What is the fluconazole dosage for esophageal candidiasis?

Fluconazole Dosage for Esophageal Candidiasis

For esophageal candidiasis, the recommended dosage of fluconazole is 200-400 mg (3-6 mg/kg) daily for 14-21 days. 1

First-line Treatment

• Initial dosing:

  • 200 mg on the first day, followed by 100-200 mg daily 2
  • Doses up to 400 mg daily may be used based on severity and clinical response 1
  • Treatment should continue for a minimum of 14-21 days 1
  • Continue treatment for at least 2 weeks following resolution of symptoms 2

• Intravenous option:

  • For patients unable to tolerate oral therapy: IV fluconazole 400 mg (6 mg/kg) daily 1
  • Consider de-escalating to oral therapy once the patient can tolerate oral intake 1

Clinical Response Timeline

Most patients with esophageal candidiasis will show improvement or resolution of symptoms within 7 days after starting fluconazole therapy 1. In one study, 89% of patients had complete symptomatic response by day 7 3.

Pediatric Dosing

For children with esophageal candidiasis:

• 6 mg/kg on the first day, followed by 3 mg/kg once daily
• Doses up to 12 mg/kg/day may be used based on clinical response
• Treat for a minimum of 3 weeks and for at least 2 weeks following symptom resolution 2

Dosing in Renal Impairment

• Normal renal function (CrCl >50 mL/min): 100% of recommended dose
• Impaired renal function (CrCl ≤50 mL/min, no dialysis): 50% of recommended dose
• Hemodialysis patients: 100% of recommended dose after each hemodialysis 2

For Fluconazole-Refractory Disease

If the infection does not respond to fluconazole, alternative options include:

1. Itraconazole oral solution: 200 mg daily for 14-21 days 1
2. Voriconazole: 200 mg (3 mg/kg) twice daily (IV or oral) for 14-21 days 1
3. Posaconazole: 400 mg twice daily or extended-release tablets 300 mg once daily 1
4. Echinocandins:
   • Micafungin: 150 mg daily
   • Caspofungin: 70 mg loading dose, then 50 mg daily
   • Anidulafungin: 200 mg daily For 14-21 days 1

For Recurrent Infections

For patients with recurrent esophageal candidiasis, chronic suppressive therapy with fluconazole 100-200 mg three times weekly is recommended 1.

Important Clinical Considerations

• A diagnostic trial of antifungal therapy is appropriate before performing an endoscopic examination 1
• For HIV-infected patients, antiretroviral therapy is strongly recommended to reduce the incidence of recurrent infections 1
• Higher doses of echinocandins are recommended for esophageal disease than for candidemia to decrease relapse rates 1
• Echinocandins are as effective as fluconazole but are associated with higher relapse rates 1

Monitoring

Monitor for clinical response within 5-7 days of initiating therapy. If symptoms persist beyond this timeframe, consider alternative diagnoses or treatment options.