromised status, renal function)

2. Dosing Based on Severity:

   • Mild to moderate infection: 400 mg loading dose, then 200 mg daily
   • Severe infection or immunocompromised host: 400 mg loading dose, then 400 mg daily

3. Duration:

   • Continue treatment for at least 2 weeks
   • Extend therapy until 48 hours after resolution of symptoms
   • For immunocompromised patients, longer duration may be necessary

4. Monitoring:

   • Assess clinical response within 3-5 days of treatment initiation
   • Monitor liver function tests if treatment extends beyond 7-10 days

Special Considerations

Alternative Treatments

For fluconazole-resistant Candida species (e.g., C. glabrata, C. krusei):

• Consider an echinocandin (caspofungin: 70 mg loading dose, then 50 mg daily; micafungin: 100 mg daily; or anidulafungin: 200 mg loading dose, then 100 mg daily) 1
• Lipid formulation amphotericin B (3-5 mg/kg daily) may be used if echinocandins are unavailable 1

Adjunctive Measures

• Wound debridement and appropriate drainage are essential components of treatment 1
• Source control through debridement is as important as antifungal therapy for successful treatment

Common Pitfalls to Avoid

1. Inadequate duration of therapy: Treating for too short a period can lead to recurrence of infection. Continue treatment until clinical parameters indicate the infection has resolved.

2. Failure to adjust for renal impairment: Fluconazole is primarily eliminated unchanged in urine. Dosage adjustment is necessary for patients with creatinine clearance <50 mL/min.

3. Overlooking drug interactions: Fluconazole inhibits CYP3A4 and can interact with numerous medications. Review the patient's medication list for potential interactions.

4. Neglecting source control: Antifungal therapy alone is insufficient without proper wound care, debridement, and drainage if indicated.

5. Missing resistant species: Consider species identification when possible, as some Candida species have intrinsic resistance to fluconazole.

By following these guidelines, you can effectively treat yeast infections in wounds while minimizing the risk of treatment failure or recurrence.