What is the recommended fluconazole (Fluconazole) dosing for an inpatient with a yeast infection?

Fluconazole Dosing for Inpatient Yeast Infections

For inpatient yeast infections, fluconazole should be administered with a loading dose of 800 mg (12 mg/kg), followed by a daily dose of 400 mg (6 mg/kg). 1

Dosing Based on Infection Type

Candidemia/Invasive Candidiasis

• Initial therapy:
  • Loading dose: 800 mg (12 mg/kg) IV
  • Maintenance: 400 mg (6 mg/kg) IV daily
  • Duration: Continue for 2 weeks after documented clearance of Candida from bloodstream and resolution of symptoms 1

Oropharyngeal Candidiasis

• Loading dose: 200 mg on first day
• Maintenance: 100 mg daily
• Duration: Minimum 2 weeks 2

Esophageal Candidiasis

• Loading dose: 200 mg on first day
• Maintenance: 100-400 mg daily (based on severity)
• Duration: Minimum 3 weeks and at least 2 weeks following symptom resolution 2

Urinary Tract Candidiasis

• For cystitis: 200 mg daily for 2 weeks 1
• For pyelonephritis: 200-400 mg daily for 2 weeks 1

Species-Specific Considerations

C. albicans

• Fluconazole is preferred (most susceptible species) 3

C. glabrata

• Caution: Consider echinocandin instead of fluconazole due to reduced susceptibility
• If using fluconazole, higher doses may be required 1, 3

C. krusei

• Avoid fluconazole: Intrinsically resistant
• Use echinocandin, amphotericin B, or voriconazole instead 1, 3

C. parapsilosis

• Fluconazole is preferred 1, 3

Patient-Specific Considerations

Critically Ill Patients

• Consider echinocandin as first-line therapy instead of fluconazole, especially with:
  • Recent azole exposure
  • Moderate to severe illness
  • High risk for C. glabrata or C. krusei 1

Renal Impairment

• Dose adjustment required for creatinine clearance <50 mL/min 2
• For patients on CAPD with fungal peritonitis: 50 mg intraperitoneally or 100 mg orally 4

Important Clinical Pearls

1. Bioavailability: Oral and IV doses are equivalent due to ~90% oral bioavailability 2, 4

2. Source control: Always remove infected catheters when possible 1

3. Therapeutic monitoring:

   • Follow clinical response
   • For candidemia, obtain follow-up blood cultures to document clearance 1

4. Common pitfalls to avoid:

   • Using fluconazole for suspected C. glabrata or C. krusei without susceptibility testing
   • Stopping treatment prematurely before full clinical resolution
   • Failing to remove infected catheters or address other sources 3

5. Maximum daily dose: Total maximum daily dose of 1600 mg is recommended to avoid neurological toxicity 4

The linear pharmacokinetics of fluconazole and its excellent penetration into tissues, including CSF, make it a valuable option for treating susceptible Candida infections in hospitalized patients when appropriately dosed 4, 5.